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| 1 | + | Amended IN Senate March 18, 2025 CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION Senate Bill No. 386Introduced by Senator LimnFebruary 14, 2025An act to add Section 1371.11 to the Health and Safety Code, and to add Section 10123.146 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTSB 386, as amended, Limn. Dental providers: fee-based payments.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 acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law imposes specified coverage and disclosure requirements on health care service plans and health insurers, including specialized plans and insurers, that cover dental services.This bill would require a health care service plan contract or health insurance policy, as defined, issued, amended, or renewed on and after January 1, 2026, that provides payment directly or through a contracted vendor to a dental provider to have a non-fee-based default method of payment, as specified. The bill would require a health care service plan, health insurer, or contracted vendor to obtain written authorization from a dental provider opting in to a fee-based payment method before the plan or vendor provides a fee-based payment method to the provider and would authorize the dental provider to opt out of the fee-based payment method at any time by providing written authorization to the health care service plan, health insurer, or contracted vendor. The bill would require a health care service plan, health insurer, or contracted vendor that obtains written authorization to opt in or opt out of fee-based payment to apply the decision to include both the dental providers entire practice and all products or services covered pursuant to a contract with the dental provider, as specified. The bill would specify that its provisions do not apply if a health care service plan or health insurer has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered.Because a violation of the bills requirements 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 TextThe people of the State of California do enact as follows:SECTION 1. Section 1371.11 is added to the Health and Safety Code, to read:1371.11. (a) The following definitions apply for purposes of this section:(1) Contracted vendor means a third party facilitating payment processing on behalf of the health care service plan.(2) Dental provider means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code.(3) Fee-based payment refers to any payment type that requires the dental provider to incur a fee to access payment from a plan or its contracted vendor.(4) Health care service plan or planmeans a health care service plan defined in paragraph (2) of subdivision (a) of Section 1374.194.(5) Written authorization means a dental providers express consent to opt in or opt out of receiving fee-based payment indicated by a providers written, signed, or similar authentication, including electronic signature or checking a box to indicate authorization. A written authorization shall be identified as an authorization to the provider. The terms of the written authorization shall be clear and readily understandable. A provider accessing funds does not constitute consent to receive fee-based payment.(b) (1) A health care service plan contract issued, amended, or renewed on and after January 1, 2026, that provides payment directly, or through a contracted vendor, to a dental provider, shall have a non-fee-based default method of payment.(2) The health care service plan shall remit or associate with each payment the claims and claim details associated with payment.(c) (1) A health care service plan or its contracted vendor shall obtain written authorization from a dental provider opting in to a fee-based payment method before the plan or vendor provides a fee-based payment method to the provider.(2) At the time a dental provider opts in to a fee-based payment method, the health care service plan or its contracted vendor shall provide information on the payment method, including a notice of the fees charged by the plan or contracted vendor, alternative methods of payment, instructions on how to opt out of the fee-based payment method, and a notice of the dental providers ability to opt out of the fee-based payment method at any time.(3) Upon receipt of the dental providers written authorization, the health care service plan or its contracted vendor subsequently may issue payments to the dental provider using a fee-based payment method.(4) The health care service plan also shall notify the dental provider if its contracted vendor is sharing any part of the profit, fee arrangement, or board composition with the plan.(d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written authorization to the health care service plan or its contracted vendor.(2) If a dental provider opts out of a fee-based method of payment pursuant to paragraph (1), the providers payment method decision shall remain in effect until the provider informs the plan or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods.(e) A health care service plan or its contracted vendor that obtains a dental providers written authorization to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following:(1) The dental providers entire practice. (2) To all products or services covered by the health care service plan pursuant to a contract with the dental provider, including network provider contracts, as described in Section 1374.193.(f) This section does not apply if a health care service plan has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered.(g) This section does not change, alter, or extend the scope of Section 1367.SEC. 2. Section 10123.146 is added to the Insurance Code, to read:10123.146. (a) The following definitions shall apply for purposes of this section:(1) Contracted vendor means a third party facilitating payment processing on behalf of the health insurer.(2) Dental provider means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code.(3) Fee-based payment refers to any payment type that requires the dental provider to incur a fee to access payment from a plan or its contracted vendor.(4) Health insurerhas the same meaning as defined in paragraph (2) of subdivision (a) of Section 10120.41.(5) Written authorization means a dental providers express consent to opt in or opt out of receiving fee-based payment indicated by a providers written, signed, or similar authentication, including electronic signature or checking a box to indicate authorization. A written authorization shall be identified as an authorization to the provider. The terms of the written authorization shall be clear and readily understandable. A provider accessing funds does not constitute consent to receive fee-based payment.(b) (1) A health insurance policy issued, amended, or renewed on and after January 1, 2026, that provides payment directly, or through a contracted vendor to a dental provider, shall have a non-fee-based default method of payment.(2) A health insurer shall remit or associate with each payment the claims and claim details associated with payment.(c) (1) A health insurer or its contracted vendor shall obtain written authorization from a dental provider opting in to a fee-based payment method before the insurer or vendor provides a fee-based payment method to the provider.(2) At the time a dental provider opts in to a fee-based payment method, the health insurer or its contracted vendor shall provide information on the payment method, including a notice of the fees charged by the health insurer or contracted vendor, alternative methods of payment, instructions on how to opt-out of the fee-based payment method, and a notice of the dental providers ability to opt out of a fee-based payment method at any time.(3) Upon receipt of the written authorization, the health insurer or its contracted vendor subsequently may issue payments using a fee-based payment method.(4) A health insurer also shall notify the dental provider if its contracted vendor is sharing a part of the profit, fee arrangement, or board composition with the plan.(d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written authorization to the health insurer or its contracted vendor.(2) If a dental provider opts out of a method of payment pursuant to paragraph (1), the providers payment method decision shall remain in effect until the provider informs the health insurer or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods.(e) A health insurer or its contracted vendor that obtains a dental providers written authorization to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following:(1) The dental providers entire practice.(2) To all products or services covered by the health insurer pursuant to a contract with the dental provider, including network provider contracts, as described in Section 10120.4.(f) This section does not apply if a health insurer has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered. SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution. | |
