California Laws: Health and Safety Code Sections 1367-1374.17
- California Laws: Health and Safety Code Section 1367
A health care service plan and, if applicable, a specialized health care service plan shall meet the following requirements: (a) Facilities located in this state...
- California Laws: Health and Safety Code Section 1367.01
(a) A health care service plan and any entity with which it contracts for services that include utilization review or utilization management functions, that prospectively,...
- California Laws: Health and Safety Code Section 1367.01
(a) A health care service plan and any entity with which it contracts for services that include utilization review or utilization management functions, that prospectively,...
- California Laws: Health and Safety Code Section 1367.02
(a) On or before July 1, 1999, for purposes of public disclosure, every health care service plan shall file with the department a description of...
- California Laws: Health and Safety Code Section 1367.03
(a) Not later than January 1, 2004, the department shall develop and adopt regulations to ensure that enrollees have access to needed health care services...
- California Laws: Health and Safety Code Section 1367.04
(a) Not later than January 1, 2006, the department shall develop and adopt regulations establishing standards and requirements to provide health care service plan enrollees...
- California Laws: Health and Safety Code Section 1367.05
(a) Nothing in this chapter shall prohibit a health care service plan from entering into a contract with a dental college approved by the Board...
- California Laws: Health and Safety Code Section 1367.06
(a) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after...
- California Laws: Health and Safety Code Section 1367.07
Within one year after a health care service plan's assessment pursuant to subdivision (b) of Section 1367.06, the health care service plan shall report to...
- California Laws: Health and Safety Code Section 1367.09
(a) An enrollee with coverage for Medicare benefits who is discharged from an acute care hospital shall be allowed to return to a skilled nursing...
- California Laws: Health and Safety Code Section 1367.1
Subdivision (i) of Section 1367 shall apply to transitionally licensed plans only insofar as it relates to contracts entered into, amended, delivered, or renewed in...
- California Laws: Health and Safety Code Section 1367.2
(a) On and after January 1, 1990, every health care service plan that covers hospital, medical, or surgical expenses on a group basis shall offer...
- California Laws: Health and Safety Code Section 1367.3
(a) On and after January 1, 1993, every health care service plan that covers hospital, medical, or surgical expenses on a group basis shall offer...
- California Laws: Health and Safety Code Section 1367.35
(a) On and after January 1, 1993, every health care service plan that covers hospital, medical, or surgical expenses on a group basis shall provide...
- California Laws: Health and Safety Code Section 1367.36
(a) A risk-based contract between a health care service plan and a physician or physician group that is issued, amended, delivered, or renewed in this...
- California Laws: Health and Safety Code Section 1367.4
No plan issuing, providing, or administering any contract of individual or group coverage providing medical, surgical, or dental expense benefits applied for and issued on...
- California Laws: Health and Safety Code Section 1367.45
(a) Every individual or group health care service plan contract that is issued, amended, or renewed on or after January 1, 2002, that covers hospital,...
- California Laws: Health and Safety Code Section 1367.5
No health care service plan contract that is issued, amended, renewed, or delivered on and after January 1, 2002, shall contain a provision that prohibits...
- California Laws: Health and Safety Code Section 1367.51
(a) Every health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after...
- California Laws: Health and Safety Code Section 1367.54
Every group health care service plan contract that provides maternity benefits, except for a specialized health care service plan contract, that is issued, amended, renewed,...
- California Laws: Health and Safety Code Section 1367.6
(a) Every health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after...
- California Laws: Health and Safety Code Section 1367.61
Every health care service plan contract which provides for the surgical procedure known as a laryngectomy and which is issued, amended, delivered, or renewed in...
- California Laws: Health and Safety Code Section 1367.62
(a) No health care service plan contract that is issued, amended, renewed, or delivered on or after the effective date of the act adding this...
- California Laws: Health and Safety Code Section 1367.63
(a) Every health care service plan contract, except a specialized health care service plan contract, that is issued, amended, renewed, or delivered in this state...
- California Laws: Health and Safety Code Section 1367.635
(a) Every health care service plan contract that is issued, amended, renewed, or delivered on or after January 1, 1999, that provides coverage for surgical...
- California Laws: Health and Safety Code Section 1367.64
(a) Every individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, or renewed...
- California Laws: Health and Safety Code Section 1367.65
(a) On or after January 1, 2000, every health care service plan contract, except a specialized health care service plan contract, that is issued, amended,...
