California Health and Safety Code

§ 1375.1

HSC § 1375.1 Effective Jan 1, 2013Div. 2 · Ch. 2.2 · Art. 6

Statute text

(a)Every plan shall have and shall demonstrate to the director that it has all of the following:

(1)A fiscally sound operation and adequate provision against the risk of insolvency.

(2)Assumed full financial risk on a prospective basis for the provision of covered health care services, except that a plan may obtain insurance or make other arrangements for the cost of providing to any subscriber or enrollee covered health care services, the aggregate value of which exceeds five thousand dollars ($5,000) in any year, for the cost of covered health care services provided to its members other than through the plan because medical necessity required their provision before they could be secured through the plan, and for not more than 90 percent of the amount by which its costs for any of its fiscal years exceed 115 percent of its income for that fiscal year.

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Legislative history

Amended by Stats. 2012, Ch. 782, Sec. 7. (AB 1733) Effective January 1, 2013.