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| 3 | - | ||
| 3 | + | Amended IN Senate March 18, 2025 CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION Senate Bill No. 386Introduced by Senator LimnFebruary 14, 2025An act to add Section 1371.11 to the Health and Safety Code, and to add Section 10123.146 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTSB 386, as amended, Limn. Dental providers: fee-based payments.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 acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law imposes specified coverage and disclosure requirements on health care service plans and health insurers, including specialized plans and insurers, that cover dental services.This bill would require a health care service plan contract or health insurance policy, as defined, issued, amended, or renewed on and after January 1, 2026, that provides payment directly or through a contracted vendor to a dental provider to have a non-fee-based default method of payment, as specified. The bill would require a health care service plan, health insurer, or contracted vendor to obtain written authorization from a dental provider opting in to a fee-based payment method before the plan or vendor provides a fee-based payment method to the provider and would authorize the dental provider to opt out of the fee-based payment method at any time by providing written authorization to the health care service plan, health insurer, or contracted vendor. The bill would require a health care service plan, health insurer, or contracted vendor that obtains written authorization to opt in or opt out of fee-based payment to apply the decision to include both the dental providers entire practice and all products or services covered pursuant to a contract with the dental provider, as specified. The bill would specify that its provisions do not apply if a health care service plan or health insurer has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered.Because a violation of the bills requirements 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 | |
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| 5 | - | ||
| 5 | + | Amended IN Senate March 18, 2025 | |
| 6 | 6 | ||
| 7 | - | Amended IN Senate April 07, 2025 | |
| 8 | 7 | Amended IN Senate March 18, 2025 | |
| 9 | 8 | ||
| 10 | 9 | CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION | |
| 11 | 10 | ||
| 12 | 11 | Senate Bill | |
| 13 | 12 | ||
| 14 | 13 | No. 386 | |
| 15 | 14 | ||
| 16 | 15 | Introduced by Senator LimnFebruary 14, 2025 | |
| 17 | 16 | ||
| 18 | 17 | Introduced by Senator Limn | |
| 19 | 18 | February 14, 2025 | |
| 20 | 19 | ||
| 21 | 20 | An act to add Section 1371.11 to the Health and Safety Code, and to add Section 10123.146 to the Insurance Code, relating to health care coverage. | |
| 22 | 21 | ||
| 23 | 22 | LEGISLATIVE COUNSEL'S DIGEST | |
| 24 | 23 | ||
| 25 | 24 | ## LEGISLATIVE COUNSEL'S DIGEST | |
| 26 | 25 | ||
| 27 | 26 | SB 386, as amended, Limn. Dental providers: fee-based payments. | |
| 28 | 27 | ||
| 29 | - | 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 acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law imposes specified coverage and disclosure requirements on health care service plans and health insurers, including specialized plans and insurers, that cover dental services.This bill would require a health care service plan contract or health insurance policy, as defined, issued, amended, or renewed on and after January | |
| 28 | + | 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 acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law imposes specified coverage and disclosure requirements on health care service plans and health insurers, including specialized plans and insurers, that cover dental services.This bill would require a health care service plan contract or health insurance policy, as defined, issued, amended, or renewed on and after January 1, 2026, that provides payment directly or through a contracted vendor to a dental provider to have a non-fee-based default method of payment, as specified. The bill would require a health care service plan, health insurer, or contracted vendor to obtain written authorization from a dental provider opting in to a fee-based payment method before the plan or vendor provides a fee-based payment method to the provider and would authorize the dental provider to opt out of the fee-based payment method at any time by providing written authorization to the health care service plan, health insurer, or contracted vendor. The bill would require a health care service plan, health insurer, or contracted vendor that obtains written authorization to opt in or opt out of fee-based payment to apply the decision to include both the dental providers entire practice and all products or services covered pursuant to a contract with the dental provider, as specified. The bill would specify that its provisions do not apply if a health care service plan or health insurer has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered.Because a violation of the bills requirements 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. | |
| 30 | 29 | ||
| 31 | 30 | 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 acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law imposes specified coverage and disclosure requirements on health care service plans and health insurers, including specialized plans and insurers, that cover dental services. | |
| 32 | 31 | ||
| 33 | - | This bill would require a health care service plan contract or health insurance policy, as defined, issued, amended, or renewed on and after January | |
| 32 | + | This bill would require a health care service plan contract or health insurance policy, as defined, issued, amended, or renewed on and after January 1, 2026, that provides payment directly or through a contracted vendor to a dental provider to have a non-fee-based default method of payment, as specified. The bill would require a health care service plan, health insurer, or contracted vendor to obtain written authorization from a dental provider opting in to a fee-based payment method before the plan or vendor provides a fee-based payment method to the provider and would authorize the dental provider to opt out of the fee-based payment method at any time by providing written authorization to the health care service plan, health insurer, or contracted vendor. The bill would require a health care service plan, health insurer, or contracted vendor that obtains written authorization to opt in or opt out of fee-based payment to apply the decision to include both the dental providers entire practice and all products or services covered pursuant to a contract with the dental provider, as specified. The bill would specify that its provisions do not apply if a health care service plan or health insurer has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered. | |
| 34 | 33 | ||
| 35 | 34 | Because a violation of the bills requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program. | |
| 36 | 35 | ||
| 37 | 36 | 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. | |
| 38 | 37 | ||