- California Laws: Health and Safety Code Section 1367.66
Every individual or group health care service plan contract, except for a specialized health care service plan, that is issued, amended, or renewed, on or...
- California Laws: Health and Safety Code Section 1367.665
Every individual or group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, delivered, or renewed...
- California Laws: Health and Safety Code Section 1367.67
Every health care service plan contract that provides hospital, medical, or surgical coverage, that is issued, amended, delivered, or renewed in this state on or...
- California Laws: Health and Safety Code Section 1367.68
(a) Any provision in a health care service plan contract entered into, amended, or renewed in this state on or after July 1, 1995, that...
- California Laws: Health and Safety Code Section 1367.69
(a) On or after January 1, 1995, every health care service plan contract that provides hospital, medical, or surgical coverage, that is issued, amended, delivered,...
- California Laws: Health and Safety Code Section 1367.695
(a) The Legislature finds and declares that the unique, private, and personal relationship between women patients and their obstetricians and gynecologists warrants direct access to...
- California Laws: Health and Safety Code Section 1367.7
On and after January 1, 1980, every health care service plan contract that covers hospital, medical, or surgical expenses on a group basis, and which...
- California Laws: Health and Safety Code Section 1367.71
(a) Every health care service plan contract, other than a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or...
- California Laws: Health and Safety Code Section 1367.8
No plan issuing, providing, or administering any individual or group health care service plan entered into, amended, or issued on or after January 1, 1981,...
- California Laws: Health and Safety Code Section 1367.9
No health care service plan contract which covers hospital, medical, or surgical expenses shall be issued, amended, delivered, or renewed in this state on or...
- California Laws: Health and Safety Code Section 1367.10
(a) Every health care service plan shall include within its disclosure form and within its evidence of coverage a statement clearly describing how participation in...
- California Laws: Health and Safety Code Section 1367.11
(a) Every health care service plan issued, amended, or renewed on or after January 1, 1987, that offers coverage for medical transportation services, shall contain...
- California Laws: Health and Safety Code Section 1367.12
No health care service plan that administers Medicare coverage and federal employee programs may require that more than one form be submitted per claim in...
- California Laws: Health and Safety Code Section 1367.15
(a) This section shall apply to individual health care service plan contracts and plan contracts sold to employer groups with fewer than two eligible employees...
- California Laws: Health and Safety Code Section 1367.18
(a) Every health care service plan, except a specialized health care service plan, that covers hospital, medical, or surgical expenses on a group basis shall...
- California Laws: Health and Safety Code Section 1367.19
On and after January 1, 1991, every health care service plan, except a specialized health care service plan, that covers hospital, medical, or surgical expenses...
- California Laws: Health and Safety Code Section 1367.20
Every health care service plan that provides prescription drug benefits and maintains one or more drug formularies shall provide to members of the public, upon...
- California Laws: Health and Safety Code Section 1367.20
Every health care service plan that provides prescription drug benefits and maintains one or more drug formularies shall provide to members of the public, upon...
- California Laws: Health and Safety Code Section 1367.21
(a) No health care service plan contract which covers prescription drug benefits shall be issued, amended, delivered, or renewed in this state if the plan...
- California Laws: Health and Safety Code Section 1367.215
(a) Every health care service plan contract that covers prescription drug benefits shall provide coverage for appropriately prescribed pain management medications for terminally ill patients...
- California Laws: Health and Safety Code Section 1367.22
(a) A health care service plan contract, issued, amended, or renewed on or after July 1, 1999, that covers prescription drug benefits shall not limit...
- California Laws: Health and Safety Code Section 1367.23
(a) On and after January 1, 1994, every group health care service plan contract, which is issued, amended, or renewed, shall include a provision requiring...
- California Laws: Health and Safety Code Section 1367.24
(a) Every health care service plan that provides prescription drug benefits shall maintain an expeditious process by which prescribing providers may obtain authorization for a...
- California Laws: Health and Safety Code Section 1367.25
(a) Every group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on...
- California Laws: Health and Safety Code Section 1367.26
(a) A health care service plan shall provide, upon request, a list of the following contracting providers, within the enrollee's or prospective enrollee's general geographic...
- California Laws: Health and Safety Code Section 1368
(a) Every plan shall do all of the following: (1) Establish and maintain a grievance system approved by the department under which enrollees may submit...
- California Laws: Health and Safety Code Section 1368.01
(a) The grievance system shall require the plan to resolve grievances within 30 days. (b) The grievance system shall include a requirement for expedited plan...
