California PHC

Assembly Bill (AB) 2843 is a significant legislative measure aimed at enhancing support for survivors of rape and sexual assault. This bill introduces critical changes to health care coverage requirements, directly impacting the services you provide.

PHC California in accordance with AB 2843 requirements, ensures coverage is provided for emergency room medical care and follow-up health care treatment for enrollees who are treated following a rape or sexual assault without imposing cost sharing for the first nine months after the enrollee initiates treatment.

Other key provisions of AB 2843:

• • “follow-up health care treatment” is defined to include medical or surgical services necessary for the diagnosis, prevention, or treatment of medical conditions arising from an instance of rape or sexual assault.

  • To facilitate the waiver of cost sharing, treating providers must submit all claims using accurate diagnosis codes specific to rape or sexual assault.

  • The Health Plan does not require any of the following to provide the required coverage:
    1.) An enrollee 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 rape or sexual assault.

  • The Health Plan arranges and provides coverage for the provision of follow-up health care treatment from providers outside the plan’s network if those services are unavailable within the network to ensure timely access to covered health care services, consistent with HSC §1367.03.

  • The Health Plan covers follow-up health care treatment furnished by a non-participating provider if those services are for emergency services and care as defined in HSC §1317.1.

  • The Health Plan treats the required coverage as coverage of sensitive services provided to a protected individual as defined in California Civil Code section §56.05 and §56.107. 

If you have any questions please contact Provider Relations by email at [email protected] or by phone at (888) 726-5411, Monday through Friday, 8:30 a.m. – 5:30 p.m.