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.
For additional information, please contact your Burnham Benefits Consultant or Burnham Benefits at 949‐833‐2983 or firstname.lastname@example.org.
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