SECTIONS 12715-12718 - California Statutes

INSURANCE CODE

SECTION 12715-12718

12715. If the board is unable to contract with participating health
plans pursuant to Chapter 5 (commencing with Section 12720) the
board shall issue or cause to be issued a policy of major risk
medical coverage to subscribers. The policy may be offered directly
by the program or by a participating health plan through a contract
with the board. The contract may provide that the contracting health
plan assumes full or partial risk for the cost of covered health
services or that the contracting health plan undertakes only to
provide administrative services. The subscriber contribution under
this chapter shall not exceed 125 percent of the standard average
individual rate for comparable coverage as determined by the board.

12716. The program may place a lien on compensation or benefits
recovered or recoverable by a subscriber from any party or parties
responsible for the compensation or benefits for which benefits have
been provided under a policy issued under this chapter or Chapter 5
(commencing with Section 12720).

12717. Except as provided in Article 3.5 (commencing with Section
14124.70) of Chapter 7 of Part 3 of Division 9 of the Welfare and
Institutions Code, benefits received under this chapter or Chapter 5
(commencing with Section 12720) are in excess of and secondary to,
any other form of health benefits coverage.

12718. Benefits under this chapter or Chapter 5 (commencing with
Section 12720) shall be subject to required subscriber copayments and
deductibles as the board may authorize. Any authorized copayments
shall not exceed 25 percent and any authorized deductible shall not
exceed an annual household deductible amount of five hundred dollars
($500). However, health plans not utilizing a deductible may be
authorized to charge an office visit copayment of up to twenty-five
dollars ($25). If the board contracts with participating health plans
pursuant to Chapter 5 (commencing with Section 12720), copayments or
deductibles shall be authorized in a manner consistent with the
basic method of operation of the participating health plans. The
aggregate amount of deductible and copayments payable annually under
this section shall not exceed two thousand five hundred dollars
($2,500) for an individual and four thousand dollars ($4,000) for a
family.