Health care coverage cost sharing.

Plain English Breakdown

The official source does not specify the exact penalties for violations, only that they would be considered criminal.

Health Care Coverage Cost Sharing

AB-298 prohibits large group health care plans and insurance policies from charging deductibles, coinsurance, copayments, or other cost-sharing for in-network services provided to individuals under 21 years of age starting January 1, 2027.

What This Bill Does

• Prohibits large group health care service plan contracts and health insurance policies from requiring deductibles, coinsurance, copayments, or other cost-sharing for in-network health care services provided to individuals under 21 years of age starting January 1, 2027.
• Prevents any individual or entity from billing or seeking reimbursement for in-network health care services given to people under 21 years old, except as otherwise specified.

Who It Names or Affects

• People with large group health care service plan contracts and health insurance policies who are under 21 years of age.
• Health care providers, insurers, and managed health care departments that deal with such plans.

Terms To Know

Deductible

The amount a person must pay for health care services before their insurance starts covering costs.

Coinsurance

A percentage of the cost of a health care service that an insured person pays after meeting their deductible.

Limits and Unknowns

• The bill does not specify what happens if someone tries to seek reimbursement for services provided under 21 years old, except as otherwise specified.
• It is unclear how this will affect smaller health care plans or individual policies outside of large groups.

Official Summary Text

AB 298, as amended, Bonta.
Health care coverage cost sharing.
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’s requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law limits the copayment, coinsurance, deductible, and other cost sharing that may be imposed for specified health care services.
This bill would prohibit a
large group
health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1,
2026,
2027,
from imposing a deductible, coinsurance, copayment, or other cost-sharing requirement for in-network health care services, as defined, provided to an enrollee or insured under 21 years of age, except as otherwise specified. The bill would prohibit an individual or entity from billing or seeking
reimbursement
reimbursement, as provided,
for in-network health care services provided to an enrollee or insured under 21 years of age, except as otherwise 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.

Current Bill Text

Download Bill PDF