Cal. Code Regs. Tit. 22, § 53920.5 - Marketing and Member Materials

(a) The Evidence of Coverage, disclosure form, and any marketing brochure developed by or for a GMC plan and distributed to prospective members shall meet the requirements contained in Section 1300.63(a), Title 10, as to print size, readability, and understandability of text.

(b) All marketing materials distributed to eligible beneficiaries by a GMC plan shall fully disclose the availability of and restrictions upon the services provided by the GMC plan, and any exclusions from coverage. Marketing materials shall, at a minimum, specify:

(1) The scope, access to, and availability of services, including service site locations and telephone numbers, and the service area authorized in that GMC plan's GMC contract.

(2) A description of the membership identification card issued by the GMC plan, if applicable, and an explanation as to its use in authorizing or assisting members to obtain services.

(3) That members shall obtain all Medi-Cal covered nonemergency health care services through the GMC plan's providers.

(4) That medical or dental services required in an emergency may be obtained from specified GMC plan providers or from non-plan providers, if necessary.

(5) The disenrollment process, and an explanation that disenrollment is possible only under the conditions specified in Section 53925.5 and is effective only after the disenrollment transaction is completed by the department.

(6) The GMC plan's grievance process, including instructions on how to use it.

(7) That members have the right to a fair hearing, including instructions on how to request one.

(8) The interpretive, linguistic, and cultural services available through plan personnel.

(9) Any transportation services to service sites that are available through the GMC plan or under the Medi-Cal program. This shall include a description of both medical and non-medical transportation services, and the conditions under which non-medical transportation is available to members, if available.

Notes

Cal. Code Regs. Tit. 22, § 53920.5

1. New section filed 3-11-94; operative 3-11-94; Submitted to OAL for printing only pursuant to section 147, SB 485 (Chapter 722, Statutes of 1992) (Register 94, No. 15).

Note: Authority cited: Sections 10725, 14089.7, 14105, 14124.5, 14203 and 14312, Welfare and Institutions Code. Reference: Sections 14088.15, 14088.22, 14089 and 14408, Welfare and Institutions Code; and Sections 1363 and 1364, Health and Safety Code.

1. New section filed 3-11-94; operative 3-11-94; Submitted to OAL for printing only pursuant to section 147, SB 485 (Chapter 722, Statutes of 1992) (Register 94, No. 15).