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California Knox-Keene Health Care Service Plan Act and Regulations

Publisher: Michie

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Print Book :1 volume, softbound, updated annually
2017 Edition
ISBN: 9781522126843
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The Knox-Keene Health Care Service Plan Act of 1975 (Act) at California Health & Safety Code section 1340 et seq. governs the licensing and activities of health care service plans in the State of California. The Act and corresponding regulations at title 28 of the California Code of Regulations (Act and Rules) are administered by the Department of Managed Health Care (DMHC) under the California Health and Human Services Agency.

The DMHC, created by consumer-sponsored legislation in 1999 and funded by health plan assessments, oversees full-service health plans, including all California HMOs and some PPOs, as well as specialized plans such as dental and vision. Overall, the DMHC regulates more than 95 percent of the commercial and public insurance enrollment in California.

Table of Contents

Table of Code Sections Affected

Table of Regulations Affected



HEALTH AND SAFETY CODE

Division 2. Licensing Provisions

Chapter 2.2. Health Care Service Plans

Article 1. General, §§ 1340 to 1345

Article 2. Administration, §§ 1346 to 1348.96

Article 3. Licensing and Fees, §§ 1349 to 1356.2

Article 3.1. Small Employer Group Access to Contracts for Health Care Services, §§ 1357 to 1357.19

Article 3.11. Insurance Market Reform, §§ 1357.20 to 1357.23

Article 3.15. Preexisting Condition Provisions, §§ 1357.50 to 1357.55

Article 3.16. Nongrandfathered Small Employer Plans, §§ 1357.500 to 1357.516

Article 3.17. Grandfathered Small Employer Plans, §§ 1357.600 to 1357.618

Article 3.2. Additional Requirements for Medicare Supplement Contracts [Renumbered]

Article 3.5. Additional Requirements for Medicare Supplement Contracts, §§ 1358 to 1358.24

Article 4. Solicitation and Enrollment, §§ 1359 to 1366.6

Article 4.5. California COBRA Program, §§ 1366.20 to 1366.29

Article 4.6. Coverage for Federally Eligible Defined Individuals, §§ 1366.35, 1366.50

Article 5. Standards, §§ 1367 to 1374.195

Article 5.5. Health Care Service Plan Coverage Contract Changes, §§ 1374.20 to 1374.29

Article 5.55. Appeals Seeking Independent Medical Reviews, §§ 1374.30 to 1374.36

Article 5.6. Point-of-Service Health Care Service Plan Contracts, §§ 1374.60 to 1374.76

Article 6. Operation and Renewal Requirements and Procedures, §§ 1375 to 1385

Article 6.2. Review of Rate Increases, §§ 1385.01 to 1385.13

Article 7. Discipline, §§ 1386 to 1389

Article 7.5. Underwriting Practices, §§ 1389.1 to 1389.8

Article 8. Other Enforcement Procedures, §§ 1390 to 1394.3

Article 8.5. Service of Process, §§ 1394.5 to 1394.8

Article 9. Miscellaneous, §§ 1395 to 1399.5

Article 9.5. Claims Reviewers, §§ 1399.55 to 1399.57

Article 10. Discontinuance and Replacement of Group Health Care Service Plan Contracts, §§ 1399.60 to 1399.64

Article 10.5. Individual Access to Contracts for Health Care Services [Renumbered]

Article 11. Nonprofit Plans, §§ 1399.70 to 1399.76

Article 11.1. Consumer Operated and Oriented Plans §§ 1399.80 to 1399.88

Article 11.5. Individual Access to Contracts for Health Care Services, §§ 1399.801 to 1399.900

Article 11.7. Child Access to Health Care Coverage, §§ 1399.825 to 1399.836

Article 11.8. Individual Access to Health Care Coverage, §§ 1399.845 to 1399.864

CALIFORNIA CODE OF REGULATIONS

Title 28. Managed Health Care

Division 1. The Department of Managed Health Care

Chapter 1. Department Administration

Article 1. Conflict of Interest, §§ 1000

Article 2. Administration, §§ 1001 to 1011

Article 3. Electronic Filing, § 1300.41.8

Chapter 2. Health Care Service Plans

Article 1. Exemptions, §§ 1300.43 to 1300.43.15

Article 2. Administration, §§ 1300.44 to 1300.47

Article 3. Plan Applications and Amendments, §§ 1300.50 to 1300.52.4

Article 4. Solicitors, §§ 1300.57 to 1300.59.2

Article 5. Advertising and Disclosure, §§ 1300.61 to 1300.64.55

Article 6. Appeals on Cancellation, §§ 1300.65 to 1300.66

Article 7. Standards, §§ 1300.67 to 1300.67.59

Article 8. Self-Policing Procedures, §§ 1300.60 to 1300.74.73

Article 9. Financial Responsibility, §§ 1300.75 to 1300.78

Article 10. Medical Surveys, §§ 1300.80, 1300.80.10

Article 11. Examinations, §§ 1300.81 to 1300.82.1

Article 12. Reports, §§ 1300.83 to 1300.84.7

Article 13. Books and Records, §§ 1300.85, 1300.85.1

Article 14. Miscellaneous Provisions, §§ 1300.86 to 1300.99.7

Article 15. Charitable or Public Activities, §§ 1300.824 to 1300.826

Index