California Code
CHAPTER 2.2 - Health Care Service Plans
ARTICLE 5 - Standards

Section 1367. - 1367. A health care service plan and, if applicable, a...

Section 1367.001. - 1367.001. (a) An individual or group health care service plan...

Section 1367.002. - 1367.002. (a) A group or individual nongrandfathered health care service...

Section 1367.003. - 1367.003. (a) A health care service plan that issues, sells,...

Section 1367.004. - 1367.004. (a) A health care service plan that issues, sells,...

Section 1367.005. - 1367.005. (a) An individual or small group health care service...

Section 1367.006. - 1367.006. (a) This section shall apply to nongrandfathered individual and...

Section 1367.0061. - 1367.0061. (a) For a health care service plan contract issued,...

Section 1367.007. - 1367.007. (a) (1) For a small employer health care service...

Section 1367.008. - 1367.008. (a) Levels of coverage for the nongrandfathered individual market...

Section 1367.0085. - 1367.0085. Notwithstanding paragraph (1) of subdivision (b) of Section 1367.008...

Section 1367.009. - 1367.009. (a) Levels of coverage for the nongrandfathered small group...

Section 1367.01. - 1367.01. (a) A health care service plan and any entity...

Section 1367.010. - 1367.010. (a) (1) A nongrandfathered health care service plan, except...

Section 1367.012. - 1367.012. (a) (1) A small employer health care service plan...

Section 1367.015. - 1367.015. In addition to complying with subdivision (h) of Section...

Section 1367.016. - 1367.016. (a) A health care service plan shall accept premium...

Section 1367.02. - 1367.02. (a) On or before July 1, 1999, for purposes...

Section 1367.03. - 1367.03. (a) A health care service plan that provides or...

Section 1367.031. - 1367.031. (a) A health care service plan contract that is...

Section 1367.035. - 1367.035. (a) As part of the reports submitted to the...

Section 1367.04. - 1367.04. (a) Not later than January 1, 2006, the department...

Section 1367.041. - 1367.041. (a) A health care service plan that advertises or...

Section 1367.042. - 1367.042. (a) A health care service plan shall notify enrollees...

Section 1367.043. - 1367.043. (a) (1) Within six months after the department issues...

Section 1367.045. - 1367.045. (a) If a health care service plan contract offered,...

Section 1367.05. - 1367.05. (a) Nothing in this chapter shall prohibit a health...

Section 1367.06. - 1367.06. (a) A health care service plan contract, except a...

Section 1367.07. - 1367.07. Within one year after a health care service plan’s...

Section 1367.08. - 1367.08. A health care service plan shall annually disclose to...

Section 1367.09. - 1367.09. (a) An enrollee with coverage for Medicare benefits who...

Section 1367.1. - 1367.1. Subdivision (i) of Section 1367 shall apply to transitionally...

Section 1367.2. - 1367.2. (a) On and after January 1, 1990, every health...

Section 1367.3. - 1367.3. (a) Every health care service plan that covers hospital,...

Section 1367.34. - 1367.34. (a) (1) Every health care service plan contract issued,...

Section 1367.34. - 1367.34. (a) A health care service plan contract issued, amended,...

Section 1367.35. - 1367.35. (a) On and after January 1, 1993, every health...

Section 1367.36. - 1367.36. (a) A risk-based contract between a health care service...

Section 1367.4. - 1367.4. No plan issuing, providing, or administering any contract of...

Section 1367.41. - 1367.41. (a) Commencing January 1, 2017, a health care service...

Section 1367.42. - 1367.42. (a) For plan years commencing on or after January...

Section 1367.43. - 1367.43. Commencing January 1, 2019, a health care service plan...

Section 1367.45. - 1367.45. (a) Every individual or group health care service plan...

Section 1367.46. - 1367.46. Every individual or group health care service plan contract...

Section 1367.47. - 1367.47. (a) The maximum amount a health care service plan...

Section 1367.49. - 1367.49. (a) A contract issued, amended, renewed, or delivered on...

