SF 3157 Summary

• Defines "very high deductible health plan" (VHDHP) as a high deductible health plan with annual maximum out-of-pocket expenses exceeding $3,000 for individual coverage or $6,000 for family coverage.

• Requires health plan companies issuing VHDHPs to pay emergency room and ambulance service charges directly to providers within 15 days after learning the enrollee has not paid within 30 days of treatment, regardless of whether the annual deductible has been satisfied.

• Permits health plan companies to seek reimbursement from enrollees for payments made under the new requirement, subject to the same collection restrictions that apply to health care providers.

• Prohibits health plan companies from canceling, terminating, suspending, or reducing an enrollee's coverage as a means of collection or penalty for failure to reimburse the plan.

• Applies to all VHDHPs offered, issued, sold, or renewed on or after August 1, 2020.