California Health and Safety Code

§ 1371.56

HSC § 1371.56 Effective Jan 1, 2025Div. 2 · Ch. 2.2 · Art. 5

Statute text

(a)(1) Unless otherwise required by this chapter, a health care service plan contract issued, amended, or renewed on or after January 1, 2024, shall require an enrollee who receives covered services from a noncontracting ground ambulance provider to pay no more than the same cost-sharing amount that the enrollee would pay for the same covered services received from a contracting ground ambulance provider. This amount shall be referred to as the “in-network cost-sharing amount.”

(2)An enrollee shall not owe the noncontracting ground ambulance provider more than the in-network cost-sharing amount for services subject to this section. At the time of payment by the plan to the noncontracting provider, the plan shall inform the enrollee and the noncontracting provider of the in-network cost-sharing amount owed by the enrollee and shall disclose whether or not the enrollee’s coverage is regulated by the department or if the coverage is not state-regulated.

(b)(1) The in-network cost-sharing amount paid by the enrollee pursuant to this section shall count toward the limit on annual out-of-pocket expenses established under Section 1367.006.

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Legislative history

Amended by Stats. 2024, Ch. 520, Sec. 7. (SB 1061) Effective January 1, 2025.