SB 1049: Health care claims reimbursement.

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 completeness, to notify the claimant no later than 30 calendar days after receipt that the claim or portion thereof is contested or denied.

This bill would grant a claimant no less than 90 calendar days to submit a corrected claim after a health care service plan or health insurer denies a claim or portion thereof or sends a notice of overpayment for a claim based on a defect that may be remedied by submitting a corrected claim. The bill would prohibit a plan or insurer from denying a corrected claim on the grounds that the claim was not submitted within another applicable claim filing deadline. Under the bill, a dispute related to a corrected claim would be required to be eligible for submission to the plan’s or insurer’s fast, fair, and cost-effective dispute resolution mechanism. 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 2

“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 1001, Statutes of 2026.
2. September 30, 2026Approved by the Governor.
3. August 28, 2026Enrolled and presented to the Governor at 11 a.m.
4. August 24, 2026Assembly amendments concurred in. (Ayes 32. Noes 6.) Ordered to engrossing and enrolling.
5. August 20, 2026In Senate. Concurrence in Assembly amendments pending.
6. August 20, 2026Read third time. Passed. (Ayes 73. Noes 0. Page 6307.) Ordered to the Senate.
7. August 17, 2026Read second time. Ordered to third reading.
8. August 13, 2026Read second time and amended. Ordered to second reading.
9. August 13, 2026From committee: Do pass as amended. (Ayes 11. Noes 0.) (August 13).
10. August 13, 2026Assembly Rule 63 suspended.
11. August 5, 2026August 5 set for first hearing. Placed on suspense file.
12. June 24, 2026Coauthors revised.