| 39 | 38 | This bill would provide that no reimbursement is required by this act for a specified reason. | |
| 40 | 39 | ||
| 41 | 40 | ## Digest Key | |
| 42 | 41 | ||
| 43 | 42 | ## Bill Text | |
| 44 | 43 | ||
| 45 | - | The people of the State of California do enact as follows:SECTION 1. Section 1371.11 is added to the Health and Safety Code, to read:1371.11. (a) The following definitions | |
| 44 | + | The people of the State of California do enact as follows:SECTION 1. Section 1371.11 is added to the Health and Safety Code, to read:1371.11. (a) The following definitions apply for purposes of this section:(1) Contracted vendor means a third party facilitating payment processing on behalf of the health care service plan.(2) Dental provider means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code.(3) Fee-based payment refers to any payment type that requires the dental provider to incur a fee to access payment from a plan or its contracted vendor.(4) Health care service plan or planmeans a health care service plan defined in paragraph (2) of subdivision (a) of Section 1374.194.(5) Written authorization means a dental providers express consent to opt in or opt out of receiving fee-based payment indicated by a providers written, signed, or similar authentication, including electronic signature or checking a box to indicate authorization. A written authorization shall be identified as an authorization to the provider. The terms of the written authorization shall be clear and readily understandable. A provider accessing funds does not constitute consent to receive fee-based payment.(b) (1) A health care service plan contract issued, amended, or renewed on and after January 1, 2026, that provides payment directly, or through a contracted vendor, to a dental provider, shall have a non-fee-based default method of payment.(2) The health care service plan shall remit or associate with each payment the claims and claim details associated with payment.(c) (1) A health care service plan or its contracted vendor shall obtain written authorization from a dental provider opting in to a fee-based payment method before the plan or vendor provides a fee-based payment method to the provider.(2) At the time a dental provider opts in to a fee-based payment method, the health care service plan or its contracted vendor shall provide information on the payment method, including a notice of the fees charged by the plan or contracted vendor, alternative methods of payment, instructions on how to opt out of the fee-based payment method, and a notice of the dental providers ability to opt out of the fee-based payment method at any time.(3) Upon receipt of the dental providers written authorization, the health care service plan or its contracted vendor subsequently may issue payments to the dental provider using a fee-based payment method.(4) The health care service plan also shall notify the dental provider if its contracted vendor is sharing any part of the profit, fee arrangement, or board composition with the plan.(d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written authorization to the health care service plan or its contracted vendor.(2) If a dental provider opts out of a fee-based method of payment pursuant to paragraph (1), the providers payment method decision shall remain in effect until the provider informs the plan or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods.(e) A health care service plan or its contracted vendor that obtains a dental providers written authorization to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following:(1) The dental providers entire practice. (2) To all products or services covered by the health care service plan pursuant to a contract with the dental provider, including network provider contracts, as described in Section 1374.193.(f) This section does not apply if a health care service plan has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered.(g) This section does not change, alter, or extend the scope of Section 1367.SEC. 2. Section 10123.146 is added to the Insurance Code, to read:10123.146. (a) The following definitions shall apply for purposes of this section:(1) Contracted vendor means a third party facilitating payment processing on behalf of the health insurer.(2) Dental provider means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code.(3) Fee-based payment refers to any payment type that requires the dental provider to incur a fee to access payment from a plan or its contracted vendor.(4) Health insurerhas the same meaning as defined in paragraph (2) of subdivision (a) of Section 10120.41.(5) Written authorization means a dental providers express consent to opt in or opt out of receiving fee-based payment indicated by a providers written, signed, or similar authentication, including electronic signature or checking a box to indicate authorization. A written authorization shall be identified as an authorization to the provider. The terms of the written authorization shall be clear and readily understandable. A provider accessing funds does not constitute consent to receive fee-based payment.(b) (1) A health insurance policy issued, amended, or renewed on and after January 1, 2026, that provides payment directly, or through a contracted vendor to a dental provider, shall have a non-fee-based default method of payment.(2) A health insurer shall remit or associate with each payment the claims and claim details associated with payment.(c) (1) A health insurer or its contracted vendor shall obtain written authorization from a dental provider opting in to a fee-based payment method before the insurer or vendor provides a fee-based payment method to the provider.(2) At the time a dental provider opts in to a fee-based payment method, the health insurer or its contracted vendor shall provide information on the payment method, including a notice of the fees charged by the health insurer or contracted vendor, alternative methods of payment, instructions on how to opt-out of the fee-based payment method, and a notice of the dental providers ability to opt out of a fee-based payment method at any time.(3) Upon receipt of the written authorization, the health insurer or its contracted vendor subsequently may issue payments using a fee-based payment method.(4) A health insurer also shall notify the dental provider if its contracted vendor is sharing a part of the profit, fee arrangement, or board composition with the plan.(d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written authorization to the health insurer or its contracted vendor.(2) If a dental provider opts out of a method of payment pursuant to paragraph (1), the providers payment method decision shall remain in effect until the provider informs the health insurer or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods.(e) A health insurer or its contracted vendor that obtains a dental providers written authorization to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following:(1) The dental providers entire practice.(2) To all products or services covered by the health insurer pursuant to a contract with the dental provider, including network provider contracts, as described in Section 10120.4.(f) This section does not apply if a health insurer has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered. SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution. | |
| 46 | 45 | ||
| 47 | 46 | The people of the State of California do enact as follows: | |
| 48 | 47 | ||
| 49 | 48 | ## The people of the State of California do enact as follows: | |
| 50 | 49 | ||
| 51 | - | SECTION 1. Section 1371.11 is added to the Health and Safety Code, to read:1371.11. (a) The following definitions | |
