[UCRDBR] Anthem Blue Cross PPO Plans - California Assembly Bill 3059

[Departmental Benefits Representatives]

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June 2, 2025

To:
Department Benefits Representatives (DBRs)
From:
Central HR Benefits Office on behalf of UC Office of the President
Re:
Anthem Blue Cross PPO Plans - California Assembly Bill 3059

DBRs, please share this information via your internal listserv.  Do not reply to this email.  Please
send a separate email with questions to benefits at ucr.edu<mailto:benefits at ucr.edu>.

This update provides additional guidance on California Assembly Bill 3059 (Coverage: Human Milk).  According to Anthem, human donor milk is already a covered medical benefit under the UC PPO plans.  As a result, the benefit coding configuration currently being developed is primarily for informational purposes, designed to track this mandate.


  *   The benefit coding development is expected to be completed by mid-July 2025, with the earliest estimated implementation date for this mandate set for August 1, 2025.
  *   The most notable change introduced by this mandate is the removal of a regulatory barrier that previously required hospitals to hold a tissue bank license in order to distribute donor milk.
  *   Although the PPO plan booklets do not currently contain specific language regarding human donor milk, standard language will be added accordingly.

It is important to note that human donor milk coverage remains subject to medical necessity and follows the general basis of payment according to plan.  If a claim were submitted today using Current Procedural Terminology (CPT) code T2101, the following member cost shares would apply:


  *   UC Care
     *   Tier 1: Covered in full
     *   Tier 2: 30% coinsurance
     *   Out-of-Network (OON): 50% coinsurance


  *   CORE
     *   In-Network (INN) & Out-of-Network (OON): 20% coinsurance


  *   HSP
     *   In-Network (INN): 20% coinsurance
     *   Out-of-Network (OON): 40% coinsurance

UCOP will continue to provide updates on California Assembly Bill 3059, and other Assembly Bills, as necessary.

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