Section 1367.5. - 1367.5. No health care service plan contract that is issued,...

Section 1367.50. - 1367.50. (a) No contract in existence or issued, amended, or...

Section 1367.51. - 1367.51. (a) Every health care service plan contract, except a...

Section 1367.54. - 1367.54. (a) Every group health care service plan contract that...

Section 1367.6. - 1367.6. (a) Every health care service plan contract, except a...

Section 1367.61. - 1367.61. Every health care service plan contract which provides for...

Section 1367.62. - 1367.62. (a) No health care service plan contract that is...

Section 1367.625. - 1367.625. (a) By July 1, 2023, a health care service...

Section 1367.63. - 1367.63. (a) Every health care service plan contract, except a...

Section 1367.635. - 1367.635. (a) Every health care service plan contract that is...

Section 1367.64. - 1367.64. (a) Every individual or group health care service plan...

Section 1367.65. - 1367.65. (a) On or after January 1, 2000, each health...

Section 1367.656. - 1367.656. (a) Notwithstanding any other law, an individual or group...

Section 1367.66. - 1367.66. Every individual or group health care service plan contract,...

Section 1367.665. - 1367.665. (a) A health care service plan contract, except for...

Section 1367.668. - 1367.668. (a) Every health care service plan contract, except a...

Section 1367.67. - 1367.67. Every health care service plan contract that provides hospital,...

Section 1367.68. - 1367.68. (a) Any provision in a health care service plan...

Section 1367.69. - 1367.69. (a) On or after January 1, 1995, every health...

Section 1367.695. - 1367.695. (a) The Legislature finds and declares that the unique,...

Section 1367.7. - 1367.7. On and after January 1, 1980, every health care...

Section 1367.71. - 1367.71. (a) Every health care service plan contract, other than...

Section 1367.8. - 1367.8. No plan issuing, providing, or administering any individual or...

Section 1367.9. - 1367.9. No health care service plan contract which covers hospital,...

Section 1367.10. - 1367.10. (a) Every health care service plan shall include within...

Section 1367.11. - 1367.11. (a) Every health care service plan issued, amended, or...

Section 1367.12. - 1367.12. No health care service plan that administers Medicare coverage...

Section 1367.15. - 1367.15. (a) This section shall apply to individual health care...

Section 1367.18. - 1367.18. (a) Every health care service plan, except a specialized...

Section 1367.19. - 1367.19. On and after January 1, 1991, every health care...

Section 1367.20. - 1367.20. Every health care service plan that provides prescription drug...

Section 1367.205. - 1367.205. (a) In addition to the list required to be...

Section 1367.206. - 1367.206. (a) If there is more than one drug that...

Section 1367.207. - 1367.207. (a) A health care service plan contract issued, amended,...

Section 1367.21. - 1367.21. (a) No health care service plan contract which covers...

Section 1367.215. - 1367.215. (a) Every health care service plan contract that covers...

Section 1367.22. - 1367.22. (a) A health care service plan contract, issued, amended,...

Section 1367.23. - 1367.23. (a) On and after January 1, 1994, every group...

Section 1367.24. - 1367.24. (a) Every health care service plan that provides prescription...

Section 1367.241. - 1367.241. (a) Notwithstanding any other law, on and after January...

Section 1367.243. - 1367.243. (a) (1) A health care service plan that reports...

Section 1367.244. - 1367.244. (a) A request for an exception to a health...

Section 1367.25. - 1367.25. (a) A group health care service plan contract, except...

Section 1367.251. - 1367.251. (a) (1) A health care service plan, except for...

Section 1367.255. - 1367.255. (a) (1) A health care service plan contract issued,...

Section 1367.27. - 1367.27. (a) Commencing July 1, 2016, a health care service...

Section 1367.28. - 1367.28. Within six months after the department issues guidance pursuant...

Section 1367.29. - 1367.29. (a) On and after July 1, 2011, in accordance...

Section 1367.30. - 1367.30. Notwithstanding any other provision of law, every group health...

