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Sensitive Services / Minors' Rights — Consent-based coverage criteria

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This document governs Health Net National procedures for providing sensitive medical services to minors under California Family Code, specifying when minors can consent to care and protections for confidentiality and parental liability. It affects providers delivering care to members who are minors in California.

Policy Summary

Payerhealthnetnational

PolicySensitive Services / Minors' Rights — Consent-based coverage criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionDocument that the minor meets statutory criteria for consent and that the provided care relates to pregnancy/family planning, reportable communicable disease/related STI, or qualifying medical/dental care.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12minimum age for STI-related consent

15age for consent when living apart

6925/6926/6922referenced Code sections

Coverage Criteria for Minors' Sensitive Services

Policy Summary

Payerhealthnetnational

PolicySensitive Services / Minors' Rights — Consent-based coverage criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

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On This Page

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CurrenthealthnetnationalPolicy N/A

Sensitive Services / Minors' Rights — Consent-based coverage criteria

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Policy Summary

Payerhealthnetnational

PolicySensitive Services / Minors' Rights — Consent-based coverage criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12minimum age for STI-related consent

15age for consent when living apart

6925/6926/6922referenced Code sections

Coverage Criteria for Minors' Sensitive Services

Policy Summary

Payerhealthnetnational

PolicySensitive Services / Minors' Rights — Consent-based coverage criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

SourceLink

On This Page

Consent-based coverage criteria

Covered when statutory conditions in California Family Code are met.

Pregnancy-related and family planning services: Parental consent is not required for members under age 18 to access pregnancy-related services, including family planning (Cal. Fam. Code §6925)age <18

Communicable disease/STI care: A minor 12 years of age or older who may have been exposed to an infectious, contagious, or communicable disease may consent to diagnosis or treatment when the condition is reportable to the local health officer or is a related sexually transmitted disease (Cal. Fam. Code §6926). Parents/guardian are not liable for payment for care provided under this section.age >=12

Parents/guardian not liable for payment

Separate-living financial independence consent: A minor 15 years of age or older who is living separate and apart from parents/guardian and is managing the minor's own financial affairs may consent to medical or dental care (Cal. Fam. Code §6922). Parents/guardian are not liable for payment for care provided under this section.age >=15 + living apart + managing finances

Confidentiality safeguards: Providers must take special precautions to protect communication regarding the minor's medical information related to sensitive services (e.g., do not send letters or make phone calls to the home without the minor's authorization).

Physician or dentist may inform parent/guardian of treatment if they have reason to know the parent's whereabouts based on information from the minor (Cal. Fam. Code §6922)

No parental notification or consent is required for the specified sensitive services when statutory conditions in the California Family Code are met. This includes pregnancy-related services and family planning for minors under age 18 (Cal. Fam. Code §6925), diagnosis or treatment of reportable infectious, contagious, or communicable diseases and related STIs for minors age 12 and older (Cal. Fam. Code §6926), and medical or dental care for minors age 15 and older who live separate from their parents/guardian and manage their own finances (Cal. Fam. Code §6922).

Physicians should document that the minor meets the applicable statutory criteria for consent (for example, age thresholds, living situation, and financial independence where relevant). Although parental consent or notification is not required, a physician or dentist may inform a parent or guardian of treatment if the clinician reasonably knows the parent or guardian's whereabouts based on information provided by the minor.

Provider Actions, Documentation, and Risk

Prior Authorization

No prior authorization for minors' consented sensitive services

Health Net does not require prior authorization for services provided when a minor consents under the cited California Family Code provisions (e.g., pregnancy-related care, family planning, reportable communicable disease/STI care, or qualifying care for minors living apart and managing finances).

Step Therapy

No step therapy for minors' consented services

No step therapy protocols or medication/failure‑first requirements are specified for services accessed under minors' consent in this procedure. Provide the covered service when statutory consent criteria are met without imposing step therapy.