| 50 | + | SECTION 1. Section 1371.11 is added to the Health and Safety Code, to read:1371.11. (a) The following definitions apply for purposes of this section:(1) Contracted vendor means a third party facilitating payment processing on behalf of the health care service plan.(2) Dental provider means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code.(3) Fee-based payment refers to any payment type that requires the dental provider to incur a fee to access payment from a plan or its contracted vendor.(4) Health care service plan or planmeans a health care service plan defined in paragraph (2) of subdivision (a) of Section 1374.194.(5) Written authorization means a dental providers express consent to opt in or opt out of receiving fee-based payment indicated by a providers written, signed, or similar authentication, including electronic signature or checking a box to indicate authorization. A written authorization shall be identified as an authorization to the provider. The terms of the written authorization shall be clear and readily understandable. A provider accessing funds does not constitute consent to receive fee-based payment.(b) (1) A health care service plan contract issued, amended, or renewed on and after January 1, 2026, that provides payment directly, or through a contracted vendor, to a dental provider, shall have a non-fee-based default method of payment.(2) The health care service plan shall remit or associate with each payment the claims and claim details associated with payment.(c) (1) A health care service plan or its contracted vendor shall obtain written authorization from a dental provider opting in to a fee-based payment method before the plan or vendor provides a fee-based payment method to the provider.(2) At the time a dental provider opts in to a fee-based payment method, the health care service plan or its contracted vendor shall provide information on the payment method, including a notice of the fees charged by the plan or contracted vendor, alternative methods of payment, instructions on how to opt out of the fee-based payment method, and a notice of the dental providers ability to opt out of the fee-based payment method at any time.(3) Upon receipt of the dental providers written authorization, the health care service plan or its contracted vendor subsequently may issue payments to the dental provider using a fee-based payment method.(4) The health care service plan also shall notify the dental provider if its contracted vendor is sharing any part of the profit, fee arrangement, or board composition with the plan.(d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written authorization to the health care service plan or its contracted vendor.(2) If a dental provider opts out of a fee-based method of payment pursuant to paragraph (1), the providers payment method decision shall remain in effect until the provider informs the plan or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods.(e) A health care service plan or its contracted vendor that obtains a dental providers written authorization to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following:(1) The dental providers entire practice. (2) To all products or services covered by the health care service plan pursuant to a contract with the dental provider, including network provider contracts, as described in Section 1374.193.(f) This section does not apply if a health care service plan has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered.(g) This section does not change, alter, or extend the scope of Section 1367. | |
| 52 | 51 | ||
| 53 | 52 | SECTION 1. Section 1371.11 is added to the Health and Safety Code, to read: | |
| 54 | 53 | ||
| 55 | 54 | ### SECTION 1. | |
| 56 | 55 | ||
| 57 | - | 1371.11. (a) The following definitions | |
| 56 | + | 1371.11. (a) The following definitions apply for purposes of this section:(1) Contracted vendor means a third party facilitating payment processing on behalf of the health care service plan.(2) Dental provider means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code.(3) Fee-based payment refers to any payment type that requires the dental provider to incur a fee to access payment from a plan or its contracted vendor.(4) Health care service plan or planmeans a health care service plan defined in paragraph (2) of subdivision (a) of Section 1374.194.(5) Written authorization means a dental providers express consent to opt in or opt out of receiving fee-based payment indicated by a providers written, signed, or similar authentication, including electronic signature or checking a box to indicate authorization. A written authorization shall be identified as an authorization to the provider. The terms of the written authorization shall be clear and readily understandable. A provider accessing funds does not constitute consent to receive fee-based payment.(b) (1) A health care service plan contract issued, amended, or renewed on and after January 1, 2026, that provides payment directly, or through a contracted vendor, to a dental provider, shall have a non-fee-based default method of payment.(2) The health care service plan shall remit or associate with each payment the claims and claim details associated with payment.(c) (1) A health care service plan or its contracted vendor shall obtain written authorization from a dental provider opting in to a fee-based payment method before the plan or vendor provides a fee-based payment method to the provider.(2) At the time a dental provider opts in to a fee-based payment method, the health care service plan or its contracted vendor shall provide information on the payment method, including a notice of the fees charged by the plan or contracted vendor, alternative methods of payment, instructions on how to opt out of the fee-based payment method, and a notice of the dental providers ability to opt out of the fee-based payment method at any time.(3) Upon receipt of the dental providers written authorization, the health care service plan or its contracted vendor subsequently may issue payments to the dental provider using a fee-based payment method.(4) The health care service plan also shall notify the dental provider if its contracted vendor is sharing any part of the profit, fee arrangement, or board composition with the plan.(d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written authorization to the health care service plan or its contracted vendor.(2) If a dental provider opts out of a fee-based method of payment pursuant to paragraph (1), the providers payment method decision shall remain in effect until the provider informs the plan or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods.(e) A health care service plan or its contracted vendor that obtains a dental providers written authorization to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following:(1) The dental providers entire practice. (2) To all products or services covered by the health care service plan pursuant to a contract with the dental provider, including network provider contracts, as described in Section 1374.193.(f) This section does not apply if a health care service plan has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered.(g) This section does not change, alter, or extend the scope of Section 1367. | |
| 58 | 57 | ||
| 59 | - | 1371.11. (a) The following definitions | |
