SB 363CALIFORNIASession 20252026

High Impact

California SB 363 requires health insurers to report denial rates and imposes penalties for high overturn rates

Original title: Health care coverage: independent medical review.

August 13, 2026

Healthcare Insurance Consumer Protection Medical Review Administrative Penalties Healthcarecoverage independentmedicalreview

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The Frame

What this does

This bill creates a new financial accountability mechanism for health plans that frequently deny care, potentially reducing the number of improper treatment denials for California patients.

Who is mentioned in the record

Potentially affected actors named in the source documents. Mention is not a position.

Health care service plans

They must report denial data and are subject to administrative penalties and potential criminal liability for willful violations.

Health insurers

They must report denial data and are subject to administrative penalties if their denial overturn rates exceed the specified threshold.

Enrollees and insured individuals

They may experience changes in how their health plans handle treatment denials and grievances due to the new oversight and penalty structure.

What changed

Last recorded activity August 13, 2026.

What's next

Introduced.

Summary

SB 363 requires health care service plans and insurers to annually report their treatment denial and modification data to state regulators starting June 1, 2026. Plans and insurers will face administrative penalties if more than 50% of s in specific care categories are overturned or reversed.

Key Facts

You don't have to trust us. Each fact below is taken straight from the official document - click any one to see the exact passage, highlighted in the original.

Why It Matters

This bill creates a new financial accountability mechanism for health plans that frequently deny care, potentially reducing the number of improper treatment denials for California patients.

Frequently Asked Questions

What happens if my health plan denies my treatment?

You can seek an if your plan denies, modifies, or delays a service after you have filed a grievance that remains unresolved for 30 days.

When do these new reporting requirements start?

Health plans and insurers must begin reporting their annual claim and denial data on or before June 1, 2026.

Will my health plan be penalized for every denial?

No. Penalties only apply if a plan has 10 or more s in a year and more than 50% of those reviews in a specific category result in an overturn or reversal of the plan's decision.

News Coverage

No news coverage found yet. Articles are indexed twice daily.

Lobbying Activity

CURE SMA

$75,000

View filing →

Connected Entities

organizationDepartment of Managed Health Care“Regulates health care service plans”Map →

otherHealth Insurance Independent Medical Review Administrative Penalties Fund“New fund for penalties collected from health insurers”Map →

otherKnox-Keene Health Care Service Plan Act of 1975“Existing law governing health care service plans”Map →

otherManaged Care Independent Medical Review Administrative Penalties Subaccount“New fund for penalties collected from health care service plans”Map →

organizationDepartment of Insurance“Regulates health insurers”Map →

Sources

Open source document

openstates.org

Analysis Score

0–100

Significance85
How much this matters to a regular citizen
Controversy60
Intensity of disagreement among stakeholders
Entertainment10
Compellingness for a non-policy-wonk reader
Buzz30
Current news / social attention level

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