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