California § 1374.65. 1374.65. (Added by Stats. 1993, Ch. 987, Sec. 3.)

California Statutes

§ 1374.65. — 1374.65. (Added by Stats. 1993, Ch. 987, Sec. 3.)

California·Code HSC Health and Safety Code - HSC·Div. 2. DIVISION 2. LICENSING PROVISIONS·Ch. 2.2. CHAPTER 2.2. Health Care Service Plans·Art. 5.6. ARTICLE 5.6. Point-of-Service Health Care Service Plan Contracts

Point-of-service plan contracts shall:

(a)Provide incentives, including financial incentives, for enrollees to use in-network coverage or services.

(b)Only offer coverage or services obtained out-of-network if it also provides coverage or services on an in-network basis.

(c)Shall not consider the following to be out-of-network coverage or services:

(1)Health care services received from a provider not affiliated with the health care service plan when the plan arranges for the enrollee to receive services from that provider.

(2)Out-of-area emergency care provided in accordance with the procedures set by the health care service plan to be followed in securing these services.

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Point-of-service plan contracts shall:
(a)
Provide incentives, including financial incentives, for enrollees to use in-network coverage or services.
(b)
Only offer coverage or services obtained out-of-network if it also provides coverage or services on an in-network basis.
(c)
Shall not consider the following to be out-of-network coverage or services:
(1)
Health care services received from a provider not affiliated with the health care service plan when the plan arranges for the enrollee to receive services from that provider.
(2)
Out-of-area emergency care provided in accordance with the procedures set by the health care service plan to be followed in securing these services.

California § 1374.65. (1374.65. (Added by Stats. 1993, Ch. 987, Sec. 3.)) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.