Vote Smart's Synopsis:

Vote to pass a bill that amends statutes governing health care coverage for California residents.

Highlights:

• Requires a plan or insurer to annually verify and delete inaccurate listings from its provider directories (Sec. 1). 

• Requires a provider directory to be 60% accurate on July 1, 2025, with increasing required percentage accuracy benchmarks to be met each year until the directories are 95% accurate on or before July 1, 2028 (Sec. 1). 

• Requires penalties for an insurer to administrative penalties for failure to meet the prescribed benchmarks (Sec. 1). 

• Requires an insurance plan or insurer to arrange care and provide coverage for all covered health care services provided to an enrollee or insured who reasonably relied on inaccurate, incomplete, or misleading information contained in a health plan or policy’s provider directory or directories and to reimburse the provider the contracted amount for those services (Sec. 1).

• Prohibits an insurance provider from collecting any additional amount from an enrollee or insured other than the applicable in-network cost sharing (Sec. 1). 

• Requires an insurer to provide information about in-network providers to enrollees and insureds upon request (Sec. 1). 

• Limits the cost-sharing amounts an enrollee or insured is required to pay for services from those providers under specified circumstances (Sec. 1). 

• Authorizes the Department of Managed Health Care and the Department of Insurance to develop uniform formats for plans and insurers to use to request directory information from providers and to establish a methodology and processes to ensure accuracy of provider directories and consistency with other laws, regulations, or standards (Sec. 1). 

• Require the health plan or the insurer, as applicable, to ensure the accuracy of a request to add back a provider who was previously removed from a directory and approve the request within 10 business days of receipt, if accurate (Sec. 1).

Full Bill Text