ARTICLE 6. Operation and Renewal Requirements and Procedures

Article 6 added by Stats. 1975, Ch. 941.

§§ 1375.1–1385 · 27 sections

§ 1375.1 (a) Every plan shall have and shall demonstrate to the director that it has all of the following: (1) A fiscally sound operation and adequate provision against…
§ 1375.2 On and after October 1, 1977, every plan operating under a transitional license shall have a fiscally sound operation.
§ 1375.3 (a) A health care service plan shall meet and confer with the director and his or her designated representatives at least 10 business days prior to filing a…
§ 1375.4 (a) Every contract between a health care service plan and a risk-bearing organization that is issued, amended, renewed, or delivered in this state on or after…
§ 1375.5 No contract between a risk-bearing organization and a health care service plan that is issued, amended, delivered, or renewed in this state on or after July 1,…
§ 1375.6 No contract between a risk-bearing organization and a health care service plan that is issued, amended, delivered, or renewed in this state on or after July 1,…
§ 1375.61 (a) A contract between a health care service plan and a provider of health care services shall not contain any term that would result in termination or…
§ 1375.7 (a) This section shall be known and may be cited as the Health Care Providers’ Bill of Rights. (b) No contract issued, amended, or renewed on or after January…
§ 1375.8 (a) The Legislature finds the following: (1) Because of the nature and cost of certain medical items, the financial risk of these items is better retained by…
§ 1375.9 (a) A health care service plan shall ensure that there is at least one full-time equivalent primary care physician for every 2,000 enrollees of the plan. The…
§ 1376 (a) No plan shall conduct any activity regulated by this chapter in contravention of such rules and regulations as the director may prescribe as necessary or…
§ 1376.1 The deposit requirements of Section 1300.76.1 of Title 28 of the California Code of Regulations shall not apply to any plan operated by a county, or city and…
§ 1377 (a) Every plan which reimburses providers of health care services that do not contract in writing with the plan to provide health care services, or which…
§ 1378 No plan shall expend for administrative costs in any fiscal year an excessive amount of the aggregate dues, fees and other periodic payments received by the…
§ 1379 (a) Every contract between a plan and a provider of health care services shall be in writing, and shall set forth that in the event the plan fails to pay for…
§ 1379.5 (a) On and after July 1, 2008, every contract between a plan and a health care provider who provides health care services in Mexico to an enrollee of the plan…
§ 1380 (a) The department shall conduct periodically an onsite medical survey of the health delivery system of each plan. The survey shall include a review of the…
§ 1380.1 (a) The Legislature finds and declares as follows: (1) Multiple medical quality audits of health care providers, as many as 25 for some physician offices,…
§ 1380.2 (a) (1) Notwithstanding any other law, except as provided in Section 1374.197, on and after January 1, 2028, a full service health care service plan or its…
§ 1380.3 The department shall coordinate the surveys conducted pursuant to Section 1380 with the State Department of Health Care Services, to the extent possible, in…
§ 1381 (a) All records, books, and papers of a plan, management company, solicitor, solicitor firm, and any provider or subcontractor providing health care or other…
§ 1382 (a) The director shall conduct an examination of the fiscal and administrative affairs of any health care service plan, and each person with whom the plan has…
§ 1383 Every plan that is a health maintenance organization qualified under Section 1310(d) of Title XIII of the federal Public Health Service Act, shall provide the…
§ 1383.1 (a) On or before July 1, 1997, every health care service plan shall file with the department a written policy, which is not subject to approval or disapproval…
§ 1383.15 (a) When requested by an enrollee or participating health professional who is treating an enrollee, a health care service plan shall provide or authorize a…
§ 1384 (a) Within 90 days after receipt of a request from the director, a plan or other person subject to this chapter shall submit to the director an audit report…
§ 1385 Each plan, solicitor firm, and solicitor shall keep and maintain current such books of account and other records as the director may by rule require for the…