Section 2240.2 - Insurance Contract ProvisionsInsurance contracts containing provisions covering network provider services shall contain the following:
(a) A provision for coverage on an indemnity or provision of service basis at in-network cost sharing at the lowest cost-sharing tier for emergency health care services rendered to covered persons, consistent with the requirements of Insurance Code section 10112.7, and any other applicable law.(b) A provision that the insurer shall give written notice to the contract holder, within a reasonable period of time, of any termination or permanent breach of contract by, or permanent inability to perform of, any network provider if such termination, breach or inability would materially and adversely affect the contract holder or covered persons or will result in the insurer's network not being in compliance with this article.(c) A provision that the contract holder shall distribute to the primary covered persons the substance of any notice given to the contract holder pursuant to subdivision (b) not later than 30 days after its receipt.(d) A provision that, pursuant to Insurance Code Section 10133.56, upon termination of a network provider contract, the insurer shall be liable for covered services rendered by such provider to a covered person under the care of such provider at the time of termination until such services are completed, unless reasonable and medically appropriate arrangements for assumption of such services by another network provider are made. This provision need not provide that the insurer shall be liable for any services rendered to a covered person after such person ceases to be eligible for coverage under the insurance contract.(e) A provision defining the service area.Cal. Code Regs. Tit. 10, § 2240.2
1. Amendment of section heading, section and NOTE filed 1-8-2008; operative 2-7-2008 (Register 2008, No. 2).
2. Amendment of subsections (a)-(c) filed 3-8-2016; operative 3-8-2016 pursuant to Government Code section 11343.4(b)(3) (Register 2016, No. 11). Note: Authority cited: Section 10133.5, Insurance Code. Reference: Sections 10133, 10133.5 and 10133.56, Insurance Code.
1. Amendment of section heading, section and Note filed 1-8-2008; operative 2-7-2008 (Register 2008, No. 2).
2. Amendment of subsections (a)-(c) filed 3-8-2016; operative 3/8/2016 pursuant to Government Code section 11343.4(b)(3) (Register 2016, No. 11).