Major Risk Medical Insurance Fund

Cal. WIC § 15894

California Statutes

(

a) Except as provided in

Section 15894.5, the department shall authorize the expenditure of money in the fund to cover program expenses, including program expenses that exceed subscriber contributions, and to cover expenses relating to

Section 10127.16 of the Insurance Code,

Section 1373.622 of the Health and Safety Code, and health care services for eligible individuals in the Medi-Cal program. The department shall determine the amount of funds expended for each of these purposes, taking into consideration the requirements of this chapter,

Section 10127.16 of the Insurance Code, and

Section 1373.622 of the Health and Safety Code. Funds may be expended for health care services for eligible individuals in the Medi-Cal program only after all costs for the administration and delivery of health care services under

Section 1373.622 of the Health and Safety Code and

Section 10127.16 of the Insurance Code have been fully funded. (

b) Following consultation with a health care service plan or health insurer, if the department and the health care service plan or health insurer have not agreed to a final reconciliation of the amount to be expended from the fund or to be reimbursed to the fund, the department shall give written notice of its determination to the health care service plan or health insurer of the final reconciliation amount, as determined by the department. The health care service plan or health insurer shall remit payment to the department within days of the date of notice from the department.

If payment is not received, interest shall accrue in the amount of percent per annum. The department may offset the amount to be reimbursed to the fund against any other payments owed to the health care service plan or health insurer by the department, or may negotiate a payment plan with the health care service plan or health insurer for full payment, and in that case may waive interest accrual as long as payment from the health care service plan or health insurer is made in accordance with the payment plan.

This subdivision shall control over any conflict or ambiguity between this subdivision and the provisions of

Section 1373.622 of the Health and Safety Code,

Section 10127.16 of the Insurance Code,

Part 6.5 (commencing with

Section 12700) of Division of the Insurance Code, or this chapter.

Document details

CollectionCalifornia Statutes
CitationCal. WIC § 15894
Date2017-07-10
Typestatute
Languageen
SourceCA_STAT
IdentifierWIC15894.20175281

Major Risk Medical Insurance Fund

Cal. WIC § 15894

California Statutes

Major Risk Medical Insurance Fund

Cal. WIC § 15894

California Statutes

(

a) Except as provided in

Section 15894.5, the department shall authorize the expenditure of money in the fund to cover program expenses, including program expenses that exceed subscriber contributions, and to cover expenses relating to

Section 10127.16 of the Insurance Code,

Section 1373.622 of the Health and Safety Code, and health care services for eligible individuals in the Medi-Cal program. The department shall determine the amount of funds expended for each of these purposes, taking into consideration the requirements of this chapter,

Section 10127.16 of the Insurance Code, and

Section 1373.622 of the Health and Safety Code. Funds may be expended for health care services for eligible individuals in the Medi-Cal program only after all costs for the administration and delivery of health care services under

Section 1373.622 of the Health and Safety Code and

Section 10127.16 of the Insurance Code have been fully funded. (

b) Following consultation with a health care service plan or health insurer, if the department and the health care service plan or health insurer have not agreed to a final reconciliation of the amount to be expended from the fund or to be reimbursed to the fund, the department shall give written notice of its determination to the health care service plan or health insurer of the final reconciliation amount, as determined by the department. The health care service plan or health insurer shall remit payment to the department within days of the date of notice from the department.

If payment is not received, interest shall accrue in the amount of percent per annum. The department may offset the amount to be reimbursed to the fund against any other payments owed to the health care service plan or health insurer by the department, or may negotiate a payment plan with the health care service plan or health insurer for full payment, and in that case may waive interest accrual as long as payment from the health care service plan or health insurer is made in accordance with the payment plan.

This subdivision shall control over any conflict or ambiguity between this subdivision and the provisions of

Section 1373.622 of the Health and Safety Code,

Section 10127.16 of the Insurance Code,

Part 6.5 (commencing with

Section 12700) of Division of the Insurance Code, or this chapter.

Document details

CollectionCalifornia Statutes
CitationCal. WIC § 15894
Date2017-07-10
Typestatute
Languageen
SourceCA_STAT
IdentifierWIC15894.20175281