You are here: California / Health and Safety Code - HSC / ARTICLE 5.6. Point-of-Service Health Care Service Plan Contracts [1374.60. - 1374.72.] / Section 1374.65.


Section 1374.65. (Added by Stats. 1993, Ch. 987, Sec. 3.)
Cite as: Cal. Health & Safety Code §1374.65.

Point-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.



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