§ 10123.199
443 words·~2 min read·
/ca/insurance-code/10123-199A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(a)A health insurer that provides coverage for professional mental health services shall establish an Internet Web site. Each Internet Web site shall include, or provide a link to, the following information:
(1)A telephone number that the insured or provider can call, during normal business hours, for assistance obtaining mental health benefits coverage information, including the extent to which benefits have been exhausted, in-network provider access information, and claims processing information.
(2)A link to prescription drug formularies posted pursuant to Section 10123.192, or instructions on how to obtain formulary information.
(3)A detailed summary description of the process by which the insurer reviews and approves, modifies, or denies requests for health care services as described in Section 10123.135.
(4)Lists of providers or instructions on how to obtain a provider list as required by Section 10133.1.
(5)A detailed summary of the health insurer’s grievance process.
(6)A detailed description of how the insured may request continuity of care as described in Section 10133.55.
(7)Information concerning the right, and applicable procedure, of the insured to request an independent medical review pursuant to Section 10169.
(b)Except as otherwise specified, the material described in subdivision
(a)shall be updated at least quarterly.
(c)The information described in subdivision
(a)may be made available through a secured Internet Web site that is only accessible to the insured.
(d)The material described in subdivision
(a)shall also be made available to insureds in hard copy upon request.
(e)This article does not preclude an insurer from including additional information on its Internet Web site for applicants or insureds, including, but not limited to, the cost of procedures or services by health care providers in an insurer’s network.
(f)The department shall include on the department’s Internet Web site, a link to the Internet Web site of each health insurer described in subdivision (a).
(g)This section shall not apply to Medicare supplement insurance, employee assistance programs, CHAMPUS supplement insurance, or TRI-CARE supplement insurance, or to hospital indemnity, accident-only, and specified disease insurance. This section shall also not apply to specialized health insurance policies, except behavioral health-only policies.
(h)This section shall not apply to a health insurer that contracts with a specialized health care service plan, insurer, or other entity to cover professional mental health services for its insureds, provided that the health insurer provides a link on its Internet Web site to an Internet Web site operated by the specialized health care service plan, insurer, or other entity with which it contracts, and that plan, insurer, or other entity complies with this section or Section 1368.016 of the Health and Safety Code.