Coverage for behavioral health visits.

The document was reformatted from a formal enrolled legislative document (with page numbers, clerk/governor signature lines, and traditional layout) to a web page rendering that includes website navigation elements such as skip-to-content links, search bars, and menu items. No changes to the bill's operative language.

Individual health care service plan contracts and individual health insurance policies are no longer covered. The bill now applies only to large group plans and policies.

Medicare supplement plans are now explicitly excluded from the bill's requirements, alongside dental/vision-only plans and federal Medicare coverage.

Enrollees and insureds must have personally experienced a loss, trauma, or displacement because of the fire to qualify for the 12-visit benefit, not merely reside in an affected county.

New definitions clarify that a 'state of emergency' means a declaration by the Governor under Government Code Section 8625 and a 'local emergency' means one declared under Article 14 (Section 8630) of Chapter 7 of Division 1 of Title 2 of the Government Code.

The term 'behavioral health provider' is redefined from a provider licensed under Division 2 of the Business and Professions Code to any health care provider as defined in Section 1374.72 (Health and Safety Code) or Section 10144.5 (Insurance Code), broadening who qualifies.

The department may issue guidance to health care service plans and insurers until the emergency is terminated, and this guidance is exempt from the Administrative Procedure Act.

A new provision allows a health insurer or provider to seek relief in any court to resolve a payment dispute, and clarifies that providers are not prohibited from using an insurer's existing dispute resolution process.

A new provision states the section shall not be construed to limit the Governor's authority under the California Emergency Services Act or the director's authority under the relevant code chapter.

Notice requirements are expanded to include specific language about the enrollee's existing rights under Section 1374.72 or 10144.5 for medically necessary mental health services without visit limits, and a sample notice form is provided.

Noncontracting providers may only collect from the enrollee the in-network cost sharing amount, making the out-of-network cost protection more explicit.

Removed residual amendment markup: struck-through phrases like 'is lives' corrected to 'lives', duplicate 'cost sharing cost-sharing amount' cleaned to 'cost-sharing amount', and '(CalSTRS) who receive a health care benefit under CalSTRS. System.' simplified to just 'System.'

Removed struck-through language 'without limit on the number of services' in favor of the final wording 'without arbitrary or discriminatory limits on the number of visits' in both the Health and Safety Code and Insurance Code sections.

Added standard enrolled bill elements: Assembly passage date (September 12, 2025), Senate passage date (September 11, 2025), Governor's receipt and approval blocks, and removed line-number annotations and amendment history headers.

Changed applicability from 'individual or group' health care service plan contracts and insurance policies to 'individual or a large group,' excluding small group plans from the mandate.

Extended applicability to health care benefit plans or contracts with the Board of Administration of the Public Employees Retirement System and CalSTRS members receiving health care benefits under CalSTRS.

Added an explicit exclusion for Medi-Cal managed care plans that contract with the State Department of Health Care Services.

Added an exclusion for Medicare supplement insurance policies in the Insurance Code section.

Added a prohibition on utilization review for the 12 annual behavioral health visits, meaning plans cannot use prior authorization or medical necessity reviews to deny or limit access to these services.

Added a requirement that out-of-network behavioral health providers be treated the same as in-network providers for cost sharing purposes: enrollees pay no more than in-network cost sharing, and costs accrue toward the annual deductible regardless of network status.

Added a notice requirement obligating plans and insurers to notify all affected enrollees within 30 days of a wildfire emergency declaration about their rights under this section and their separate rights under existing out-of-network care provisions.

Added a requirement that noncontracting behavioral health providers be paid consistent with chapter requirements, ensuring providers are compensated even if they have no contract with the plan.

Added continuity of care language referencing existing statutory provisions (Section 1373.96 for health care service plans and Section 10133.56 for insurers) to ensure ongoing treatment is not interrupted.

Renumbered the Health and Safety Code section from 1374.726 to 1368.9 and the Insurance Code section from 10144.45 to 10112.97, repositioning the provisions within their respective codes.