California Code
DIVISION 2 - LICENSING PROVISIONS
CHAPTER 2.2 - Health Care Service Plans

ARTICLE 1 - General

Section 1340. - 1340. This chapter shall be known and may be cited...

Section 1341. - 1341. (a) There is in state government, in the California...

Section 1341.1. - 1341.1. The director shall have his or her principal office...

Section 1341.2. - 1341.2. In accordance with the laws governing the state civil...

Section 1341.3. - 1341.3. The director shall adopt a seal bearing the inscription:...

Section 1341.4. - 1341.4. (a) In order to effectively support the Department of...

Section 1341.45. - 1341.45. (a) There is hereby created in the State Treasury...

Section 1341.5. - 1341.5. (a) The director, as a general rule, shall publish...

Section 1341.6. - 1341.6. (a) The Attorney General shall render to the director...

Section 1341.7. - 1341.7. (a) Neither the director nor any of the director’s...

Section 1341.8. - 1341.8. The director shall have the powers of a head...

Section 1341.9. - 1341.9. The director and department succeed to, and are vested...

Section 1341.10. - 1341.10. The department may use the unexpended balance of funds...

Section 1341.11. - 1341.11. All officers and employees of the Department of Corporations...

Section 1341.12. - 1341.12. The department shall have possession and control of all...

Section 1341.13. - 1341.13. All officers or employees of the department employed after...

Section 1341.14. - 1341.14. (a) Any regulation, order, or other action, adopted, prescribed,...

Section 1342. - 1342. It is the intent and purpose of the Legislature...

Section 1342.2. - 1342.2. (a) Notwithstanding any other law, a health care service...

Section 1342.3. - 1342.3. (a) A health care service plan contract that covers...

Section 1342.4. - 1342.4. (a) The Department of Managed Health Care and the...

Section 1342.5. - 1342.5. The director shall consult with the Insurance Commissioner prior...

Section 1342.6. - 1342.6. It is the intent of the Legislature to ensure...

Section 1342.7. - 1342.7. (a) The Legislature finds that in enacting Sections 1367.215,...

Section 1342.71. - 1342.71. (a) The Legislature hereby finds and declares all of...

Section 1342.73. - 1342.73. (a) (1) With respect to an individual or group...

Section 1342.74. - 1342.74. (a) (1) Notwithstanding Section 1342.71, a health care service...

Section 1342.8. - 1342.8. The State Department of Health Services and the department...

Section 1343. - 1343. (a) This chapter shall apply to health care service...

Section 1343.1. - 1343.1. This chapter shall not apply to any program developed...

Section 1343.3. - 1343.3. (a) The director, no later than May 1, 2021,...

Section 1343.5. - 1343.5. In any proceeding under this chapter, the burden of...

Section 1344. - 1344. (a) The director may from time to time adopt,...

Section 1345. - 1345. As used in this chapter: (a) “Advertisement” means any...

Section 1345.5. - 1345.5. (a) “Minimum essential coverage” means any of the following:...

ARTICLE 2 - Administration

Section 1346. - 1346. (a) The director shall administer and enforce this chapter...

Section 1346.1. - 1346.1. The department shall maintain a database indicating for each...

Section 1346.2. - 1346.2. The director shall, in coordination with the Insurance Commissioner,...

Section 1346.4. - 1346.4. (a) The Legislature finds and declares all of the...

Section 1346.5. - 1346.5. If the director determines that an entity purporting to...

Section 1347.15. - 1347.15. (a) There is hereby established in the Department of...

Section 1347.5. - 1347.5. (a) A health care service plan providing individual coverage...

Section 1347.8. - 1347.8. (a) Beginning on July 1, 2023, and annually thereafter,...

Section 1348. - 1348. (a) Every health care service plan licensed to do...

Section 1348.5. - 1348.5. A health care service plan shall comply with the...

Section 1348.6. - 1348.6. (a) No contract between a health care service plan...

Section 1348.8. - 1348.8. (a) A health care service plan that provides, operates,...

Section 1348.9. - 1348.9. (a) On or before July 1, 2003, the director...

Section 1348.95. - 1348.95. (a) Commencing March 1, 2013, and at least annually...

