Section 1374.65 - Requirements for point-of-service plan contractsPoint-of-service plan contracts shall:
(a) Provide incentives, including financial incentives, for enrollees to use in-network coverage or services.(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.Ca. Health and Saf. Code § 1374.65
Added by Stats. 1993, Ch. 987, Sec. 3. Effective January 1, 1994.