| 58 | + | 1371.11. (a) The following definitions apply for purposes of this section:(1) Contracted vendor means a third party facilitating payment processing on behalf of the health care service plan.(2) Dental provider means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code.(3) Fee-based payment refers to any payment type that requires the dental provider to incur a fee to access payment from a plan or its contracted vendor.(4) Health care service plan or planmeans a health care service plan defined in paragraph (2) of subdivision (a) of Section 1374.194.(5) Written authorization means a dental providers express consent to opt in or opt out of receiving fee-based payment indicated by a providers written, signed, or similar authentication, including electronic signature or checking a box to indicate authorization. A written authorization shall be identified as an authorization to the provider. The terms of the written authorization shall be clear and readily understandable. A provider accessing funds does not constitute consent to receive fee-based payment.(b) (1) A health care service plan contract issued, amended, or renewed on and after January 1, 2026, that provides payment directly, or through a contracted vendor, to a dental provider, shall have a non-fee-based default method of payment.(2) The health care service plan shall remit or associate with each payment the claims and claim details associated with payment.(c) (1) A health care service plan or its contracted vendor shall obtain written authorization from a dental provider opting in to a fee-based payment method before the plan or vendor provides a fee-based payment method to the provider.(2) At the time a dental provider opts in to a fee-based payment method, the health care service plan or its contracted vendor shall provide information on the payment method, including a notice of the fees charged by the plan or contracted vendor, alternative methods of payment, instructions on how to opt out of the fee-based payment method, and a notice of the dental providers ability to opt out of the fee-based payment method at any time.(3) Upon receipt of the dental providers written authorization, the health care service plan or its contracted vendor subsequently may issue payments to the dental provider using a fee-based payment method.(4) The health care service plan also shall notify the dental provider if its contracted vendor is sharing any part of the profit, fee arrangement, or board composition with the plan.(d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written authorization to the health care service plan or its contracted vendor.(2) If a dental provider opts out of a fee-based method of payment pursuant to paragraph (1), the providers payment method decision shall remain in effect until the provider informs the plan or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods.(e) A health care service plan or its contracted vendor that obtains a dental providers written authorization to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following:(1) The dental providers entire practice. (2) To all products or services covered by the health care service plan pursuant to a contract with the dental provider, including network provider contracts, as described in Section 1374.193.(f) This section does not apply if a health care service plan has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered.(g) This section does not change, alter, or extend the scope of Section 1367. | |
| 60 | 59 | ||
| 61 | - | 1371.11. (a) The following definitions | |
| 60 | + | 1371.11. (a) The following definitions apply for purposes of this section:(1) Contracted vendor means a third party facilitating payment processing on behalf of the health care service plan.(2) Dental provider means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code.(3) Fee-based payment refers to any payment type that requires the dental provider to incur a fee to access payment from a plan or its contracted vendor.(4) Health care service plan or planmeans a health care service plan defined in paragraph (2) of subdivision (a) of Section 1374.194.(5) Written authorization means a dental providers express consent to opt in or opt out of receiving fee-based payment indicated by a providers written, signed, or similar authentication, including electronic signature or checking a box to indicate authorization. A written authorization shall be identified as an authorization to the provider. The terms of the written authorization shall be clear and readily understandable. A provider accessing funds does not constitute consent to receive fee-based payment.(b) (1) A health care service plan contract issued, amended, or renewed on and after January 1, 2026, that provides payment directly, or through a contracted vendor, to a dental provider, shall have a non-fee-based default method of payment.(2) The health care service plan shall remit or associate with each payment the claims and claim details associated with payment.(c) (1) A health care service plan or its contracted vendor shall obtain written authorization from a dental provider opting in to a fee-based payment method before the plan or vendor provides a fee-based payment method to the provider.(2) At the time a dental provider opts in to a fee-based payment method, the health care service plan or its contracted vendor shall provide information on the payment method, including a notice of the fees charged by the plan or contracted vendor, alternative methods of payment, instructions on how to opt out of the fee-based payment method, and a notice of the dental providers ability to opt out of the fee-based payment method at any time.(3) Upon receipt of the dental providers written authorization, the health care service plan or its contracted vendor subsequently may issue payments to the dental provider using a fee-based payment method.(4) The health care service plan also shall notify the dental provider if its contracted vendor is sharing any part of the profit, fee arrangement, or board composition with the plan.(d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written authorization to the health care service plan or its contracted vendor.(2) If a dental provider opts out of a fee-based method of payment pursuant to paragraph (1), the providers payment method decision shall remain in effect until the provider informs the plan or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods.(e) A health care service plan or its contracted vendor that obtains a dental providers written authorization to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following:(1) The dental providers entire practice. (2) To all products or services covered by the health care service plan pursuant to a contract with the dental provider, including network provider contracts, as described in Section 1374.193.(f) This section does not apply if a health care service plan has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered.(g) This section does not change, alter, or extend the scope of Section 1367. | |
| 62 | 61 | ||
| 63 | 62 | ||
| 64 | 63 | ||
| 65 | - | 1371.11. (a) The following definitions | |
| 64 | + | 1371.11. (a) The following definitions apply for purposes of this section: | |
| 66 | 65 | ||
| 67 | - | (1) | |
| 66 | + | (1) Contracted vendor means a third party facilitating payment processing on behalf of the health care service plan. | |
| 68 | 67 | ||
| 69 | - | ( | |
| 68 | + | (2) Dental provider means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code. | |
| 70 | 69 | ||
| 71 | - | ( | |
| 70 | + | (3) Fee-based payment refers to any payment type that requires the dental provider to incur a fee to access payment from a plan or its contracted vendor. | |
| 72 | 71 | ||
| 73 | - | (1) | |
| 74 | - | ||
| 75 | - | ||
| 76 | - | ||
| 77 | - | (2) Contracted vendor means a third party facilitating payment processing on behalf of the health care service plan. | |
| 78 | - | ||
| 79 | - | (2) | |
| 80 | - | ||
| 81 | - | ||
| 82 | - | ||
| 83 | - | (3) Dental provider means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code. | |
| 84 | - | ||
| 85 | - | (3) | |
| 86 | - | ||
| 87 | - | ||
| 88 | - | ||
| 89 | - | (4) Fee-based payment refers to any payment type that requires the dental provider to incur a fee from the health care service plan or its contracted vendor to access payment from a plan or its contracted vendor. | |
| 90 | - | ||
| 91 | - | (4) | |
| 92 | - | ||
| 93 | - | ||
| 94 | - | ||
| 95 | - | (5) Health care service plan or planmeans a health care service plan defined in paragraph (2) of subdivision (a) of Section 1374.194. | |
| 72 | + | (4) Health care service plan or planmeans a health care service plan defined in paragraph (2) of subdivision (a) of Section 1374.194. | |
| 96 | 73 | ||
| 97 | 74 | (5) Written authorization means a dental providers express consent to opt in or opt out of receiving fee-based payment indicated by a providers written, signed, or similar authentication, including electronic signature or checking a box to indicate authorization. A written authorization shall be identified as an authorization to the provider. The terms of the written authorization shall be clear and readily understandable. A provider accessing funds does not constitute consent to receive fee-based payment. | |
