Coverage for behavioral health visits.

Plain English Breakdown

The bill has been vetoed and it's unclear whether lawmakers will override the governor’s decision.

Behavioral Health Visits Coverage

AB-1032 requires health insurance plans for large groups to cover up to 12 visits with a behavioral health provider if the policyholder lives in an area affected by wildfires and has experienced loss, trauma, or displacement.

What This Bill Does

• Requires large group health care service plan contracts or health insurance policies to pay for up to 12 visits with a behavioral health provider starting January 1, 2026.
• Applies only if the policyholder lives in an area where there is a declared local or state emergency due to wildfires and has experienced loss, trauma, or displacement from the fire.
• Does not allow insurance companies to review these visits for approval before payment (no utilization review).
• Requires health care service plans to inform all affected members about this new coverage.

Who It Names or Affects

• People with large group health insurance policies who live in areas declared as emergency zones due to wildfires.
• Insurance companies that provide these policies.

Terms To Know

Utilization review

A process where an insurance company checks if a medical service is necessary before paying for it.

Enrollee

Someone who has joined or signed up for a health care plan.

Limits and Unknowns

• The bill was vetoed by the governor, but lawmakers could still override this veto.
• It does not specify how much each visit will cost or if there is a limit on what the insurance company must pay per visit.

Official Summary Text

AB 1032, Harabedian.
Coverage for behavioral health visits.
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 contract or health insurance policy issued, amended, or renewed on or after January 1, 2021, to provide coverage for medically necessary treatment of mental health and substance use disorders, as defined, under the same terms and conditions applied to other medical conditions.
This bill would generally require a large group health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2026, to reimburse an eligible enrollee or
insured for up to 12 visits with a behavioral health provider if the enrollee or insured lives in a county where a local or state emergency has been declared due to wildfires and the enrollee or insured has experienced a loss, trauma, or displacement because of the fire. The bill would prohibit these benefits from being subject to utilization review. The bill would require a health care service plan contract or health insurer to provide notice to all affected enrollees of these provisions, as specified. 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.
This bill would declare that it is to take effect immediately as an urgency statute.

Current Bill Text

Download Bill PDF