§ 10123.211
449 words·~2 min read·
/ca/insurance-code/10123-211A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(1)A health insurance policy that is issued, amended, or renewed on or after July 1, 2025, excluding a specialized health insurance policy, shall provide coverage for emergency room medical care and followup health care treatment for an insured who is treated following a rape or sexual assault, as defined in Sections 261, 261.6, 263, 263.1, 286, 287, and 288.7 of the Penal Code, without imposing cost sharing, including copayments, coinsurance, or deductibles, for the first nine months after the enrollee initiates treatment.
(2)For the purposes of this section, “followup health care treatment” includes medical or surgical services for the diagnosis, prevention, or treatment of medical conditions arising from an instance of rape or sexual assault.
(3)The waiver of the imposition of cost sharing pursuant to paragraph
(1)shall only apply if the enrollee’s treating provider submits all requests for claims payments using accurate diagnosis codes specific to rape or sexual assault.
(b)A health insurer shall not require any of the following to provide coverage under this section:
(1)An insured to file a police report on the rape or sexual assault.
(2)Charges to be brought against an assailant.
(3)An assailant to be convicted of an offense listed in subdivision (a).
(1)This section does not authorize an insured to receive followup health care treatment required to be covered by this section if treatment is furnished by a nonparticipating provider, except as specified in paragraphs
(2)and (3).
(2)A health insurer shall arrange for the provision of followup health care treatment required by this section from providers outside the insurer’s network if those services are unavailable within the network to ensure timely access to covered health care services consistent with Section 10133.54.
(3)A health insurer shall cover followup health care treatment if those services are for emergency services and care as defined in Section 1317.1 of the Health and Safety Code.
(d)For a health insurance policy that meets the definition of a “high deductible health plan” set forth in Section 223(c)(2) of Title 26 of the United States Code, this section shall only apply once an enrollee’s deductible has been satisfied for the year.
(e)“Cost sharing” includes any copayment, coinsurance, or deductible, or any other form of cost sharing paid by the insured other than premium or share of premium.
(f)This section does not apply to specialized health insurance, Medicare supplement insurance, CHAMPUS supplement insurance, or TRI-CARE supplement insurance, or to hospital indemnity, accident-only, or specified disease insurance.
(g)Coverage provided under this section is coverage of sensitive services provided to a protected individual as those terms are defined in Section 791.02 and pursuant to Section 791.29.