Point-of-Service Health Care Service Plan Contracts

Cal. HSC § 1374.68

California Statutes

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 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.

Document details

CollectionCalifornia Statutes
CitationCal. HSC § 1374.68
Date2000-01-01
Typestatute
Languageen
SourceCA_STAT
IdentifierHSC1374.68.1999525119

Point-of-Service Health Care Service Plan Contracts

Cal. HSC § 1374.68

California Statutes

Point-of-Service Health Care Service Plan Contracts

Cal. HSC § 1374.68

California Statutes

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 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.

Document details

CollectionCalifornia Statutes
CitationCal. HSC § 1374.68
Date2000-01-01
Typestatute
Languageen
SourceCA_STAT
IdentifierHSC1374.68.1999525119