California Health and Safety Code 1374.194 – (a) The following definitions shall apply for purposes of this …
(a) The following definitions shall apply for purposes of this section:
(1) “Dental waiting period provision” means a plan contract provision that limits coverage for a specified period of time following an enrollee‘s effective date of coverage.
Terms Used In California Health and Safety Code 1374.194
- Contract: A legal written agreement that becomes binding when signed.
- Enrollee: means a person who is enrolled in a plan and who is a recipient of services from the plan. See California Health and Safety Code 1345
- plan: refers to health care service plans and specialized health care service plans. See California Health and Safety Code 1345
- Plan contract: means a contract between a plan and its subscribers or enrollees or a person contracting on their behalf pursuant to which health care services, including basic health care services, are furnished. See California Health and Safety Code 1345
- specialized health care service plan: means either of the following:
California Health and Safety Code 1345
(2) “Plan” means a health care service plan that issues, sells, renews, or offers a plan contract covering dental services, including a specialized health care service plan covering dental services.
(3) “Preexisting condition provision” means a contract provision that excludes or limits coverage for services, charges, or expenses incurred following an enrollee’s effective date of coverage for a condition for which dental services, diagnosis, care, or treatment was recommended or received preceding the effective date of coverage.
(b) On and after January 1, 2025, a plan shall not issue, amend, renew, or offer a plan contract that imposes a dental waiting period provision in a large group plan or preexisting condition provision for any plan.
(c) This section does not apply to Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
(Added by Stats. 2023, Ch. 557, Sec. 1. (AB 1048) Effective January 1, 2024.)