(a) A health care service plan shall accept premium payments from the following third-party entities without the need to comply with subdivision (c): (1) A Ryan White HIV/AIDS Program under Title XXVI of the federal Public Health Service Act. (2) An Indian tribe, tribal organization, or urban Indian organization. (3) A local, state, or federal government program, including a grantee directed by a government program to make payments on its behalf. (4) A member of the individualâs family, defined for purposes of this section to include the individualâs spouse, domestic partner, child, parent, grandparent, and siblings, unless the true source of funds used to make the premium payment originates with a financially interested entity. (b) A financially interested entity that is not specified in subdivision (a) and is making third-party premium payments shall comply with all of the following requirements: (1) It shall provide assistance for the full plan year and notify the enrollee prior to an open enrollment period, if applicable, if financial assistance will be discontinued. Notification shall include information regarding alternative coverage options, including, but not limited to, Medicare, Medicaid, individual market plans, and employer plans, if applicable. Assistance may be discontinued at the request of an enrollee who obtains other health coverage, or if the enrollee dies during the plan year. (2) It shall agree not to condition financial assistance on eligibility for, or receipt of, any surgery, transplant, procedure, drug, or device. (3) It shall inform an applicant of financial assistance, and shall inform a recipient annually, of all available health coverage options, including, but not limited to, Medicare, Medicaid, individual market plans, and employer plans, if applicable. (4) It shall agree not to steer, direct, or advise the patient into or away from a specific coverage program option or health care service plan contract. (5) It shall agree that financial assistance shall not be conditioned on the use of a specific facility, health care provider, or coverage type. (6) It shall agree that financial assistance shall be based on financial need in accordance with criteria that are uniformly applied and publicly available. (c) A financially interested entity shall not make a third-party premium payment unless the entity complies with both of the following requirements: (1) Annually provides a statement to the health care service plan that it meets the requirements set forth in subdivision (b), as applicable. (2) Discloses to the health care service plan, prior to making the initial payment, the name of the enrollee for each health care service plan contract on whose behalf a third-party premium payment described in this section will be made. (d) (1) Reimbursement for enrollees for whom a nonprofit financially interested entity described in paragraph (2) of subdivision (h) that was already making premium payments to a health care service plan on the enrolleeâs behalf prior to October 1, 2019, is not subject to subdivisions (e) and (f) and the financially interested entity is not required to comply with the disclosure requirements described in subdivision (c) for those enrollees. (2) Notwithstanding paragraph (1), a financially interested entity shall comply with the disclosure requirements of subdivision (c) for an enrollee on whose behalf the financially interested entity was making premium payments to a health care service plan on the enrolleeâs behalf prior to October 1, 2019, if the enrollee changes health care service plans on or after March 1, 2020. (3) The amount of reimbursement for services paid to a financially interested provider shall be governed by the terms of the enrolleeâs health care service plan contract, except for an enrollee who has changed health care service plans pursuant to paragraph (2), in which case, commencing January 1, 2022, the reimbursement amount shall be determined in accorda
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