California Insurance Code

§ 10133.5

INS § 10133.5 Effective Jan 1, 2003Div. 2 · Part 2 · Ch. 1 · Art. 2

Statute text

(a)The commissioner shall, on or before January 1, 2004, promulgate regulations applicable to health insurers which contract with providers for alternative rates pursuant to Section 10133 to ensure that insureds have the opportunity to access needed health care services in a timely manner.

(b)These regulations shall be designed to assure accessibility of provider services in a timely manner to individuals comprising the insured or contracted group, pursuant to benefits covered under the policy or contract. The regulations shall insure: 1.Adequacy of number and locations of institutional facilities and professional providers, and consultants in relationship to the size and location of the insured group and that the services offered are available at reasonable times. 2.Adequacy of number of professional providers, and license classifications of such providers, in relationship to the projected demands for services covered under the group policy or plan. The department shall consider the nature of the specialty in determining the adequacy of professional providers. 3.The policy or contract is not inconsistent with standards of good health care and clinically appropriate care. 4. All contracts including contracts with providers, and other persons furnishing services, or facilities shall be fair and reasonable.

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Legislative history

Amended by Stats. 2002, Ch. 797, Sec. 5. Effective January 1, 2003.