| 98 | 75 | ||
| 99 | - | ||
| 100 | - | ||
| 101 | - | (6) Signature includes an electronic or digital signature if the form of the signature is recognized as a valid signature under applicable federal or state law, including, but not limited to, checking a box indicating affirmative consent. | |
| 102 | - | ||
| 103 | - | (b) (1) A health care service plan contract issued, amended, or renewed on and after January April 1, 2026, that provides payment directly, or through a contracted vendor, to a dental provider, provider shall have a non-fee-based default method of payment. | |
| 76 | + | (b) (1) A health care service plan contract issued, amended, or renewed on and after January 1, 2026, that provides payment directly, or through a contracted vendor, to a dental provider, shall have a non-fee-based default method of payment. | |
| 104 | 77 | ||
| 105 | 78 | (2) The health care service plan shall remit or associate with each payment the claims and claim details associated with payment. | |
| 106 | 79 | ||
| 107 | - | (c) (1) | |
| 80 | + | (c) (1) A health care service plan or its contracted vendor shall obtain written authorization from a dental provider opting in to a fee-based payment method before the plan or vendor provides a fee-based payment method to the provider. | |
| 108 | 81 | ||
| 109 | 82 | (2) At the time a dental provider opts in to a fee-based payment method, the health care service plan or its contracted vendor shall provide information on the payment method, including a notice of the fees charged by the plan or contracted vendor, alternative methods of payment, instructions on how to opt out of the fee-based payment method, and a notice of the dental providers ability to opt out of the fee-based payment method at any time. | |
| 110 | 83 | ||
| 111 | - | (3) Upon receipt of the dental providers written authorization | |
| 84 | + | (3) Upon receipt of the dental providers written authorization, the health care service plan or its contracted vendor subsequently may issue payments to the dental provider using a fee-based payment method. | |
| 112 | 85 | ||
| 113 | - | (4) The health care service plan also shall notify the dental provider if its contracted vendor is sharing any | |
| 86 | + | (4) The health care service plan also shall notify the dental provider if its contracted vendor is sharing any part of the profit, fee arrangement, or board composition with the plan. | |
| 114 | 87 | ||
| 115 | - | (d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written authorization | |
| 88 | + | (d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written authorization to the health care service plan or its contracted vendor. | |
| 116 | 89 | ||
| 117 | - | (2) If a dental provider | |
| 90 | + | (2) If a dental provider opts out of a fee-based method of payment pursuant to paragraph (1), the providers payment method decision shall remain in effect until the provider informs the plan or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods. | |
| 118 | 91 | ||
| 119 | - | (e) A health care service plan or its contracted vendor that obtains a dental providers written authorization | |
| 92 | + | (e) A health care service plan or its contracted vendor that obtains a dental providers written authorization to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following: | |
| 120 | 93 | ||
| 121 | 94 | (1) The dental providers entire practice. | |
| 122 | 95 | ||
| 123 | 96 | (2) To all products or services covered by the health care service plan pursuant to a contract with the dental provider, including network provider contracts, as described in Section 1374.193. | |
| 124 | 97 | ||
| 125 | - | (f) This section does not apply if a health care service plan has a direct contract with a provider that allows the provider to choose payment methods, including a non-fee-based payment method for services rendered. | |
| 98 | + | (f) This section does not apply if a health care service plan has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered. | |
| 126 | 99 | ||
| 127 | 100 | (g) This section does not change, alter, or extend the scope of Section 1367. | |
| 128 | 101 | ||
| 129 | - | SEC. 2. Section 10123.146 is added to the Insurance Code, to read:10123.146. (a) The following definitions shall apply for purposes of this section:(1) | |
| 102 | + | SEC. 2. Section 10123.146 is added to the Insurance Code, to read:10123.146. (a) The following definitions shall apply for purposes of this section:(1) Contracted vendor means a third party facilitating payment processing on behalf of the health insurer.(2) Dental provider means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code.(3) Fee-based payment refers to any payment type that requires the dental provider to incur a fee to access payment from a plan or its contracted vendor.(4) Health insurerhas the same meaning as defined in paragraph (2) of subdivision (a) of Section 10120.41.(5) Written authorization means a dental providers express consent to opt in or opt out of receiving fee-based payment indicated by a providers written, signed, or similar authentication, including electronic signature or checking a box to indicate authorization. A written authorization shall be identified as an authorization to the provider. The terms of the written authorization shall be clear and readily understandable. A provider accessing funds does not constitute consent to receive fee-based payment.(b) (1) A health insurance policy issued, amended, or renewed on and after January 1, 2026, that provides payment directly, or through a contracted vendor to a dental provider, shall have a non-fee-based default method of payment.(2) A health insurer shall remit or associate with each payment the claims and claim details associated with payment.(c) (1) A health insurer or its contracted vendor shall obtain written authorization from a dental provider opting in to a fee-based payment method before the insurer or vendor provides a fee-based payment method to the provider.(2) At the time a dental provider opts in to a fee-based payment method, the health insurer or its contracted vendor shall provide information on the payment method, including a notice of the fees charged by the health insurer or contracted vendor, alternative methods of payment, instructions on how to opt-out of the fee-based payment method, and a notice of the dental providers ability to opt out of a fee-based payment method at any time.(3) Upon receipt of the written authorization, the health insurer or its contracted vendor subsequently may issue payments using a fee-based payment method.(4) A health insurer also shall notify the dental provider if its contracted vendor is sharing a part of the profit, fee arrangement, or board composition with the plan.(d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written authorization to the health insurer or its contracted vendor.(2) If a dental provider opts out of a method of payment pursuant to paragraph (1), the providers payment method decision shall remain in effect until the provider informs the health insurer or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods.(e) A health insurer or its contracted vendor that obtains a dental providers written authorization to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following:(1) The dental providers entire practice.(2) To all products or services covered by the health insurer pursuant to a contract with the dental provider, including network provider contracts, as described in Section 10120.4.(f) This section does not apply if a health insurer has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered. | |
| 130 | 103 | ||
| 131 | 104 | SEC. 2. Section 10123.146 is added to the Insurance Code, to read: | |
| 132 | 105 | ||
| 133 | 106 | ### SEC. 2. | |
| 134 | 107 | ||
| 135 | - | 10123.146. (a) The following definitions shall apply for purposes of this section:(1 | |
