Section 10850 Of Article 6. Participating Carriers From California Insurance Code >> Division 2. >> Part 2. >> Chapter 9. >> Article 6.
10850
. (a) In order to be eligible to be a participating carrier, a
carrier shall demonstrate the following operating characteristics
satisfactory to the board:
(1) Be licensed and approved as a carrier and in good standing
with the appropriate regulatory authority.
(2) The ability to provide data required by the board, including
information on enrollee satisfaction based on standard surveys, as
may be prescribed, and to meet reasonable satisfaction measures as
may be established.
(3) The ability to provide standard data elements in a manner
prescribed by the board.
(4) All other criteria established by the board.
(b) Carriers that contract with or employ health care providers
shall have mechanisms to accomplish all of the following in a manner
satisfactory to the purchasing alliance, provided that the
requirements of the alliance do not conflict with the carrier's
licensing requirements:
(1) Review the quality of care covered.
(2) Review the appropriateness of care covered.
(3) Provide accessible health care services.
(c) In evaluating which carriers may participate in the purchasing
alliance, the board shall consider all of the following:
(1) Minimum geographic service and participation requirements,
maximum thresholds for premium rates, and standards for determining
whether a carrier operates efficiently.
(2) The ability of a carrier to provide services within the
purchasing alliance service regions.
(3) Pricing and the competitiveness of each bid from a carrier.