Section 1348.96. - 1348.96. Any data submitted by a health care service plan...

ARTICLE 3 - Licensing and Fees

Section 1349. - 1349. It is unlawful for any person to engage in...

Section 1349.1. - 1349.1. A health care service plan which satisfies both of...

Section 1349.2. - 1349.2. (a) A health care service plan, including a self-insured...

Section 1350. - 1350. (a) Consistent with federal law, a sponsor of a...

Section 1351. - 1351. Each application for licensure as a health care service...

Section 1351.1. - 1351.1. In addition to the requirements of Section 1351 and...

Section 1351.2. - 1351.2. (a) If a prepaid health plan operating lawfully under...

Section 1351.3. - 1351.3. On and after January 1, 2007, the department, in...

Section 1352. - 1352. (a) A licensed plan shall, within 30 days after...

Section 1352.1. - 1352.1. (a) Except as provided in subdivision (b), no plan...

Section 1353. - 1353. The director shall issue a license to any person...

Section 1354. - 1354. Upon denial of application for licensure, or the issuance...

Section 1355. - 1355. Every plan’s license issued under this chapter shall remain...

Section 1356. - 1356. (a) Each plan applying for licensure under this chapter...

Section 1356.1. - 1356.1. Notwithstanding subdivision (f) of Section 1356, as amended by...

Section 1356.2. - 1356.2. The director, by notice to all licensed health care...

ARTICLE 3.1 - Small Employer Group Access to Contracts for Health Care Services

Section 1357. - 1357. As used in this article: (a) “Dependent” means the...

Section 1357.01. - 1357.01. Every health care service plan offering plan contracts to...

Section 1357.02. - 1357.02. (a) A health care service plan providing or arranging...

Section 1357.025. - 1357.025. Nothing in this article shall be construed to preclude...

Section 1357.03. - 1357.03. (a) (1) Upon the effective date of this article,...

Section 1357.035. - 1357.035. (a) Between July 26, 1993, and October 24, 1993,...

Section 1357.04. - 1357.04. (a) After a small employer submits a completed application...

Section 1357.05. - 1357.05. Except in the case of a late enrollee, or...

Section 1357.06. - 1357.06. (a) (1) Preexisting condition provisions of a plan contract...

Section 1357.07. - 1357.07. No plan contract may exclude late enrollees from coverage...

Section 1357.08. - 1357.08. All health care service plan contracts offered to a...

Section 1357.09. - 1357.09. No plan shall be required to offer a health...

Section 1357.10. - 1357.10. The director may require a plan to discontinue the...

Section 1357.12. - 1357.12. Premiums for contracts offered or delivered by plans on...

Section 1357.13. - 1357.13. Plans shall apply standard employee risk rates consistently with...

Section 1357.14. - 1357.14. In connection with the offering for sale of any...

Section 1357.15. - 1357.15. (a) At least 20 business days prior to renewing...

Section 1357.16. - 1357.16. (a) Health care service plans may enter into contractual...

Section 1357.17. - 1357.17. The director may issue regulations that are necessary to...

Section 1357.19. - 1357.19. This article shall not apply to a health care...

ARTICLE 3.15 - Preexisting Condition Provisions

Section 1357.50. - 1357.50. (a) For purposes of this article, the following definitions...

Section 1357.51. - 1357.51. (a) A health benefit plan for group coverage shall...

Section 1357.52. - 1357.52. A health benefit plan for group coverage shall not...

Section 1357.55. - 1357.55. This article shall become operative on January 1, 2014....

ARTICLE 3.16 - Nongrandfathered Small Employer Plans

Section 1357.500. - 1357.500. As used in this article, the following definitions shall...

Section 1357.501. - 1357.501. This article shall apply only to nongrandfathered small employer...

Section 1357.502. - 1357.502. (a) A health care service plan providing or arranging...

Section 1357.502.5. - 1357.502.5. Nothing in this article shall be construed to preclude...

Section 1357.503. - 1357.503. (a) (1) Each plan shall fairly and affirmatively offer,...

Section 1357.503.035. - 1357.503.035. (a) For plan contracts subject to this article, an...

Section 1357.504. - 1357.504. (a) With respect to small employer health care service...