Section 1367.31. - 1367.31. (a) Every health care service plan contract issued, amended,...

Section 1367.32. - 1367.32. (a) A health care service plan that provides health...

Section 1367.33. - 1367.33. Notwithstanding any other law, a plan directly operated by...

Section 1368. - 1368. (a) Every plan shall do all of the following:...

Section 1368.01. - 1368.01. (a) The grievance system shall require the plan to...

Section 1368.015. - 1368.015. (a) Effective July 1, 2003, every plan with an...

Section 1368.016. - 1368.016. (a) A health care service plan that provides coverage...

Section 1368.02. - 1368.02. (a) The director shall establish and maintain a toll-free...

Section 1368.03. - 1368.03. (a) The department may require enrollees and subscribers to...

Section 1368.04. - 1368.04. (a) The director shall investigate and take enforcement action...

Section 1368.05. - 1368.05. (a) (1) By enacting this section, which was originally...

Section 1368.1. - 1368.1. (a) A plan that denies coverage to an enrollee...

Section 1368.2. - 1368.2. (a) On and after January 1, 2002, every group...

Section 1368.5. - 1368.5. (a) Every health care service plan that offers coverage...

Section 1368.7. - 1368.7. (a) A health care service plan shall provide an...

Section 1369. - 1369. Every plan shall establish procedures to permit subscribers and...

Section 1370. - 1370. Every plan shall establish procedures in accordance with department...

Section 1370.1. - 1370.1. Nothing in this article shall be construed to prevent...

Section 1370.2. - 1370.2. Upon an appeal to the plan of a contested...

Section 1370.4. - 1370.4. (a) Every health care service plan shall provide an...

Section 1370.6. - 1370.6. (a) An individual or group health care service plan...

Section 1371. - 1371. (a) (1) A health care service plan, including a...

Section 1371.1. - 1371.1. (a) (1) Whenever a health care service plan, including...

Section 1371.2. - 1371.2. No health care service plan, including a specialized health...

Section 1371.22. - 1371.22. If a contract between a health care service plan...

Section 1371.25. - 1371.25. A plan, any entity contracting with a plan, and...

Section 1371.3. - 1371.3. On and after January 1, 1994, every group health...

Section 1371.30. - 1371.30. (a) (1) By September 1, 2017, the department shall...

Section 1371.31. - 1371.31. (a) (1) For services rendered subject to Section 1371.9,...

Section 1371.35. - 1371.35. (a) A health care service plan, including a specialized...

Section 1371.36. - 1371.36. (a) A health care service plan shall not deny...

Section 1371.37. - 1371.37. (a) A health care service plan is prohibited from...

Section 1371.38. - 1371.38. (a) The department shall, on or before July 1,...

Section 1371.39. - 1371.39. (a) Providers may report to the department through the...

Section 1371.4. - 1371.4. (a) A health care service plan that covers hospital,...

Section 1371.5. - 1371.5. (a) No health care service plan that provides basic...

Section 1371.55. - 1371.55. (a) (1) Notwithstanding Section 1367.11, a health care service...

Section 1371.8. - 1371.8. A health care service plan that authorizes a specific...

Section 1371.9. - 1371.9. (a) (1) Except as provided in subdivision (c), a...

Section 1372. - 1372. Subject to the applicable provisions of this chapter, a...

Section 1373. - 1373. (a) (1) A plan contract may not provide an...

Section 1373.1. - 1373.1. Every group plan entered into, amended, or renewed on...

Section 1373.2. - 1373.2. Every group health care service plan entered into, amended,...

Section 1373.3. - 1373.3. An enrollee shall not be prohibited from selecting as...

Section 1373.4. - 1373.4. (a) No health care service plan contract that is...

Section 1373.5. - 1373.5. When spouses are both employed as employees, and both...

Section 1373.6. - 1373.6. This section does not apply to a specialized health...

Section 1373.620. - 1373.620. (a) (1) At least 60 days prior to the...

