CA SB 1049: new version, 09/30/26 - Chaptered

California SB 1049, chaptered September 30, 2026 as Chapter 1001, Statutes of 2026, amends California law governing health care claims reimbursement under the Knox-Keene Health Care Service Plan Act of 1975 and the parallel regulatory framework for health insurers overseen by the Department of Insurance. The bill grants claimants 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, where the denial or overpayment notice is based on a defect that may be remedied by submitting a corrected claim. This 90-day window runs from the date of the denial or overpayment notice. The bill prohibits a plan or insurer from denying a corrected claim on the grounds that the claim was not submitted within another applicable claim filing deadline. This prohibition directly overrides otherwise applicable contractual or regulatory claim filing deadlines when the claimant is responding to a defect-based denial or overpayment notice with a corrected submission. Under the bill, disputes related to corrected claims must 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 constitutes a crime under the Knox-Keene Act, the bill is characterized as imposing a state-mandated local program, though the bill provides that no state reimbursement to local agencies is required for the specified reason stated in the act.