Section 1357.506. - 1357.506. A small employer health care service plan contract shall...

Section 1357.507. - 1357.507. Nothing in this article shall be construed as prohibiting...

Section 1357.508. - 1357.508. A small employer health care service plan contract shall...

Section 1357.509. - 1357.509. (a) To the extent permitted by PPACA, a plan...

Section 1357.510. - 1357.510. The director may require a plan to discontinue the...

Section 1357.512. - 1357.512. (a) The premium rate for a small employer health...

Section 1357.514. - 1357.514. In connection with the offering for sale of a...

Section 1357.515. - 1357.515. (a) At least 20 business days prior to renewing...

Section 1357.516. - 1357.516. (a) Health care service plans may enter into contractual...

ARTICLE 3.17 - Grandfathered Small Employer Plans

Section 1357.600. - 1357.600. As used in this article, the following definitions shall...

Section 1357.601. - 1357.601. This article shall apply only to grandfathered small group...

Section 1357.602. - 1357.602. (a) A health care service plan providing or arranging...

Section 1357.603. - 1357.603. Nothing in this article shall be construed to preclude...

Section 1357.604. - 1357.604. (a) (1) A plan shall fairly and affirmatively renew...

Section 1357.606. - 1357.606. (a) For plan contracts expiring after July 1, 1994,...

Section 1357.607. - 1357.607. A small employer health care service plan contract shall...

Section 1357.608. - 1357.608. Nothing in this article shall be construed as prohibiting...

Section 1357.609. - 1357.609. All grandfathered small employer health care service plan contracts...

Section 1357.610. - 1357.610. (a) No plan shall be required by the provisions...

Section 1357.611. - 1357.611. (a) The director may require a plan to discontinue...

Section 1357.612. - 1357.612. Premiums for grandfathered contracts renewed by plans on or...

Section 1357.613. - 1357.613. Plans shall apply standard employee risk rates consistently with...

Section 1357.614. - 1357.614. In connection with the renewal of a grandfathered small...

Section 1357.615. - 1357.615. (a) At least 20 business days prior to renewing...

Section 1357.616. - 1357.616. (a) Health care service plans may enter into contractual...

Section 1357.618. - 1357.618. (a) The department may adopt emergency regulations implementing this...

ARTICLE 3.5 - Additional Requirements for Medicare Supplement Contracts

Section 1358.1. - 1358.1. Every health care service plan that offers any contract...

Section 1358.2. - 1358.2. The purpose of this article is to provide for...

Section 1358.3. - 1358.3. (a) Except as otherwise provided in this section or...

Section 1358.4. - 1358.4. The following definitions apply for the purposes of this...

Section 1358.5. - 1358.5. (a) A contract shall not be advertised, solicited, or...

Section 1358.6. - 1358.6. (a) (1) Except for permitted preexisting condition clauses as...

Section 1358.7. - 1358.7. A contract shall not be advertised, solicited, or issued...

Section 1358.8. - 1358.8. The following standards are applicable to all Medicare supplement...

Section 1358.81. - 1358.81. The following standards are applicable to all Medicare supplement...

Section 1358.9. - 1358.9. The following standards are applicable to all Medicare supplement...

Section 1358.91. - 1358.91. The following standards are applicable to all Medicare supplement...

Section 1358.92. - 1358.92. The following standards are applicable to all Medicare supplement...

Section 1358.10. - 1358.10. (a) (1) This section shall apply to Medicare Select...

Section 1358.11. - 1358.11. (a) (1) An issuer shall not deny or condition...

Section 1358.12. - 1358.12. (a) (1) With respect to the guaranteed issue of...

Section 1358.13. - 1358.13. (a) An issuer shall comply with Section 1882(c)(3) of...

Section 1358.14. - 1358.14. (a) (1) (A) With respect to loss ratio standards,...

Section 1358.145. - 1358.145. (a) The calculation of actual or expected loss ratios...

Section 1358.146. - 1358.146. The following format shall be used for reporting loss...

Section 1358.15. - 1358.15. (a) An issuer shall not advertise, solicit, or issue...

Section 1358.16. - 1358.16. (a) An issuer or other entity may provide a...

Section 1358.17. - 1358.17. (a) (1) Medicare supplement contracts shall include a renewal...

