ARTICLE 4. Solicitation and Enrollment

Article 4 added by Stats. 1975, Ch. 941.

§§ 1359–1366.6 · 30 sections

§ 1359 (a) The director may require that solicitors and solicitor firms, and principal persons engaged in the supervision of solicitation for plans of solicitor…
§ 1360 (a) No plan, solicitor, solicitor firm, or representative shall use or permit the use of any advertising or solicitation which is untrue or misleading, or any…
§ 1360.1 It is unlawful for any person, including a plan, subject to this chapter to represent or imply in any manner that the person or plan has been sponsored,…
§ 1360.5 (a) For purposes of this section, “Exchange” means the California Health Benefit Exchange established pursuant to Section 100500 of the Government Code. (b) It…
§ 1361 (a) Except as provided in subdivision (b), no plan shall publish or distribute, or allow to be published or distributed on its behalf, any advertisement not…
§ 1361.1 (a) It is an unfair business practice for a solicitor, solicitor firm, or representative of a health care service plan to sell, solicit, or negotiate the…
§ 1362 As used in Sections 1363 and 1364: (a) “Benefits and coverage” means the health care services available under a plan contract. (b) “Exception” means any…
§ 1363 (a) (1) The director shall require the use by each plan of disclosure forms or materials containing information regarding the benefits, services, and terms of…
§ 1363.01 (a) Every plan that covers prescription drug benefits shall provide notice in the evidence of coverage and disclosure form to enrollees regarding whether the…
§ 1363.02 (a) The Legislature finds and declares that the right of every patient to receive basic information necessary to give full and informed consent is a…
§ 1363.03 (a) Every health care service plan that covers prescription drug benefits and that issues a card to enrollees for claims processing purposes shall issue to…
§ 1363.04 (a) For plan years on and after January 1, 2021, or 12 months after regulations are adopted under subdivision (f), whichever occurs later, a health care…
§ 1363.05 (a) For every plan contract that provides or supplements Medicare benefits, a plan shall include within its disclosure form the following statement in at least…
§ 1363.06 (a) The Department of Managed Health Care and the Department of Insurance shall compile information as required by this section and Section 10127.14 of the…
§ 1363.07 (a) Each health care service plan shall send copies of the comparative benefit matrix prepared pursuant to Section 1363.06 on an annual basis, or more…
§ 1363.1 Any health care service plan that includes terms that require binding arbitration to settle disputes and that restrict, or provide for a waiver of, the right…
§ 1363.2 On or before July 1, 1999, the disclosure form required pursuant to Section 1363 shall also contain a statement that enrollees are encouraged to use…
§ 1363.3 (a) The department may develop standard templates for a schedule of benefits, an explanation of benefits, a cost-sharing summary, or any similar document. The…
§ 1363.5 (a) A plan shall disclose or provide for the disclosure to the director and to network providers the process the plan, its contracting provider groups, or any…
§ 1364 Where the director finds it necessary in the interest of full and fair disclosure, all advertising and other consumer information disseminated by a plan for…
§ 1364.1 Within 30 days of receiving the notice required by Section 1255.1, a health care service plan shall notify, or provide for the notification of, enrollees who…
§ 1364.5 (a) On or before July 1, 2001, every health care service plan shall file with the director a copy of their policies and procedures to protect the security of…
§ 1365 (a) An enrollment or a subscription shall not be canceled or not renewed except for the following reasons: (1) (A) Except as otherwise specified in…
§ 1365.5 (a) No health care service plan or specialized health care service plan shall refuse to enter into any contract or shall cancel or decline to renew or…
§ 1366 (a) No plan may use in its name, any of the words “insurance,” “casualty,” “surety,” “mutual,” or any other words descriptive of the insurance, casualty, or…
§ 1366.1 (a) The department shall adopt regulations on or before July 1, 2003, that establish an extended geographic accessibility standard for access to health care… see note
§ 1366.2 (a) A full health care service plan shall make available to a group subscriber, upon request, the termination date of all major health care provider contracts…
§ 1366.3 (a) On and after January 1, 2005, a health care service plan issuing individual plan contracts that ceases to offer individual coverage in this state shall…
§ 1366.4 (a) A medical group, physician, or independent practice association that contracts with a health care service plan may enter into contracts with licensed…
§ 1366.6 (a) For purposes of this section, the following definitions shall apply: (1) “Exchange” means the California Health Benefit Exchange established in Title 22… see note