- California Laws: Health and Safety Code Section 1368.015
(a) Effective July 1, 2003, every plan with a Web site shall provide an online form through its Web site that subscribers or enrollees can...
- California Laws: Health and Safety Code Section 1368.02
(a) The director shall establish and maintain a toll-free telephone number for the purpose of receiving complaints regarding health care service plans regulated by the...
- California Laws: Health and Safety Code Section 1368.03
(a) The department may require enrollees and subscribers to participate in a plan's grievance process for up to 30 days before pursuing a grievance through...
- California Laws: Health and Safety Code Section 1368.04
(a) The director shall investigate and take enforcement action against plans regarding grievances reviewed and found by the department to involve noncompliance with the requirements...
- California Laws: Health and Safety Code Section 1368.1
(a) A plan that denies coverage to an enrollee with a terminal illness, which for the purposes of this section refers to an incurable or...
- California Laws: Health and Safety Code Section 1368.2
(a) On and after January 1, 2002, every group health care service plan contract, except a specialized health care service plan contract, which is issued,...
- California Laws: Health and Safety Code Section 1368.5
(a) Every health care service plan that offers coverage for a service that is within the scope of practice of a duly licensed pharmacist may...
- California Laws: Health and Safety Code Section 1369
Every plan shall establish procedures to permit subscribers and enrollees to participate in establishing the public policy of the plan. For purposes of this section,...
- California Laws: Health and Safety Code Section 1370
Every plan shall establish procedures in accordance with department regulations for continuously reviewing the quality of care, performance of medical personnel, utilization of services and...
- California Laws: Health and Safety Code Section 1370.1
Nothing in this article shall be construed to prevent a plan from utilizing subcommittees to participate in peer review activities, nor to prevent a plan...
- California Laws: Health and Safety Code Section 1370.2
Upon an appeal to the plan of a contested claim, the plan shall refer the claim to the medical director or other appropriately licensed health...
- California Laws: Health and Safety Code Section 1370.4
(a) Every health care service plan shall provide an external, independent review process to examine the plan's coverage decisions regarding experimental or investigational therapies for...
- California Laws: Health and Safety Code Section 1370.6
(a) For an enrollee diagnosed with cancer and accepted into a phase I, phase II, phase III, or phase IV clinical trial for cancer, every...
- California Laws: Health and Safety Code Section 1371
A health care service plan, including a specialized health care service plan, shall reimburse claims or any portion of any claim, whether in state or...
- California Laws: Health and Safety Code Section 1371.1
Whenever a health care service plan , including a specialized health care service plan, determines that in reimbursing a claim for provider services an institutional...
- California Laws: Health and Safety Code Section 1371.2
No health care service plan, including a specialized health care service plan, shall request reimbursement for overpayment or reduce the level of payment to a...
- California Laws: Health and Safety Code Section 1371.22
If a contract between a health care service plan and a provider requires that the provider accept, as payment from the plan, the lowest payment...
- California Laws: Health and Safety Code Section 1371.25
A plan, any entity contracting with a plan, and providers are each responsible for their own acts or omissions, and are not liable for the...
- California Laws: Health and Safety Code Section 1371.3
On and after January 1, 1994, every group health care service plan that provides hospital, medical, or surgical expense benefits for plan members and their...
- California Laws: Health and Safety Code Section 1371.35
(a) A health care service plan, including a specialized health care service plan, shall reimburse each complete claim, or portion thereof, whether in state or...
- California Laws: Health and Safety Code Section 1371.36
(a) A health care service plan shall not deny payment of a claim on the basis that the plan, medical group, independent practice association, or...
- California Laws: Health and Safety Code Section 1371.36
(a) A health care service plan shall not deny payment of a claim on the basis that the plan, medical group, independent practice association, or...
- California Laws: Health and Safety Code Section 1371.37
(a) A health care service plan is prohibited from engaging in an unfair payment pattern, as defined in this section. (b) Consistent with subdivision (a)...
- California Laws: Health and Safety Code Section 1371.37
(a) A health care service plan is prohibited from engaging in an unfair payment pattern, as defined in this section. (b) Consistent with subdivision (a)...
- California Laws: Health and Safety Code Section 1371.38
(a) The department shall, on or before July 1, 2001, adopt regulations that ensure that plans have adopted a dispute resolution mechanism pursuant to subdivision...
