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AB 298

Revises provisions relating to school counselors. (BDR 34-532)

2025 Regular Session

Prohibits in‑network cost sharing for health services for enrollees under 21, including bans on billing, with HDHP rules allowing deductible until met for non‑preventive services.

(Pursuant to Joint Standing Rule No. 14.3.1, no further action allowed.)
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Bill Summary · AB 298

AB 298 — Health care coverage cost sharing (Bonta) — Summary

Purpose

AB 298 prohibits most patient cost sharing (deductibles, coinsurance, copayments, and other out‑of‑pocket cost‑sharing requirements) for in‑network health care services for enrollees or insureds under 21 years of age. The bill aims to reduce financial barriers to care for children and young adults by eliminating point‑of‑service charges for covered in‑network services.

Key provisions

  • Applies to:
    • Health care service plan contracts regulated under the Knox‑Keene Act (Health & Safety Code) (new Section 1367.55).
    • Disability health insurance policies regulated by the Department of Insurance (new Section 10123.187).
  • Effective date: prohibits cost sharing in contracts/policies that are issued, amended, or renewed on or after January 1, 2026.
  • Core prohibitions:
    • Plans/policies may not impose a deductible, coinsurance, copayment, or other cost‑sharing for in‑network services provided to an enrollee/insured under 21, except as described for qualifying high‑deductible health plans (HDHPs).
    • Individuals or entities (including providers) may not bill or seek reimbursement from an enrollee, insured, contractholder, or policyholder for those in‑network services.
  • HDHP (HSA‑eligible) exception:
    • Preventive services (as defined under federal Section 223(c)(2)) provided to those under 21 must be covered without cost sharing.
    • For other in‑network services, once the HDHP’s deductible for the plan year has been satisfied, coinsurance, copayments, or other cost sharing may not be imposed for services to those under 21.
    • (The text therefore allows a deductible to apply in HDHPs until satisfied, but bars cost sharing for preventive services and bars additional cost sharing after the deductible is met.)
  • Definition of “in‑network health care services” includes:
    • Covered services by contracting providers;
    • Services at contracting facilities even if some services are by noncontracting providers;
    • Covered emergency services;
    • Services by noncontracting providers when a contracting provider is not available consistent with timely access rules.
  • The bill does not expand or change required coverage for out‑of‑network emergency services, except that cost sharing for covered out‑of‑network emergency services may not be imposed on enrollees/insureds under 21.

Who is affected

  • Primary beneficiaries: enrollees and insured individuals under 21 who have commercial health plan coverage or disability health insurance in California.
  • Payers: Health care service plans (DMHC‑regulated) and disability health insurers (Department of Insurance‑regulated) offering in‑network services.
  • Providers and facilities: encounter restrictions on billing/collection from young patients for in‑network services.
  • State/local agencies: the bill notes criminal penalties can attach to willful Knox‑Keene violations and includes a local program designation; Section 3 states no state reimbursement is required under the State Constitution for local costs tied to changes in criminal law.

Enforcement, fiscal, and procedural notes

  • Violations by health care service plans fall under Knox‑Keene enforcement; the bill creates or modifies offenses for which local agencies may incur costs but declares no state reimbursement is required because costs arise from changes relating to crimes/infractions.
  • Legislative status (as of latest data): Introduced Jan 23, 2025 (author: Assemblymember Bonta); rereferred to the Assembly Committee on Health (most recently re‑referred Mar 5, 2025). Amendments were adopted and the bill was re‑referred to Health Committee on Mar 4, 2025.

Potential impacts (high level)

  • Reduces or eliminates out‑of‑pocket spending at point of care for minors and young adults, likely increasing access to preventive and other in‑network services.
  • Shifts cost exposure to insurers/health plans; could affect premiums, plan design, or network/payment negotiations.
  • Operational impacts for providers and insurers in billing systems to prevent billing under‑21 enrollees for in‑network services.

Compiled from official sources — confirm details with the bill’s official record.

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