On September 29, 2024, California Governor Gavin Newsom approved Assembly Bill 2843 (AB 2843), which requires fully insured group health plans to provide comprehensive coverage for individuals receiving medical care following incidents of rape or sexual assault.
Effective Date
AB 2843 will apply to fully insured health plans issued, amended, renewed, or delivered in California on or after July 1, 2025.
Required Coverage
Under AB 2843, fully insured group health plans in California must provide comprehensive coverage for individuals receiving medical care following an incident of rape or sexual assault. This includes both emergency medical care and follow up treatment. Details include the following:
- Follow up care includes medical or surgical services for the diagnosis, prevention, or treatment of health conditions arising from the incident.
- Coverage must be provided without cost-sharing (no deductibles, copayments, or coinsurance) for both emergency medical care and follow up care for up to nine months after the initial treatment begins.
- No cost-sharing follow up care is required only when delivered by in-network providers, unless one of the following exceptions applies: (1) Timely access to covered health care services is unavailable within the plan’s network, or (2) The services qualify as “emergency services and care.”
Emergency services and care include:
- A medical screening, examination, and evaluation by a physician (or another appropriately licensed provider under physician supervision), to determine whether an emergency medical condition or active labor exists.
- Treatment, surgery and other medically necessary services to relieve or eliminate the emergency condition, delivered within the capability of the facility.
- Additional psychiatric screening and evaluation by a physician (or other qualified personnel) to determine if a psychiatric emergency exists.
- Care and treatment needed to stabilize or resolve the psychiatric emergency condition, also within the treating facility’s capabilities.
The law also prohibits plans from requiring any of the following to receive coverage:
- Filing a police report on the rape or sexual assault;
- Charges to be brought against an assailant; or
- An assailant to be convicted of an offense.
For High Deductible Health Plans (HDHPs), the no cost-sharing provision applies only after the plan deductible has been satisfied, to remain compliant with HSA eligibility rules.
Exceptions
Generally, AB 2843 applies to all (small and large group) fully insured plans written out of California (i.e., subject to California insurance law). There is no small group plan exception. The law would not apply to level funded and self-insured plans, as these plans are not subject to state insurance regulations.
AB 2843 explicitly states it does not apply to specialized health insurance, Medicare supplement insurance, CHAMPUS supplement insurance, or TRI-CARE supplement insurance, hospital indemnity, accident-only or specified disease insurance.
Impact on Employers
Employers with fully insured group health plans, regardless of size, written out of California should expect policies renewed after July 1, 2025, to incorporate the provisions of AB 2843.
Additional Resources
Connect with a Sequoia consultant to learn how Sequoia’s compliance services are integrated in our benefits services and tailored solutions. And if you’re already a Sequoia client, stay on top of your employer obligations with your Compliance Checklist that highlights important compliance dates, action items, and resources.
