Cal. Code Regs. Tit. 22, § 56452 - Information to New Members

Each PCCM plan shall provide to members, in writing, 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) An explanation of the procedure for obtaining services.

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

(e) An explanation of and the procedure for obtaining health service rendered in emergency circumstances occurring outside the PCCM plan's service area.

(f) The causes for which a member will lose entitlement to receive services from the PCCM plan.

(g) The procedure for processing and resolving any grievance by members. This information shall include the title, address, and telephone number of a person responsible for resolving grievances or initiating the grievance procedure and shall include 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 PCCM plan's grievance procedures when a health care service requested by the member or a provider has not been provided.

(h) Disenrollment procedures, including an explanation of the member's right to disenroll without cause, and a disenrollment form.

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

Notes

Cal. Code Regs. Tit. 22, § 56452

1. New section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 7-9-90.
2. New section refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed by operation of law on 11-6-90.
3. Request to readopt section on an emergency basis pursuant to Government Code section 11346.1 granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No. 6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 11-6-90 order transmitted to OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5. New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No. 18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or emergency language will be repealed by operation of law on the following day.
6. Repealed by operation of Government Code section 11346.1(g) (Register 92, No. 1).
7. New section filed 10-17-95; operative 11-16-95 (Register 95, No. 42).

Note: Authority cited: Sections 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 10950, 14088.16, 14088.5, 14406 and 14450, Welfare and Institutions Code.

1. New section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 7-9-90.
2. New section refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed by operation of law on 11-6-90.
3. Request to readopt section on an emergency basis pursuant to Government Code section 11346.1 granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No. 6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 11-6-90 order transmitted to OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5. New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No. 18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or emergency language will be repealed by operation of law on the following day.
6. Repealed by operation of Government Code section 11346.1(g) (Register 92, No. 1).
7. New section filed 10-17-95; operative 11-16-95 (Register 95, No. 42).