Section 1368.016 Of Article 5. Standards From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 5.
1368.016
. (a) A 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, pursuant to subdivision (f) of Section
1368.015, include on its Internet Web site, or provide a link to, the
following information:
(1) A telephone number that the enrollee or provider can call,
during normal business hours, for assistance obtaining mental health
benefits coverage information, including the extent to which benefits
have been exhausted, in-network provider access information, and
claims processing information.
(2) A link to prescription drug formularies posted pursuant to
Section 1367.205, or instructions on how to obtain the formulary, as
described in Section 1367.20.
(3) A detailed summary that describes the process by which the
plan reviews and authorizes or approves, modifies, or denies requests
for health care services as described in Sections 1363.5 and
1367.01.
(4) Lists of providers or instructions on how to obtain the
provider list, as required by Section 1367.26.
(5) A detailed summary of the enrollee grievance process as
described in Sections 1368 and 1368.015.
(6) A detailed description of how an enrollee may request
continuity of care pursuant to subdivisions (a) and (b) of Section
1373.95.
(7) Information concerning the right, and applicable procedure, of
an enrollee to request an independent medical review pursuant to
Section 1374.30.
(b) Any modified material described in subdivision (a) shall be
updated at least quarterly.
(c) The information described in subdivision (a) may be made
available through a secured Internet Web site that is only accessible
to enrollees.
(d) The material described in subdivision (a) shall also be made
available to enrollees in hard copy upon request.
(e) Nothing in this article shall preclude a health care service
plan from including additional information on its Internet Web site
for applicants, enrollees or subscribers, or providers, including,
but not limited to, the cost of procedures or services by health care
providers in a plan's network.
(f) The department shall include on the department's Internet Web
site a link to the Internet Web site of each health care service plan
and specialized health care service plan described in subdivision
(a).
(g) 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.
(h) This section shall not apply to a health care service plan
that contracts with a specialized health care service plan, insurer,
or other entity to cover professional mental health services for its
enrollees, provided that the health care service plan provides a link
on its Internet Web site to an Internet Web site operated by the
specialized health care service plan, insurer, or other entity with
which it contracts, and that plan, insurer, or other entity complies
with this section or Section 10123.199 of the Insurance Code.