AB 2499: Health care coverage: claims payments.

Official summary

Legislative Counsel’s Digest (official, as of the latest version). Written by nonpartisan legislative staff; reproduced verbatim.

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.

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.

Sponsors

Sponsors by party (alphabetical): Democratic 1

“Support” is shown only as formal sponsorship recorded by the legislature. Roll-call votes are available on the official bill page.

Recent official actions

1. September 30, 2026Chaptered by Secretary of State - Chapter 945, Statutes of 2026.
2. September 30, 2026Approved by the Governor.
3. September 4, 2026Enrolled and presented to the Governor at 4 p.m.
4. August 27, 2026Senate amendments concurred in. To Engrossing and Enrolling. (Page 6733.).
5. August 27, 2026From committee: That the Senate amendments be concurred in. (Ayes 75. Noes 0.) (August 27).
6. August 26, 2026Joint Rule 62(a), file notice suspended. (Page 6563.)
7. August 26, 2026Re-referred to Com. on HEALTH. pursuant to Assembly Rule 77.2.
8. August 26, 2026In Assembly. Concurrence in Senate amendments pending.
9. August 25, 2026Read third time. Passed. Ordered to the Assembly. (Ayes 38. Noes 0.).
10. August 24, 2026Read second time. Ordered to third reading.
11. August 20, 2026Read third time and amended. Ordered to second reading.
12. August 4, 2026Read second time. Ordered to third reading.