Section 1358.18. - 1358.18. In the interest of full and fair disclosure, and...

Section 1358.19. - 1358.19. An issuer shall provide a copy of any Medicare...

Section 1358.20. - 1358.20. (a) An issuer, directly or through solicitors or other...

Section 1358.21. - 1358.21. (a) In recommending the purchase or replacement of any...

Section 1358.22. - 1358.22. (a) On or before March 1 of each year,...

Section 1358.225. - 1358.225. (a) Every issuer shall, by June 30 of each...

Section 1358.23. - 1358.23. (a) If a Medicare supplement contract replaces another Medicare...

Section 1358.24. - 1358.24. This section applies to all contracts that become effective...

ARTICLE 4 - Solicitation and Enrollment

Section 1359. - 1359. (a) The director may require that solicitors and solicitor...

Section 1360. - 1360. (a) No plan, solicitor, solicitor firm, or representative shall...

Section 1360.1. - 1360.1. It is unlawful for any person, including a plan,...

Section 1360.5. - 1360.5. (a) For purposes of this section, “Exchange” means the...

Section 1361. - 1361. (a) Except as provided in subdivision (b), no plan...

Section 1361.1. - 1361.1. (a) It is an unfair business practice for a...

Section 1362. - 1362. As used in Sections 1363 and 1364: (a) “Benefits...

Section 1363. - 1363. (a) The director shall require the use by each...

Section 1363.01. - 1363.01. (a) Every plan that covers prescription drug benefits shall...

Section 1363.02. - 1363.02. (a) The Legislature finds and declares that the right...

Section 1363.03. - 1363.03. (a) Every health care service plan that covers prescription...

Section 1363.04. - 1363.04. (a) For plan years on and after January 1,...

Section 1363.05. - 1363.05. (a) For every plan contract that provides or supplements...

Section 1363.06. - 1363.06. (a) The Department of Managed Health Care and the...

Section 1363.07. - 1363.07. (a) Each health care service plan shall send copies...

Section 1363.1. - 1363.1. Any health care service plan that includes terms that...

Section 1363.2. - 1363.2. On or before July 1, 1999, the disclosure form...

Section 1363.5. - 1363.5. (a) A plan shall disclose or provide for the...

Section 1364. - 1364. Where the director finds it necessary in the interest...

Section 1364.1. - 1364.1. Within 30 days of receiving the notice required by...

Section 1364.5. - 1364.5. (a) On or before July 1, 2001, every health...

Section 1365. - 1365. (a) An enrollment or a subscription shall not be...

Section 1365.5. - 1365.5. (a) No health care service plan or specialized health...

Section 1366. - 1366. (a) No plan may use in its name, any...

Section 1366.1. - 1366.1. (a) The department shall adopt regulations on or before...

Section 1366.2. - 1366.2. (a) A full health care service plan shall make...

Section 1366.3. - 1366.3. (a) On and after January 1, 2005, a health...

Section 1366.4. - 1366.4. (a) A medical group, physician, or independent practice association...

Section 1366.6. - 1366.6. (a) For purposes of this section, the following definitions...

ARTICLE 4.5 - California Cobra Program

Section 1366.20. - 1366.20. (a) This article shall be known as the California...

Section 1366.21. - 1366.21. The definitions contained in this section govern the construction...

Section 1366.22. - 1366.22. The continuation coverage requirements of this article do not...

Section 1366.23. - 1366.23. (a) Every health care service plan, including a specialized...

Section 1366.24. - 1366.24. (a) Every health care service plan evidence of coverage,...

Section 1366.25. - 1366.25. (a) Every group contract between a health care service...

Section 1366.26. - 1366.26. A qualified beneficiary electing continuation coverage shall pay to...

Section 1366.27. - 1366.27. (a) The continuation coverage provided pursuant to this article...

Section 1366.28. - 1366.28. A health care service plan subject to this article...

Section 1366.29. - 1366.29. (a) A health care service plan shall offer an...

ARTICLE 4.6 - Coverage for Federally Eligible Defined Individuals

Section 1366.35. - 1366.35. (a) A health care service plan providing coverage for...

Section 1366.50. - 1366.50. (a) (1) On and after January 1, 2014, a...