- California Laws: Health and Safety Code Section 1371.38
(a) The department shall, on or before July 1, 2001, adopt regulations that ensure that plans have adopted a dispute resolution mechanism pursuant to subdivision...
- California Laws: Health and Safety Code Section 1371.39
(a) Providers may report to the department's Office of Plan and Provider Relations, either through the toll-free provider line (877-525-1295) or e-mail address (plans-providers@dmhc.ca.gov), instances...
- California Laws: Health and Safety Code Section 1371.39
(a) Providers may report to the department's Office of Plan and Provider Relations, either through the toll-free provider line (877-525-1295) or e-mail address (plans-providers@dmhc.ca.gov), instances...
- California Laws: Health and Safety Code Section 1371.4
(a) A health care service plan, or its contracting medical providers, shall provide 24-hour access for enrollees and providers to obtain timely authorization for medically...
- California Laws: Health and Safety Code Section 1371.5
(a) No health care service plan that provides basic health care services shall require prior authorization or refuse to pay for any ambulance or ambulance...
- California Laws: Health and Safety Code Section 1371.8
A health care service plan that authorizes a specific type of treatment by a provider shall not rescind or modify this authorization after the provider...
- California Laws: Health and Safety Code Section 1372
Subject to the applicable provisions of this chapter, a plan may offer one or more plan contracts or specialized health care service plan contracts, except...
- California Laws: Health and Safety Code Section 1373
(a) A plan contract may not provide an exception for other coverage if the other coverage is entitlement to Medi-Cal benefits under Chapter 7 (commencing...
- California Laws: Health and Safety Code Section 1373.1
Every group plan entered into, amended, or renewed on or after January 1, 1977, which provides hospital, medical, or surgical expense benefits for employees or...
- California Laws: Health and Safety Code Section 1373.2
Every group health care service plan entered into, amended, or renewed on or after January 1, 1976, which provides hospital, medical, or surgical expense benefits...
- California Laws: Health and Safety Code Section 1373.3
An enrollee shall not be prohibited from selecting as a primary care physician any available primary care physician who contracts with the plan in the...
- California Laws: Health and Safety Code Section 1373.4
(a) No health care service plan contract that is issued, amended, renewed, or delivered on or after July 1, 2003, that provides maternity coverage shall...
- California Laws: Health and Safety Code Section 1373.5
When a husband and wife are both employed as employees, and both have enrolled themselves and their eligible family members under a group health care...
- California Laws: Health and Safety Code Section 1373.6
This section does not apply to a specialized health care service plan contract or to a plan contract that primarily or solely supplements Medicare. The...
- California Laws: Health and Safety Code Section 1373.62
(a) (1) This section shall apply only to a health care service plan offering hospital, medical, or surgical benefits in the individual market in California...
- California Laws: Health and Safety Code Section 1373.621
(a) Except for a specialized health care service plan, every health care service plan contract that is issued, amended, delivered, or renewed in this state...
- California Laws: Health and Safety Code Section 1373.622
(a) After the termination of the pilot program under Section 1373.62, a health care service plan shall continue to provide coverage under the same terms...
- California Laws: Health and Safety Code Section 1373.65
(a) At least 75 days prior to the termination date of its contract with a provider group or a general acute care hospital, the health...
- California Laws: Health and Safety Code Section 1373.7
A health care service plan contract, which is written or issued for delivery outside of California and which provides benefits for California residents that are...
- California Laws: Health and Safety Code Section 1373.8
A health care service plan contract where the plan is licensed to do business in this state and the plan provides coverage that includes California...
- California Laws: Health and Safety Code Section 1373.9
(a) Except in the case of a specialized health care service plan, a health care service plan which negotiates and enters into a contract with...
- California Laws: Health and Safety Code Section 1373.10
(a) On and after January 1, 1985, every health care service plan, that is not a health maintenance organization or is not a plan that...
- California Laws: Health and Safety Code Section 1373.11
A health care service plan that offers or provides one or more podiatry services, as defined in Section 2472 of the Business and Professions Code,...
- California Laws: Health and Safety Code Section 1373.12
A health care service plan which offers or provides one or more chiropractic services, as defined in Section 7 of the Chiropractic Initiative Act, as...
- California Laws: Health and Safety Code Section 1373.13
(a) It is the intent of the Legislature that all persons licensed in this state to engage in the practice of dentistry shall be accorded...
