California Health and Safety Code 1374.65 – Point-of-service plan contracts shall:(a) Provide incentives, …
Point-of-service plan contracts shall:
(a) Provide incentives, including financial incentives, for enrollees to use in-network coverage or services.
Terms Used In California Health and Safety Code 1374.65
- 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
- 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
(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.
(Added by Stats. 1993, Ch. 987, Sec. 3. Effective January 1, 1994.)