SB1049 - Health care claims reimbursement.

Enrolled August 25, 2026 Passed IN Senate August 24, 2026 Passed IN Assembly August 20, 2026 Amended IN Assembly August 13, 2026 Amended IN Senate April 06, 2026 CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION Senate Bill No. 1049 Introduced by Senator Weber Pierson (Coauthor: Assembly Member Patel) February 12, 2026 An act to add Section 1371.21 to the Health and Safety Code, and to add Section 10123.134 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGEST SB 1049, Weber Pierson. Health care claims reimbursement. 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. Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill Text The people of the State of California do enact as follows: SECTION 1. Section 1371.21 is added to the Health and Safety Code, to read: 1371.21. (a) Notwithstanding any other law, if a health care service plan denies a claim or portion thereof or sends a notice of overpayment for a claim based in whole or in part on a defect that may be remedied by submitting a corrected claim, the claimant shall have no less than 90 calendar days from the plan’s most recent action to submit a corrected claim. (b) A plan shall not deny a corrected claim submitted pursuant to this section and in accordance with subdivision (a) on the grounds that the claim was not submitted within an applicable claim filing deadline other than the deadline specified in subdivision (a). A dispute related to a corrected claim submitted pursuant to this section shall be eligible for submission to the plan’s fast, fair, and cost-effective dispute resolution mechanism. (c) The department may issue guidance and amend or issue necessary regulations relating to this section. The guidance and regulations shall not be subject to the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). Notwithstanding the Administrative Procedure Act, the State Department of Health Care Services may also issue necessary guidance and necessary regulations that are consistent with guidance and regulations issued by the department pursuant to this section. SEC. 2. Section 10123.134 is added to the Insurance Code, to read: 10123.134. (a) Notwithstanding any other law, if a health insurer denies a claim or portion thereof or sends a notice of overpayment for a claim based in whole or in part on a defect that may be remedied by submitting a corrected claim, the claimant shall have no less than 90 calendar days from the insurer’s most recent action to submit a corrected claim. (b) An insurer shall not deny a corrected claim submitted pursuant to this section and in accordance with subdivision (a) on the grounds that the claim was not submitted within an applicable claim filing deadline other than the deadline specified in subdivision (a). A dispute related to a corrected claim submitted pursuant to this section shall be eligible for submission to the insurer’s fast, fair, and cost-effective dispute resolution mechanism. (c) The department may issue guidance and amend or issue necessary regulations relating to this section. The guidance and regulations shall not be subject to the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.