Section 1373.621. - 1373.621. (a) Except for a specialized health care service plan,...

Section 1373.622. - 1373.622. (a) (1) After the termination of the pilot program...

Section 1373.65. - 1373.65. (a) At least 75 days before the termination date...

Section 1373.7. - 1373.7. A health care service plan contract, which is written...

Section 1373.8. - 1373.8. A health care service plan contract where the plan...

Section 1373.9. - 1373.9. (a) Except in the case of a specialized health...

Section 1373.95. - 1373.95. (a) (1) A health care service plan, other than...

Section 1373.96. - 1373.96. (a) A health care service plan shall, at the...

Section 1373.10. - 1373.10. (a) On and after January 1, 1985, every health...

Section 1373.11. - 1373.11. A health care service plan that offers or provides...

Section 1373.12. - 1373.12. A health care service plan which offers or provides...

Section 1373.13. - 1373.13. (a) It is the intent of the Legislature that...

Section 1373.14. - 1373.14. Except for a preexisting condition, any health care service...

Section 1373.18. - 1373.18. Whenever any health care service plan, except a specialized...

Section 1373.19. - 1373.19. Any health care service plan that includes a term...

Section 1373.20. - 1373.20. (a) If a plan uses arbitration to settle disputes...

Section 1373.21. - 1373.21. (a) If a health care service plan uses arbitration...

Section 1374. - 1374. If a health care service plan entered into, amended,...

Section 1374.1. - 1374.1. (a) An individual health care service plan contract issued,...

Section 1374.3. - 1374.3. Notwithstanding any other provision of this chapter or of...

Section 1374.5. - 1374.5. A health care service plan, which is issued, renewed,...

Section 1374.51. - 1374.51. No plan may utilize any information regarding whether an...

Section 1374.55. - 1374.55. (a) On and after January 1, 1990, every health...

Section 1374.551. - 1374.551. (a) When a covered treatment may directly or indirectly...

Section 1374.56. - 1374.56. (a) On and after July 1, 2000, every health...

Section 1374.57. - 1374.57. (a) No group health care service plan that provides...

Section 1374.58. - 1374.58. (a) A group health care service plan that provides...

Section 1374.7. - 1374.7. (a) No plan shall refuse to enroll any person...

Section 1374.75. - 1374.75. (a) No health care service plan shall deny, refuse...

Section 1374.8. - 1374.8. (a) A health care service plan shall not release...

Section 1374.9. - 1374.9. For violations of Section 1374.7, the director may, after...

Section 1374.10. - 1374.10. (a) Every health care service plan that covers hospital,...

Section 1374.11. - 1374.11. No health care service plan shall deny a claim...

Section 1374.12. - 1374.12. No health care service plan contract issued, entered into,...

Section 1374.13. - 1374.13. (a) For the purposes of this section, the definitions...

Section 1374.14. - 1374.14. (a) (1) A contract between a health care service...

Section 1374.141. - 1374.141. (a) If a health care service plan offers a...

Section 1374.142. - 1374.142. (a) A health care service plan that issues, sells,...

Section 1374.15. - 1374.15. Any health care service plan shall, upon request by...

Section 1374.16. - 1374.16. (a) Every health care service plan, except a specialized...

Section 1374.17. - 1374.17. (a) A health care service plan shall not deny...

Section 1374.19. - 1374.19. (a) This section shall only apply to a health...

Section 1374.192. - 1374.192. (a) Notwithstanding any other law, a health care service...

Section 1374.193. - 1374.193. (a) A health care service plan that issues, sells,...

Section 1374.195. - 1374.195. (a) With respect to a contract between a health...

Section 1374.196. - 1374.196. (a) Commencing January 1, 2024, to facilitate patient and...

Section 1374.197. - 1374.197. (a) For provider contracts issued, amended, or renewed on...

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California Code CHAPTER 2.2 - Health Care Service Plans ARTICLE 5 - Standards

California Code
CHAPTER 2.2 - Health Care Service Plans
ARTICLE 5 - Standards