Section 1374.65 Of Article 5.6. Point-of-service Health Care Service Plan Contracts From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 5.6.
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.