Cal. HSC § 1371.11 — California Code / Code hsc / Division 2 / Chapter 2.2 / Article 5 / Section 1371.11
Section 1371.11
Status: in_force

(a) The following definitions shall apply for purposes of this section:

(1) (A) “Affirmative consent” means a dental provider’s express consent to opt in or opt out of receiving fee-based payment. Affirmative consent requires a dental provider’s signature. The terms of the affirmative consent shall be clear and readily understandable.

(B) Affirmative consent may be given through email.

(C) A provider accessing funds does not constitute affirmative consent to receive a fee-based payment.

(2) “Contracted vendor” means a third party facilitating payment processing on behalf of the health care service plan.

(3) “Dental provider” means an individual or group of individuals licensed under Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code.

(4) “Fee-based payment” refers to any payment type that requires the dental provider to incur a fee from the health care service plan or its contracted vendor to access payment from a plan or its contracted vendor.

(5) “Health care service plan” or “plan” means a health care service plan defined in paragraph (2) of subdivision (a) of Section 1374.194.

(6) “Signature” includes an electronic or digital signature if the form of the signature is recognized as a valid signature under applicable federal or state law, including, but not limited to, checking a box indicating affirmative consent.

(b) (1) A health care service plan that provides payment directly, or through a contracted vendor, to a dental provider shall have a non-fee-based default method of payment.

(2) The health care service plan shall remit or associate with each payment the claims and claim details associated with payment.

(c) (1) A health care service plan or its contracted vendor shall obtain affirmative consent from a dental provider who opts in to a fee-based payment method before the plan or vendor provides a fee-based payment method to the provider.

(2) At the time a dental provider opts in to a fee-based payment method, the health care service plan or its contracted vendor shall provide information on the payment method, including a notice of the fees charged by the plan or contracted vendor, alternative methods of payment, instructions on how to opt out of the fee-based payment method, and a notice of the dental provider’s ability to opt out of the fee-based payment method at any time.

(3) Upon receipt of the dental provider’s affirmative consent, the health care service plan or its contracted vendor subsequently may issue payments to the dental provider using a fee-based payment method.

(4) The health care service plan also shall notify the dental provider if its contracted vendor is sharing a part of the profit, fee arrangement, or board composition with the plan.

(d) (1) A dental provider may opt out of a fee-based payment method and opt in to a non-fee-based payment method at any time by providing affirmative consent to the health care service plan or its contracted vendor.

(2) If a dental provider opts in or opts out of a fee-based method of payment pursuant to this subdivision, the provider’s payment method decision shall remain in effect until the provider informs the plan or contracted vendor of another preferred method of payment, including fee-based or non-fee-based methods.

(e) A health care service plan or its contracted vendor that obtains a dental provider’s affirmative consent to opt in or opt out of a fee-based payment method shall apply the decision to include both of the following:

(1) The dental provider’s entire practice.

(2) To all products or services covered by the health care service plan pursuant to a contract with the dental provider, including network provider contracts, as described in Section 1374.193.

(f) This section does not apply if a health care service plan has a direct contract with a provider that allows the provider to choose payment methods, including a non-fee-based payment method for services rendered.

(g) This section does not change, alter, or extend the scope of Section 1367.

(h) This section shall become operative on April 1, 2026, and apply to all health care service plan contracts issued, amended, or renewed on or after that date.