(a)  A full health care service plan shall make available to a group subscriber, upon request, the termination date of all major health care provider contracts that are for services in the geographic area for which the group subscriber has secured coverage and that include a specified termination date.

(b)  For purposes of this section, the following terms have the following meanings:

Terms Used In California Health and Safety Code 1366.2

  • Contract: A legal written agreement that becomes binding when signed.
  • Person: means any person, individual, firm, association, organization, partnership, business trust, foundation, labor organization, corporation, limited liability company, public agency, or political subdivision of the state. 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
  • Provider: means any professional person, organization, health facility, or other person or institution licensed by the state to deliver or furnish health care services. See California Health and Safety Code 1345
  • specialized health care service plan: means either of the following:

    California Health and Safety Code 1345

  • Subscriber: means the person who is responsible for payment to a plan or whose employment or other status, except for family dependency, is the basis for eligibility for membership in the plan. See California Health and Safety Code 1345

(1)  “Enrollee” means a person who is enrolled in a health care service plan and who is a recipient of services from the plan.

(2)  “Full health care service plan” means a plan that meets the definition set forth in subdivision (f) of Section 1345, and that has a total enrolled membership exceeding 499,999 enrollees.

(3)  “Hospital” means a general acute care hospital.

(4)  “Major health care provider contract” means a contract between a full service plan and provider group or hospital covering more than 25,000 of that plan’s enrollees. “Major health care provider contract” does not mean a provider contract between a specialized health care service plan and a provider group or hospital.

(5)  “Provider group” means a medical group, independent practice association, or other similar group of providers with a total enrolled membership exceeding 99,999 enrollees.

(Added by Stats. 2004, Ch. 411, Sec. 1. Effective September 9, 2004.)

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