ARTICLE 5.6. Point-of-Service Health Care Service Plan Contracts
Article 5.6 added by Stats. 1993, Ch. 987, Sec. 3.
§§ 1374.60–1374.76 · 18 sections
- § 1374.60 For purpose of this article, the following definitions shall apply: (a) A “point-of-service plan contract” means any plan contract offered by a health care…
- § 1374.62 A point-of-service plan contract, in which any risk for out-of-network coverage or services is transferred from a health care service plan through reinsurance,…
- § 1374.64 (a) Only a plan that has been licensed under this chapter and in operation in this state for a period of five years or more, or a plan licensed under this…
- § 1374.65 Point-of-service plan contracts shall: (a) Provide incentives, including financial incentives, for enrollees to use in-network coverage or services. (b) Only…
- § 1374.66 Any health care service plan that offers a point-of-service plan contract may do all of the following: (a) Limit or exclude coverage for specific types of…
- § 1374.67 A health care service plan offering a point-of-service plan contract is subject to the following limitations: (a) A health care service plan shall limit its…
- § 1374.68 A health care service plan that offers a point-of-service plan contract shall do all of the following: (a) Deposit with the director or, at the discretion of…
- § 1374.69 At least 20 business days prior to offering a point-of-service plan contract, a health care service plan shall file a notice of material modification in…
- § 1374.71 No plan formerly registered under the Knox-Mills Health Plan Act (Article 2.5 (commencing with Section 12530) of Chapter 6 of Part 2 of Division 3 of Title 2…
- § 1374.72 (a) (1) Every health care service plan contract issued, amended, or renewed on or after January 1, 2021, that provides hospital, medical, or surgical coverage…
- § 1374.721 (a) A health care service plan that provides hospital, medical, or surgical coverage shall base any medical necessity determination or the utilization review…
- § 1374.722 (a) (1) A health care service plan contract issued, amended, renewed or delivered on or after January 1, 2024, that is required to provide coverage for…
- § 1374.723 (a) A health care service plan contract issued, amended, renewed, or delivered on or after July 1, 2023, that covers hospital, medical, or surgical expenses…
- § 1374.724 (a) Coverage of mental health and substance use disorder treatment pursuant to Section 1374.72 includes behavioral health crisis services that are provided to…
- § 1374.725 For services provided to an enrollee under a health care service plan contract issued, amended, or renewed on or after July 1, 2025, a health care service plan…
- § 1374.73 (a) (1) Every health care service plan contract that provides hospital, medical, or surgical coverage shall also provide coverage for behavioral health…
- § 1374.74 (a) The department, in consultation with the Department of Insurance, shall convene an Autism Advisory Task Force by February 1, 2012, in collaboration with…
- § 1374.76 (a) No later than January 1, 2015, a large group health care service plan contract shall provide all covered mental health and substance use disorder benefits…