§ 1374.65
102 words·~1 min read·
/ca/health-and-safety-code/1374-65A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Point-of-service plan contracts shall:
(a)Provide incentives, including financial incentives, for enrollees to use in-network coverage or services.
(b)Only offer coverage or services obtained out-of-network if it also provides coverage or services on an in-network basis.
(c)Shall not consider the following to be out-of-network coverage or services:
(1)Health care services received from a provider not affiliated with the health care service plan when the plan arranges for the enrollee to receive services from that provider.
(2)Out-of-area emergency care provided in accordance with the procedures set by the health care service plan to be followed in securing these services.