SB 368 mandates that health plans provide members with deductible and out-of-pocket maximum accrual notices for any month when benefits are used. Members receive these statements, showing progress toward their deductible or maximum out-of-pocket limits, until the member hits their full deductible or out-of-pocket maximum.
Blue Shield is addressing the compliance obligation of this mandate as it applies to our fully-insured group plans and will be sending member accrual notices to keep members informed.
SB 368 applies to fully-insured and flex-funded groups, but not to self-funded groups. The bill also applies to IFP, including grandfathered plans.
Beginning January 1, 2023, the California Privacy Rights Act (CPRA) will take the place of the California Consumer Protection Act of 2018 (CCPA). The 2018 CCPA created new member privacy rights and data protection requirements for businesses. While the new CPRA will strengthen certain parts of the CCPA, non-profit entities like Blue Shield will continue to remain exempt from the new CPRA as it was from the 2018 CCPA.
AB 1184 allows greater consumer protection of health plan communications that disclose personal health information (PHI). Members can submit a Confidential Communication Request (CCR) form (PDF, 67 KB) to prevent Blue Shield from
AB 1184 builds on previously passed California state law requiring privacy protections for minors 12 and older. Under these laws, a minor’s family member will not have access to a minor’s PHI, unless the minor releases this information to a given family member. The requirements of AB 1184 apply to fully-insured and flex-funded groups, but not to self-funded groups. The bill also applies to IFP on- and off-exchange plans, including grandfathered plans.
California Senate Bill (SB) 260 requires Blue Shield of California to annually notify enrollees with individual or group health care coverage that if the enrollee ceases to be enrolled in coverage, Blue Shield will provide information, including the enrollee’s name, address, and other contact information to Covered California so that the enrollee may obtain other coverage. Enrollees may opt out of this transfer of information to Covered California.
Blue Shield must also provide to Covered California the name, address and other contact information of enrollees who cease to be enrolled in coverage and who have not opted out of this information transfer.
Blue Shield is emailing and/or sending enrollees the Annual Notification with opt-out instructions between February 22,2021 through March 4, 2021.
California Senate Bill (SB) 855 updates and expands the California Mental Health Parity Act of 1999 and requires health plans and insurers to provide treatment for all mental health and substance use disorder conditions under the same terms and conditions that are applied when treating medical conditions that are medically necessary.
SB 855 applies to health plans and policies, including grandfathered plans, issued, delivered, amended, or renewed on or after January 1, 2021. SB 855 does not apply to Medicare Advantage, Med-Supp, Medi-Cal, Cal Medi-Connect (CMC), Stand-Alone Dental or Vision, and Self-funded, ASO and Shared Advantage.
The bill defines “medically necessary treatment of a mental health or substance use disorder” as “a service or product addressing the specific needs of that patient, for the purpose of preventing, diagnosing, or treating an illness, injury, condition, or its symptoms, including minimizing the progression of that illness, injury, condition, or its symptoms,” and defines “mental health and substance use disorders” as those conditions listed in the most recent edition of the World Health Organization’s International Classification of Diseases or in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
SB 855 further requires that plans utilize utilization management guidelines and criteria developed by nonprofit professional associations, when available, and that clinical staff is trained in the application of these guidelines and criteria. Training will also be available to providers and enrollees.
While SB 855 addresses the utilization review criteria for Mental Health/Substance Use Disorder (MH/SUD), the Consolidated Appropriations Act (CAA) Sec 203 Mental Health Parity and Addiction Equity Act (MHPAEA), mandates that plans and insurers conduct data analysis to ensure that MH/SUD treatment limitations are comparable and not more stringent than those applied to medical/surgical benefits. More information on CAA Sec 203 can be found on the Consolidated Appropriations Act and Transparency in Coverage Final Rule page.
The Dental Plan Transparency Effect, also known as Senate Bill No. 1008, was passed to ensure standardized health insurance reporting and disclosures for dental services. Similar to how the Affordable Care Act mandated medical plan Summary of Benefits Coverage (SBCs) to allow members to easily shop for and compare health insurance plans, SB 1008 requires a similar benefits and coverage disclosure matrix for dental plan benefits. This bill was signed into law in 2018 and goes into effect for plan or policy years on and after January 1, 2021.