Documentation Required

Document minor's statutory eligibility and that care aligns with Family Code

Document in the medical record that the minor meets the statutory criteria authorizing self-consent and that the care provided falls within those provisions (pregnancy/family planning; diagnosis/treatment of reportable infectious/communicable diseases or related STIs; or medical/dental care for minors ≥15 living separate and managing finances).

Record the minor's age and which Family Code section authorizes consent (e.g., §6925, §6926, §6922).
If applicable, document living situation and evidence the minor manages their own financial affairs for §6922 cases.
Note that parents/guardians are not liable for payment when consent is under §6926 or §6922, per the statute.

Denial Risk

Denial risk if minors' consent rights under Family Code are not honored

Claims or services may be denied if the provider fails to honor minors' statutory right to consent under California Family Code — including pregnancy-related and family planning care (§6925), diagnosis/treatment of reportable communicable diseases or related STIs for minors ≥12 (§6926), and qualifying medical/dental care for minors ≥15 living apart and managing finances (§6922).

Ensure services authorized by the Family Code are not withheld or conditioned on parental notification/consent.
Take special precautions to protect minor's confidential communications (do not send correspondence to the home without minor authorization).

Background and Legal Basis

California Family Code permits minors to consent to certain sensitive services without parental involvement. Specifically, minors under 18 may access pregnancy-related care and family planning without parental consent (Cal. Fam. Code §6925). A minor 12 years or older may consent to diagnosis or treatment for infectious, contagious, or communicable diseases that are reportable, including related sexually transmitted diseases, and the minor's parents or guardian are not liable for payment for that care (Cal. Fam. Code §6926). Additionally, a minor 15 years or older who is living separate from parents/guardian and is managing their own financial affairs may consent to medical or dental care (Cal. Fam. Code §6922).

The policy requires special precautions to protect confidentiality for communications about sensitive services (for example, do not send letters or make phone calls to the minor's home without the minor's authorization).

Definitions and Age Thresholds

inv-08: Sensitive services — Services including pregnancy-related care, family planning, diagnosis or treatment of reportable communicable diseases and related sexual health services

DefinitionServices including pregnancy-related care, family planning, diagnosis or treatment of reportable communicable diseases and related sexually transmitted diseases, and certain medical or dental care when statutory criteria are met.

Covered age for pregnancy/family planningParental consent is not required for members under the age of 18 to access pregnancy-related services, including family planning (Cal. Fam. Code §6925).

Confidentiality requirementSpecial precautions must be taken to protect communication regarding a minor's medical information for sensitive services (e.g., do not direct letters or phone calls to the home without the minor's authorization).

Parent/guardian liabilityParents or guardians are not liable for payment for medical care provided under the statutes for reportable communicable diseases or for medical/dental care when statutory consent criteria are met.

inv-09: Minor consenting under Family Code §6926 — A minor age 12 or older may consent to care for infectious or communicable diseases required to be reported, including related STIs.

StatuteCalifornia Family Code §6926

Age thresholdA minor 12 years of age or older may consent to medical care related to diagnosis or treatment of an infectious, contagious, or communicable disease that is required to be reported to the local health officer, or a related sexually transmitted disease.

Payment liabilityThe minor's parents or guardian are not liable for payment for medical care provided pursuant to this section.

ScopeApplies when the disease or condition is one required by law or regulation to be reported, or is a related sexually transmitted disease as determined by the State Public Health Officer.

inv-10: Minor consenting under Family Code §6922 — A minor 15 or older who lives separately from parents/guardian and manages own finances may consent to medical or dental care.

StatuteCalifornia Family Code §6922

Age and living requirementA minor 15 years of age or older who is living separate and apart from the minor's parents or guardian may consent to the minor's medical or dental care.

Financial requirementThe minor must be managing the minor's own financial affairs, regardless of the source of income.

Parent/guardian liabilityParents or guardian are not liable for medical or dental care provided pursuant to this section.

Physician notificationA physician or dentist may, with or without the minor's consent, advise the minor's parent or guardian of the treatment given or needed if the clinician has reason to know the parent's whereabouts based on information from the minor.