Section 1374.68 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.
1374.68
. A health care service plan that offers a point-of-service
plan contract shall do all of the following:
(a) Deposit with the director or, at the discretion of the
director, with any organization or trustee acceptable to the director
through which a custodial or controlled account is maintained, cash,
securities, or any combination of these, which is acceptable to the
director, that at all times have a fair market value equal to the
greater of either one of the following:
(1) Two hundred thousand dollars ($200,000).
(2) One hundred twenty percent of the plan's current monthly
claims payable plus incurred but not reported balance for coverage
out-of-network coverage or services provided under point-of-service
contracts.
(b) Track out-of-network point-of-service utilization separately
from in-network utilization.
(c) Record point-of-service utilization in a manner that will
permit utilization and cost reporting as the director may require.
(d) Demonstrate to the satisfaction of the director that the
health care service plan has the fiscal, administrative, and
marketing capacity to control its point-of-service plan contract
enrollment, utilization, and costs so as not to jeopardize the
financial viability or organizational and administrative capacity of
the health care service plan.
(e) Maintain the deposit required under subdivision (a) in a
manner agreed to by the director, subject to subdivision (a) of
Section 1377 and any regulations adopted thereunder.
(f) Any deposit made pursuant to this section shall be a credit
against any deposit required by subdivision (a) of Section 1377.