Health and Safety Code section 1374.65

Point-of-service plan contracts shall:

(a)

Provide incentives, including financial incentives, for enrollees to use in-network coverage or services.

(b)

Only offer coverage or services obtained out-of-network if it also provides coverage or services on an in-network basis.

(c)

Shall not consider the following to be out-of-network coverage or services:

(1)

Health care services received from a provider not affiliated with the health care service plan when the plan arranges for the enrollee to receive services from that provider.

(2)

Out-of-area emergency care provided in accordance with the procedures set by the health care service plan to be followed in securing these services.

Source: Section 1374.65, https://leginfo.­legislature.­ca.­gov/faces/codes_displaySection.­xhtml?lawCode=HSC§ionNum=1374.­65.­ (updated Jan. 1, 1994; accessed Jun. 30, 2025).

Green check means up to date. Up to date

Verified:
Jun. 30, 2025

§ 1374.65's source at ca​.gov