Cal. Code Regs. Tit. 22, § 53452 - Information to New Members

Each plan shall provide, in writing, in addition to those items of information required by Section 14406, Welfare and Institutions Code, the following to each member within seven days after the effective date of enrollment:

(a) The effective date of enrollment and the term of enrollment.

(b) A description of all available services and an explanation of any service limitations, exclusions from coverage or charges for services when applicable.

(c) The name, telephone number and service site address of the primary care physician chosen by or otherwise made available to the member.

(d) The appropriate use of health care services and the contributions the member can make toward the maintenance of the member's own health.

(e) Information concerning transportation arrangements offered by the plan.

(f) An explanation of the member's right to request a fair hearing under Welfare and Institutions Code Section 10950, et seq. for unresolved grievances and to request a fair hearing without going through the plan's grievance procedures when a health care service requested by the member or a provider has not been provided.

Notes

Cal. Code Regs. Tit. 22, § 53452

1. Amendment filed 7-5-78; effective thirtieth day thereafter (Register 78, No. 27).
2. Amendment filed 12-30-81; effective thirtieth day thereafter (Register 82, No. 1).
3. Repealer of subsection (a) designator, subsection relettering, new subsection (f) and amendment of NOTE filed 10-17-95; operative 11-16-95 (Register 95, No. 42).

Note: Authority cited: Section 14312, Welfare and Institutions Code. Reference: Sections 10950, 14406 and 14450, Welfare and Institutions Code.

1. Amendment filed 7-5-78; effective thirtieth day thereafter (Register 78, No. 27).
2. Amendment filed 12-30-81; effective thirtieth day thereafter (Register 82, No. 1).
3. Repealer of subsection (a) designator, subsection relettering, new subsection (f) and amendment of Note filed 10-17-95; operative 11-16-95 (Register 95, No. 42).