| 108 | + | 10123.146. (a) The following definitions shall apply for purposes of this section:(1) Contracted vendor means a third party facilitating payment processing on behalf of the health insurer.(2) Dental provider means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code.(3) Fee-based payment refers to any payment type that requires the dental provider to incur a fee to access payment from a plan or its contracted vendor.(4) Health insurerhas the same meaning as defined in paragraph (2) of subdivision (a) of Section 10120.41.(5) Written authorization means a dental providers express consent to opt in or opt out of receiving fee-based payment indicated by a providers written, signed, or similar authentication, including electronic signature or checking a box to indicate authorization. A written authorization shall be identified as an authorization to the provider. The terms of the written authorization shall be clear and readily understandable. A provider accessing funds does not constitute consent to receive fee-based payment.(b) (1) A health insurance policy issued, amended, or renewed on and after January 1, 2026, that provides payment directly, or through a contracted vendor to a dental provider, shall have a non-fee-based default method of payment.(2) A health insurer shall remit or associate with each payment the claims and claim details associated with payment.(c) (1) A health insurer or its contracted vendor shall obtain written authorization from a dental provider opting in to a fee-based payment method before the insurer or vendor provides a fee-based payment method to the provider.(2) At the time a dental provider opts in to a fee-based payment method, the health insurer or its contracted vendor shall provide information on the payment method, including a notice of the fees charged by the health insurer or contracted vendor, alternative methods of payment, instructions on how to opt-out of the fee-based payment method, and a notice of the dental providers ability to opt out of a fee-based payment method at any time.(3) Upon receipt of the written authorization, the health insurer or its contracted vendor subsequently may issue payments using a fee-based payment method.(4) A health insurer also shall notify the dental provider if its contracted vendor is sharing a part of the profit, fee arrangement, or board composition with the plan.(d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written authorization to the health insurer or its contracted vendor.(2) If a dental provider opts out of a method of payment pursuant to paragraph (1), the providers payment method decision shall remain in effect until the provider informs the health insurer or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods.(e) A health insurer or its contracted vendor that obtains a dental providers written authorization to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following:(1) The dental providers entire practice.(2) To all products or services covered by the health insurer pursuant to a contract with the dental provider, including network provider contracts, as described in Section 10120.4.(f) This section does not apply if a health insurer has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered. | |
| 136 | 109 | ||
| 137 | - | 10123.146. (a) The following definitions shall apply for purposes of this section:(1 | |
| 110 | + | 10123.146. (a) The following definitions shall apply for purposes of this section:(1) Contracted vendor means a third party facilitating payment processing on behalf of the health insurer.(2) Dental provider means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code.(3) Fee-based payment refers to any payment type that requires the dental provider to incur a fee to access payment from a plan or its contracted vendor.(4) Health insurerhas the same meaning as defined in paragraph (2) of subdivision (a) of Section 10120.41.(5) Written authorization means a dental providers express consent to opt in or opt out of receiving fee-based payment indicated by a providers written, signed, or similar authentication, including electronic signature or checking a box to indicate authorization. A written authorization shall be identified as an authorization to the provider. The terms of the written authorization shall be clear and readily understandable. A provider accessing funds does not constitute consent to receive fee-based payment.(b) (1) A health insurance policy issued, amended, or renewed on and after January 1, 2026, that provides payment directly, or through a contracted vendor to a dental provider, shall have a non-fee-based default method of payment.(2) A health insurer shall remit or associate with each payment the claims and claim details associated with payment.(c) (1) A health insurer or its contracted vendor shall obtain written authorization from a dental provider opting in to a fee-based payment method before the insurer or vendor provides a fee-based payment method to the provider.(2) At the time a dental provider opts in to a fee-based payment method, the health insurer or its contracted vendor shall provide information on the payment method, including a notice of the fees charged by the health insurer or contracted vendor, alternative methods of payment, instructions on how to opt-out of the fee-based payment method, and a notice of the dental providers ability to opt out of a fee-based payment method at any time.(3) Upon receipt of the written authorization, the health insurer or its contracted vendor subsequently may issue payments using a fee-based payment method.(4) A health insurer also shall notify the dental provider if its contracted vendor is sharing a part of the profit, fee arrangement, or board composition with the plan.(d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written authorization to the health insurer or its contracted vendor.(2) If a dental provider opts out of a method of payment pursuant to paragraph (1), the providers payment method decision shall remain in effect until the provider informs the health insurer or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods.(e) A health insurer or its contracted vendor that obtains a dental providers written authorization to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following:(1) The dental providers entire practice.(2) To all products or services covered by the health insurer pursuant to a contract with the dental provider, including network provider contracts, as described in Section 10120.4.(f) This section does not apply if a health insurer has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered. | |
| 138 | 111 | ||
| 139 | - | 10123.146. (a) The following definitions shall apply for purposes of this section:(1 | |
| 112 | + | 10123.146. (a) The following definitions shall apply for purposes of this section:(1) Contracted vendor means a third party facilitating payment processing on behalf of the health insurer.(2) Dental provider means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code.(3) Fee-based payment refers to any payment type that requires the dental provider to incur a fee to access payment from a plan or its contracted vendor.(4) Health insurerhas the same meaning as defined in paragraph (2) of subdivision (a) of Section 10120.41.(5) Written authorization means a dental providers express consent to opt in or opt out of receiving fee-based payment indicated by a providers written, signed, or similar authentication, including electronic signature or checking a box to indicate authorization. A written authorization shall be identified as an authorization to the provider. The terms of the written authorization shall be clear and readily understandable. A provider accessing funds does not constitute consent to receive fee-based payment.(b) (1) A health insurance policy issued, amended, or renewed on and after January 1, 2026, that provides payment directly, or through a contracted vendor to a dental provider, shall have a non-fee-based default method of payment.(2) A health insurer shall remit or associate with each payment the claims and claim details associated with payment.(c) (1) A health insurer or its contracted vendor shall obtain written authorization from a dental provider opting in to a fee-based payment method before the insurer or vendor provides a fee-based payment method to the provider.