On October 8, 2021, Governor Newsom signed into law SB 510, which requires insurers to cover COVID-19 diagnostic and screening testing, immunization, and associated health care services without cost sharing (both in-network and out-of-network) as well as any pre-authorization or other medical management requirements. The law applies to plans that cover medical, surgical and hospital benefits regulated by the either the California Department of Managed Health Care or Department of Insurance, which includes most fully insured health plans and HMOs (excluding specialized health care plans).

The legislation will also apply with respect to any future disease that is declared by the governor of California as a public health emergency. However, the prohibition on cost sharing or pre-authorization/ other medical management requirements does not extend to services provided by out-of-network providers beyond the COVID-19 federal public health emergency.

The scope of the law includes coverage for any item, service, or immunization intended to prevent or mitigate a disease as recommended by the United States Preventive Services Task Force (rating of “A” or “B”) or the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC), including services and products that are approved or granted emergency use authorization by the federal Food and Drug Administration, or recommended by the State Department of Public Health or the CDC.

SB 510’s provisions are retroactively effective as of March 4, 2020 and are severable in the event any provision is subsequently held to be invalid.

ADDITIONAL INFORMATION

For additional information, please contact your Burnham Benefits Consultant or Burnham Benefits at 949‐833‐2983 or inquiries@burnhambenefits.com.

Burnham Benefits does not engage in the practice of law and this publication should not be construed as the providing of legal advice or a legal opinion of any kind. The consulting advice we provide is intended solely to assist in assessing its compliance with the Patient Protection and Affordable Care Act and other applicable federal and state law requirements, and is based on Burnham Benefit’s interpretation of federal guidance in effect as of the date of this publication. To the best of our knowledge, the information provided herein, and assumptions relied on, are reasonable and accurate as of the date of this publication. Furthermore, to ensure compliance with IRS Circular 230, any tax advice contained in this publication is not intended to be used, and cannot be used, for purposes of (i) avoiding penalties imposed under the United States Internal Revenue Code or (ii) promoting, marketing or recommending to another person any tax-related matter.