Cal. Code Regs. Tit. 22, § 53252 - Reinsurance

(a) The provisions of Section 53251 notwithstanding, the prepaid health plan may obtain reinsurance for the cost of providing covered services, subject to the following conditions:

(1) Reinsurance shall not reduce plan liability below $5,000 per member for any one 12-month period.

(2) Reinsurance may cover both of the following:

(A) The total cost of services provided to members under emergency circumstances by nonplan providers, including the cost of inpatient care in a nonplan facility until such time as the member may be safely transported to a plan facility.

(B) Up to 90 percent of all expenditures related to the contract exceeding 115 percent of the plan's gross income from capitation payments and third-party recoveries under the terms of the contract during any plan fiscal year.

Notes

Cal. Code Regs. Tit. 22, § 53252

1. New section filed 7-5-78; effective thirtieth day thereafter (Register 78, No. 27).
2. Amendment filed 12-10-79; effective thirtieth day thereafter (Register 79, No. 50).

Note: Authority cited: Section 14312, Welfare and Institutions Code. Reference: Section 14451.5(b), Welfare and Institutions Code.

1. New section filed 7-5-78; effective thirtieth day thereafter (Register 78, No. 27).
2. Amendment filed 12-10-79; effective thirtieth day thereafter (Register 79, No. 50).