- California Laws: Health and Safety Code Section 1373.14
Except for a preexisting condition, any health care service plan, except a specialized health care service plan, which provides coverage on a group or individual...
- California Laws: Health and Safety Code Section 1373.18
Whenever any health care service plan, except a specialized health care service plan, negotiates and enters into a contract with providers to provide services at...
- California Laws: Health and Safety Code Section 1373.19
Any health care service plan that includes a term that requires the parties to submit to binding arbitration shall, for those cases or disputes for...
- California Laws: Health and Safety Code Section 1373.20
(a) If a plan uses arbitration to settle disputes with enrollees or subscribers, and does not use a professional dispute resolution organization independent of the...
- California Laws: Health and Safety Code Section 1373.21
(a) If a health care service plan uses arbitration to settle disputes with enrollees or subscribers, it shall require that an arbitration award be accompanied...
- California Laws: Health and Safety Code Section 1373.95
(a) (1) A health care service plan, other than a specialized health care service plan that offers professional mental health services on an employer-sponsored group...
- California Laws: Health and Safety Code Section 1373.96
(a) A health care service plan shall at the request of an enrollee, provide the completion of covered services as set forth in this section...
- California Laws: Health and Safety Code Section 1374
If a health care service plan entered into, amended, or renewed in this state on or after the effective date of this section provides in...
- California Laws: Health and Safety Code Section 1374.3
Notwithstanding any other provision of this chapter or of a health care service plan contract, every health care service plan shall comply with the requirements...
- California Laws: Health and Safety Code Section 1374.5
A health care service plan, which is issued, renewed, or amended on or after January 1, 1988, which includes mental health services coverage in nongroup...
- California Laws: Health and Safety Code Section 1374.51
No plan may utilize any information regarding whether an enrollee's psychiatric inpatient admission was made on a voluntary or involuntary basis for the purpose of...
- California Laws: Health and Safety Code Section 1374.55
(a) On and after January 1, 1990, every health care service plan contract which is issued, amended, or renewed that covers hospital, medical, or surgical...
- California Laws: Health and Safety Code Section 1374.56
(a) On and after July 1, 2000, every health care service plan contract, except a specialized health care service plan contract, issued, amended, delivered, or...
- California Laws: Health and Safety Code Section 1374.57
(a) No group health care service plan that provides hospital, medical, or surgical expense benefits for employees or subscribers and their dependents shall exclude a...
- California Laws: Health and Safety Code Section 1374.58
(a) A group health care service plan that provides hospital, medical, or surgical expense benefits shall provide equal coverage to employers or guaranteed associations, as...
- California Laws: Health and Safety Code Section 1374.7
(a) No plan shall refuse to enroll any person or accept any person as a subscriber or renew any person as a subscriber after appropriate...
- California Laws: Health and Safety Code Section 1374.75
(a) No health care service plan shall deny, refuse to enroll, refuse to renew, cancel, restrict, or otherwise terminate, exclude, or limit coverage, or charge...
- California Laws: Health and Safety Code Section 1374.8
A health care service plan shall not release any information to an employer that would directly or indirectly indicate to the employer that an employee...
- California Laws: Health and Safety Code Section 1374.9
For violations of Section 1374.7, the director may, after appropriate notice and opportunity for hearing, by order, levy administrative penalties as follows: (a) Any health...
- California Laws: Health and Safety Code Section 1374.10
(a) Every health care service plan that covers hospital, medical or surgical expenses and which is not qualified as a health maintenance organization under Title...
- California Laws: Health and Safety Code Section 1374.11
No health care service plan shall deny a claim for hospital, medical, surgical, dental, or optometric services for the sole reason that the individual served...
- California Laws: Health and Safety Code Section 1374.12
No health care service plan contract issued, entered into, or renewed on or after July 1, 1984, shall be deemed to contain any provision restricting...
- California Laws: Health and Safety Code Section 1374.13
(a) It is the intent of the Legislature to recognize the practice of telemedicine as a legitimate means by which an individual may receive medical...
- California Laws: Health and Safety Code Section 1374.15
Any health care service plan shall, upon request by any public entity or political subdivision of the state with whom it has entered into a...
- California Laws: Health and Safety Code Section 1374.16
(a) Every health care service plan, except a specialized health care service plan, shall establish and implement a procedure by which an enrollee may receive...
- California Laws: Health and Safety Code Section 1374.17
(a) A health care service plan shall not deny coverage that is otherwise available under the plan contract for the costs of solid organ or...
