The California Knox-Keene Health Care Service Plan Act and Regulations: Summarized

Where does the State of California rank in terms of its residents embodying the stereotypical picture of sunny California healthy living? State regulations strive to ensure that all have access to quality health care

The purpose of this important legislation is to ensure that your physician maintains her or his role as a trusted source for medical advice and maintains confidentiality. Your physician is responsible for making sure you receive accessible medical services.

Any kind of contract between your health care plan and your doctor or doctoręs group that encourages or limits specific medical treatments is prohibited. However, doctors are not prohibited from being paid a set amount for all patients as long as the payment doesnęt pertain to your doctor making specific medical conditions.

If you need to see a specialist, your health plan must provide medical referrals to other providers regardless of monetary or administrative decisions.

Continuity of care is assured through the code of regulations, which says that basic health care services shall provide continuity of care such as accessible primary care physicians, health records that can be obtained easily, and staff members who provide timely support along with proper documentation.

California code requires that health services must be easy to get to within each service area of a plan. Additionally, one full-time physician should have no more than 1,200 enrollees and one full-time primary care physician should be responsible for no more than 2,000 enrollees.

Health insurance programs in the state of California also must include plans for quality assurance so that consumers continue to receive health care that meets contractual obligations.

All health insurance plans in the state of California must disclose to the Director of the Department of Managed Health Care and network associates the process whereby the company denies, modifies or authorizes health care services. Upon request, you should be able to receive this information.