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...

ARTICLE 5.5 - Health Care Service Plan Coverage Contract Changes

Section 1374.20. - 1374.20. (a) No group health care service plan shall change...

Section 1374.21. - 1374.21. (a) (1) A change in premium rates or changes...

Section 1374.22. - 1374.22. (a) The written notice described in subdivision (a) of...

Section 1374.23. - 1374.23. Notwithstanding subdivision (a) of Section 1374.22, if the plan...

Section 1374.24. - 1374.24. There shall be no liability on the part of,...

Section 1374.25. - 1374.25. Proof of mailing a notice and the reason therefor...

Section 1374.255. - 1374.255. (a) This section shall apply to grandfathered health care...

Section 1374.26. - 1374.26. The director may, as required by this article, or...

Section 1374.27. - 1374.27. The director may levy administrative penalties and may suspend...

Section 1374.28. - 1374.28. In addition to any other penalty provided by law...

Section 1374.29. - 1374.29. The purpose of this article is to promote the...

ARTICLE 5.55 - Appeals Seeking Independent Medical Reviews

Section 1374.30. - 1374.30. (a) Commencing January 1, 2001, there is hereby established...

Section 1374.31. - 1374.31. (a) If there is an imminent and serious threat...

Section 1374.32. - 1374.32. (a) The department shall contract with one or more...

Section 1374.33. - 1374.33. (a) Upon receipt of information and documents related to...

Section 1374.34. - 1374.34. (a) Upon receiving the decision adopted by the director...

Section 1374.35. - 1374.35. (a) After considering the results of a competitive bidding...

Section 1374.36. - 1374.36. (a) The director shall submit to the Legislature by...

ARTICLE 5.6 - Point-of-Service Health Care Service Plan Contracts

Section 1374.60. - 1374.60. For purpose of this article, the following definitions shall...

Section 1374.62. - 1374.62. A point-of-service plan contract, in which any risk for...

Section 1374.64. - 1374.64. (a) Only a plan that has been licensed under...

Section 1374.65. - 1374.65. Point-of-service plan contracts shall: (a) Provide incentives, including financial...

Section 1374.66. - 1374.66. Any health care service plan that offers a point-of-service...

Section 1374.67. - 1374.67. A health care service plan offering a point-of-service plan...

Section 1374.68. - 1374.68. A health care service plan that offers a point-of-service...

Section 1374.69. - 1374.69. At least 20 business days prior to offering a...

Section 1374.71. - 1374.71. No plan formerly registered under the Knox-Mills Health Plan...

Section 1374.72. - 1374.72. (a) (1) Every health care service plan contract issued,...

Section 1374.721. - 1374.721. (a) A health care service plan that provides hospital,...

Section 1374.722. - 1374.722. (a) (1) A health care service plan contract issued,...

Section 1374.723. - 1374.723. (a) A health care service plan contract issued, amended,...

Section 1374.724. - 1374.724. (a) Coverage of mental health and substance use disorder...

Section 1374.73. - 1374.73. (a) (1) Every health care service plan contract that...

Section 1374.74. - 1374.74. (a) The department, in consultation with the Department of...

Section 1374.76. - 1374.76. (a) No later than January 1, 2015, a large...

ARTICLE 6 - Operation and Renewal Requirements and Procedures

Section 1375.1. - 1375.1. (a) Every plan shall have and shall demonstrate to...

Section 1375.2. - 1375.2. On and after October 1, 1977, every plan operating...

Section 1375.3. - 1375.3. (a) A health care service plan shall meet and...

Section 1375.4. - 1375.4. (a) Every contract between a health care service plan...

Section 1375.5. - 1375.5. No contract between a risk-bearing organization and a health...

Section 1375.6. - 1375.6. No contract between a risk-bearing organization and a health...

Section 1375.7. - 1375.7. (a) This section shall be known and may be...

Section 1375.8. - 1375.8. (a) The Legislature finds the following: (1) Because of...

Section 1375.9. - 1375.9. (a) A health care service plan shall ensure that...

Section 1376. - 1376. (a) No plan shall conduct any activity regulated by...

Section 1376.1. - 1376.1. The deposit requirements of Section 1300.76.1 of Title 28...

