CaliforniaHealth care coverage: claims payments.
What it does
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance.
More detail
Existing law requires a health care service plan or health insurer to reimburse a complete claim or a portion thereof within 30 calendar days after receipt of the claim, or, if a claim or portion thereof does not meet the criteria for a complete claim or the criteria for coverage under the plan or insurance contract, to notify the claimant in writing that the claim or portion thereof is contested or denied as soon as practicable, but no later than 30 calendar days after receipt of the claim by the plan or insurer.
This bill would, commencing May 26, 2028, require a plan or insurer to accept electronic medical records and supporting documentation necessary to process a claim through a standard electronic submission method, as specified, and would prohibit a plan or insurer from denying, pending, or delaying a claim solely because the plan's or insurer's systems are unable to accept documentation that otherwise meets the plan's or insurer's requirements. The bill would specify that if a state or federal standard is adopted that is specific to file size, number, or other capacity requirements for claims-related supporting documentation submissions, that standard would apply.
Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Where do you stand?
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Where it stands
- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Sep 30Chaptered by Secretary of State - Chapter 945, Statutes of 2026.Latest
- Sep 30Approved by the Governor Gavin Newsom.Became Law
- Sep 4Enrolled and presented to the Governor at 4 p.m.To Governor
- Aug 27Senate amendments concurred in. To Engrossing and Enrolling. (Page 6733.).Major
- Vote recorded AB 2499 Gipson Concurrence in Senate Amendments. Result: pass.Lower
- Vote recorded With recommendation: That Senate amendments be concurred in. Result: pass.Lower
- Aug 27From committee: That the Senate amendments be concurred in. (Ayes 75. Noes 0.) (August 27).Minor
- Aug 26Joint Rule 62(a), file notice suspended. (Page 6563.)
- Aug 26Re-referred to Com. on HEALTH. pursuant to Assembly Rule 77.2.Minor
- Aug 26In Assembly. Concurrence in Senate amendments pending.
- Aug 25Read third time. Passed. Ordered to the Assembly. (Ayes 38. Noes 0.).Passed Senate
- Vote recorded 3rd Reading AB2499 Gipson By Weber Pierson. Result: pass.Upper
- Aug 24Read second time. Ordered to third reading.Minor
- Aug 20Read third time and amended. Ordered to second reading.Major
- Aug 4Read second time. Ordered to third reading.Minor
- Aug 3From committee: Be ordered to second reading pursuant to Senate Rule 28.8.Minor
- Jul 2Read second time and amended. Re-referred to Com. on APPR.Major
- Jul 2From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 10. Noes 0.) (July 1).Major
- Jul 1
- Vote recorded Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations]. Result: pass.Upper
- Jun 22From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH.Major
- Jun 15Re-referred to Com. on HEALTH.Minor
- Jun 12Re-referred to Com. on RLS.Minor
- Jun 12Withdrawn from committee.Major
- Jun 11From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on L., P.E. & R.Major
- Jun 10Referred to Coms. on L., P.E. & R. and PUB. S.Minor
- Jun 1In Senate. Read first time. To Com. on RLS. for assignment.Minor
- May 28Read third time. Passed. Ordered to the Senate. (Ayes 59. Noes 13. Page 5538.)Passed Assembly
- Vote recorded AB 2499 Gipson Assembly Third Reading. Result: pass.Lower
- May 19Read second time. Ordered to third reading.Minor
- May 18Read second time and amended. Ordered returned to second reading.Major
- May 14From committee: Amend, and do pass as amended. (Ayes 11. Noes 3.) (May 14).Major
- Vote recorded Do pass as amended. Result: pass.Lower
- May 6In committee: Set, first hearing. Referred to APPR. suspense file.Minor
- Apr 23From committee: Do pass and re-refer to Com. on APPR. (Ayes 7. Noes 0.) (April 22). Re-referred to Com. on APPR.Minor
- Apr 22
- Vote recorded Do pass and be re-referred to the Committee on [Appropriations]. Result: pass.Lower
- Apr 14Re-referred to Com. on L. & E.Minor
- Apr 13From committee chair, with author's amendments: Amend, and re-refer to Com. on L. & E. Read second time and amended.Major
- Mar 25From committee: Do pass and re-refer to Com. on L. & E. (Ayes 7. Noes 0.) (March 24). Re-referred to Com. on L. & E.Minor
- Mar 25Coauthors revised.
- Mar 24
- Vote recorded Do pass and be re-referred to the Committee on [Labor and Employment]. Result: pass.Lower
- Mar 9Referred to Coms. on PUB. S. and L. & E.Minor
- Feb 21From printer. May be heard in committee March 23.
- Feb 20Read first time. To print.Introduced