§ 10020
302 words·~1 min read·
/ca/welfare-and-institutions-code/10020A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(a)No person having private health care coverage shall be entitled to receive the same health care items or services furnished or paid for by a publicly funded health care program.
(b)As used in this chapter:
(1)“Publicly funded health care program” shall mean care or services rendered by a local government or any facility thereof, or health care services for which payment is made under the California Medical Assistance Program established by Chapter 7 (commencing with Section 14000) of Part 3 of this division by the State Department of Health Services or by its fiscal intermediary, or by a carrier or other organization with which the State Department of Health Services has contracted to furnish those services or to pay providers who furnish those services.
(2)As used in this chapter, “private health care coverage” means any health insurer, self-insured plan, group health plan, as defined in Section 607(1) of the Employee Retirement Income Security Act of 1974, service benefit plan, managed care organization, including health care service plans as defined in subdivision
(f)of Section 1345 of the Health and Safety Code, licensed pursuant to the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code, pharmacy benefit manager, or other party that is, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service.
(c)If a person receives health care furnished or paid for by a publicly funded health care program, the carrier of the person’s private health care coverage shall reimburse the publicly funded health care program the cost incurred in rendering that care to the extent of the benefits provided under the terms of the policy for the items provided or the services rendered.