Section 1377. - 1377. (a) Every plan which reimburses providers of health care...

Section 1378. - 1378. No plan shall expend for administrative costs in any...

Section 1379. - 1379. (a) Every contract between a plan and a provider...

Section 1379.5. - 1379.5. (a) On and after July 1, 2008, every contract...

Section 1380. - 1380. (a) The department shall conduct periodically an onsite medical...

Section 1380.1. - 1380.1. (a) The Legislature finds and declares as follows: (1)...

Section 1380.3. - 1380.3. The department shall coordinate the surveys conducted pursuant to...

Section 1381. - 1381. (a) All records, books, and papers of a plan,...

Section 1382. - 1382. (a) The director shall conduct an examination of the...

Section 1383. - 1383. Every plan that is a health maintenance organization qualified...

Section 1383.1. - 1383.1. (a) On or before July 1, 1997, every health...

Section 1383.15. - 1383.15. (a) When requested by an enrollee or participating health...

Section 1384. - 1384. (a) Within 90 days after receipt of a request...

Section 1385. - 1385. Each plan, solicitor firm, and solicitor shall keep and...

ARTICLE 6.1 - Pharmacy Benefit Management Services

Section 1385.001. - 1385.001. For the purposes of this article, “pharmacy benefit manager”...

Section 1385.002. - 1385.002. (a) Except as specified in Section 1385.007, the requirements...

Section 1385.003. - 1385.003. (a) A health care service plan shall disclose to...

Section 1385.004. - 1385.004. (a) A health care service plan that contracts with...

Section 1385.005. - 1385.005. (a) A pharmacy benefit manager required to register with...

Section 1385.006. - 1385.006. The failure by a health care service plan to...

ARTICLE 6.2 - Review of Rate Increases

Section 1385.01. - 1385.01. For purposes of this article, the following definitions shall...

Section 1385.02. - 1385.02. This article shall apply to a health care service...

Section 1385.03. - 1385.03. (a) (1) A health care service plan shall file...

Section 1385.035. - 1385.035. (a) It is the intent of the Legislature in...

Section 1385.04. - 1385.04. (a) For large group health care service plan contracts,...

Section 1385.043. - 1385.043. (a) A health care service plan, not including a...

Section 1385.045. - 1385.045. (a) For large group health care service plan contracts,...

Section 1385.046. - 1385.046. (a) Upon receiving notice of a rate change, a...

Section 1385.05. - 1385.05. Notwithstanding any provision in a contract between a health...

Section 1385.06. - 1385.06. (a) A filing submitted under this article shall be...

Section 1385.07. - 1385.07. (a) Notwithstanding Division 10 (commencing with Section 7920.000) of...

Section 1385.08. - 1385.08. (a) On or before July 1, 2012, the director...

Section 1385.09. - 1385.09. A health care service plan contract subject to Section...

Section 1385.10. - 1385.10. (a) (1) A health care service plan shall annually...

Section 1385.11. - 1385.11. (a) Whenever it appears to the department that any...

Section 1385.13. - 1385.13. The department shall do all of the following in...

ARTICLE 7 - Discipline

Section 1386. - 1386. (a) The director may, after appropriate notice and opportunity...

Section 1387. - 1387. (a) (1) A person who violates a provision of...

Section 1388. - 1388. (a) The director may, after appropriate notice and opportunity...

Section 1389. - 1389. (a) A person whose license has been revoked, or...

ARTICLE 7.5 - Underwriting Practices

Section 1389.1. - 1389.1. (a) The director shall not approve any plan contract...

Section 1389.2. - 1389.2. At the request of the director, a health care...

Section 1389.21. - 1389.21. (a) A health care service plan shall not rescind...

Section 1389.25. - 1389.25. (a) (1) This section shall apply only to a...

Section 1389.3. - 1389.3. No health care service plan shall engage in the...

Section 1389.4. - 1389.4. (a) A full service health care service plan that...

<< Previous

Next >>

California Code DIVISION 2 - LICENSING PROVISIONS CHAPTER 2.2 - Health Care Service Plans

California Code
DIVISION 2 - LICENSING PROVISIONS
CHAPTER 2.2 - Health Care Service Plans