(2) At the time a dental provider opts in to a fee-based payment method, the health insurer or its contracted vendor shall provide information on the payment method, including a notice of the fees charged by the health insurer or contracted vendor, alternative methods of payment, instructions on how to opt-out of the fee-based payment method, and a notice of the dental providers ability to opt out of a fee-based payment method at any time.(3) Upon receipt of the written authorization, the health insurer or its contracted vendor subsequently may issue payments using a fee-based payment method.(4) A health insurer also shall notify the dental provider if its contracted vendor is sharing a part of the profit, fee arrangement, or board composition with the plan.(d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written authorization to the health insurer or its contracted vendor.(2) If a dental provider opts out of a method of payment pursuant to paragraph (1), the providers payment method decision shall remain in effect until the provider informs the health insurer or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods.(e) A health insurer or its contracted vendor that obtains a dental providers written authorization to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following:(1) The dental providers entire practice.(2) To all products or services covered by the health insurer pursuant to a contract with the dental provider, including network provider contracts, as described in Section 10120.4.(f) This section does not apply if a health insurer has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered. | |
| 140 | 113 | ||
| 141 | 114 | ||
| 142 | 115 | ||
| 143 | 116 | 10123.146. (a) The following definitions shall apply for purposes of this section: | |
| 144 | 117 | ||
| 145 | - | (1) | |
| 118 | + | (1) Contracted vendor means a third party facilitating payment processing on behalf of the health insurer. | |
| 146 | 119 | ||
| 147 | - | ( | |
| 120 | + | (2) Dental provider means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code. | |
| 148 | 121 | ||
| 149 | - | ( | |
| 122 | + | (3) Fee-based payment refers to any payment type that requires the dental provider to incur a fee to access payment from a plan or its contracted vendor. | |
| 150 | 123 | ||
| 151 | - | (1) | |
| 152 | - | ||
| 153 | - | ||
| 154 | - | ||
| 155 | - | (2) Contracted vendor means a third party facilitating payment processing on behalf of the health insurer. | |
| 156 | - | ||
| 157 | - | (2) | |
| 158 | - | ||
| 159 | - | ||
| 160 | - | ||
| 161 | - | (3) Dental provider means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code. | |
| 162 | - | ||
| 163 | - | (3) | |
| 164 | - | ||
| 165 | - | ||
| 166 | - | ||
| 167 | - | (4) Fee-based payment refers to any payment type that requires the dental provider to incur a fee from the health insurer or its contracted vendor to access payment from a plan or its contracted vendor. | |
| 168 | - | ||
| 169 | - | (4) | |
| 170 | - | ||
| 171 | - | ||
| 172 | - | ||
| 173 | - | (5) Health insurerhas the same meaning as defined in paragraph (2) of subdivision (a) of Section 10120.41. | |
| 124 | + | (4) Health insurerhas the same meaning as defined in paragraph (2) of subdivision (a) of Section 10120.41. | |
| 174 | 125 | ||
| 175 | 126 | (5) Written authorization means a dental providers express consent to opt in or opt out of receiving fee-based payment indicated by a providers written, signed, or similar authentication, including electronic signature or checking a box to indicate authorization. A written authorization shall be identified as an authorization to the provider. The terms of the written authorization shall be clear and readily understandable. A provider accessing funds does not constitute consent to receive fee-based payment. | |
| 176 | 127 | ||
| 128 | + | (b) (1) A health insurance policy issued, amended, or renewed on and after January 1, 2026, that provides payment directly, or through a contracted vendor to a dental provider, shall have a non-fee-based default method of payment. | |
| 177 | 129 | ||
| 130 | + | (2) A health insurer shall remit or associate with each payment the claims and claim details associated with payment. | |
| 178 | 131 | ||
| 179 | - | ( | |
| 132 | + | (c) (1) A health insurer or its contracted vendor shall obtain written authorization from a dental provider opting in to a fee-based payment method before the insurer or vendor provides a fee-based payment method to the provider. | |
| 180 | 133 | ||
| 181 | - | ( | |
| 134 | + | (2) At the time a dental provider opts in to a fee-based payment method, the health insurer or its contracted vendor shall provide information on the payment method, including a notice of the fees charged by the health insurer or contracted vendor, alternative methods of payment, instructions on how to opt-out of the fee-based payment method, and a notice of the dental providers ability to opt out of a fee-based payment method at any time. | |
| 182 | 135 | ||
| 183 | - | ( | |
| 136 | + | (3) Upon receipt of the written authorization, the health insurer or its contracted vendor subsequently may issue payments using a fee-based payment method. | |
| 184 | 137 | ||
| 185 | - | ( | |
| 138 | + | (4) A health insurer also shall notify the dental provider if its contracted vendor is sharing a part of the profit, fee arrangement, or board composition with the plan. | |
| 186 | 139 | ||
| 187 | - | ( | |
| 140 | + | (d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written authorization to the health insurer or its contracted vendor. | |
| 188 | 141 | ||
| 189 | - | ( | |
| 142 | + | (2) If a dental provider opts out of a method of payment pursuant to paragraph (1), the providers payment method decision shall remain in effect until the provider informs the health insurer or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods. | |
| 190 | 143 | ||
| 191 | - | (4) A The health insurer also shall notify the dental provider if its contracted vendor is sharing a part of the profit, fee arrangement, or board composition with the plan. health insurer. | |
| 192 | - | ||
| 193 | - | (d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing written authorization affirmative consent to the health insurer or its contracted vendor. | |
| 194 | - | ||
| 195 | - | (2) If a dental provider opts in or opts out of a method of payment pursuant to paragraph (1), the providers payment method decision shall remain in effect until the provider informs the health insurer or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods. | |
| 196 | - | ||
| 197 | - | (e) A health insurer or its contracted vendor that obtains a dental providers written authorization affirmative consent to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following: | |
| 144 | + | (e) A health insurer or its contracted vendor that obtains a dental providers written authorization to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following: | |
| 198 | 145 | ||
| 199 | 146 | (1) The dental providers entire practice. | |
| 200 | 147 | ||
| 201 | 148 | (2) To all products or services covered by the health insurer pursuant to a contract with the dental provider, including network provider contracts, as described in Section 10120.4. | |
| 202 | 149 | ||
| 203 | - | (f) This section does not apply if a health insurer has a direct contract with a provider that allows the provider to choose payment methods, including a non-fee-based payment method for services rendered. | |
| 150 | + | (f) This section does not apply if a health insurer has a direct contract with a provider that allows the provider to choose payment methods methods, including a non-fee-based payment method for services rendered. | |
| 204 | 151 | ||
| 205 | 152 | SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution. | |
| 206 | 153 | ||
| 207 | 154 | SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution. | |
| 208 | 155 | ||
| 209 | 156 | SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution. | |
| 210 | 157 | ||
| 211 | 158 | ### SEC. 3. |