Section 1367.29 Of Article 5. Standards From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 5.
1367.29
. (a) On and after July 1, 2011, in accordance with the
requirements of subdivision (b), every health care service plan that
provides coverage for professional mental health services, including
a specialized health care service plan that provides coverage for
professional mental health services, shall issue an identification
card to each enrollee in order to assist the enrollee with accessing
health benefits coverage information, including, but not limited to,
in-network provider access information, and claims processing
purposes. The identification card, at a minimum, shall include all of
the following information:
(1) The name of the health care service plan issuing the
identification card.
(2) The enrollee's identification number.
(3) A telephone number that enrollees or providers may call for
assistance with health benefits coverage information, in-network
provider access information, and claims processing information, and
when assessment services are provided by the health care service
plan, access to assessment services for the purpose of referral to an
appropriate level of care or an appropriate health care provider.
(4) The health care service plan's Internet Web site address.
(b) The identification card required by this section shall be
issued by a health care service plan or a specialized health care
service plan to an enrollee upon enrollment or upon any change in the
enrollee's coverage that impacts the data content or format of the
card.
(c) Nothing in this section requires a health care service plan to
issue a separate identification card for professional mental health
services coverage if the plan issues a card for health care coverage
in general and the card provides the information required by this
section.
(d) If a health care service plan or a specialized health care
service plan, as described in subdivision (a), delegates
responsibility for issuing the identification card to a contractor or
an agent, the contractor or agent shall be required to comply with
this section.
(e) Nothing in this section shall be construed to prohibit a
health care service plan or a specialized health care service plan
from meeting the standards of the Workgroup for Electronic Data
Interchange (WEDI) or other national uniform standards with respect
to identification cards, and a health care service plan shall be
deemed compliant with this section if the plan conforms with these
standards, as long as the minimum requirements described in
subdivision (a) have been met.
(f) For the purposes of this section, "identification card"
includes other technology that performs substantially the same
function as an identification card.
(g) (1) This section shall not apply to Medicare supplement
insurance, Employee Assistance Programs, short-term limited duration
health insurance, Champus-supplement insurance, or TRI-CARE
supplement insurance, or to hospital indemnity, accident-only, and
specified disease insurance. This section shall also not apply to
specialized health care service plans, except behavioral health-only
plans.
(2) Notwithstanding paragraph (1), this section shall not apply to
a behavioral health-only plan that provides coverage for
professional mental health services pursuant to a contract with a
health care service plan or insurer if that plan or insurer issues an
identification card to its subscribers or insureds pursuant to this
section or Section 10123.198 of the Insurance Code.