California Health Insurance Policies and Managed Care Plans Overview
Discover key information about health insurance policies and managed care plans regulated by the California Department of Insurance and the Department of Managed Health Care. Learn about the requirements for health care service plans with binding arbitration clauses and significant legal cases in the field of health care law.
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Michael J. Bidart Shernoff Bidart Echeverria LLP 1
Health Insurance Policies Managed Care Plans Regulated by the California Department of Insurance (DOI) Regulated by the Department of Managed Health Care (DMHC) California Insurance Code Form of disability insurance California Health and Safety Code 3
Health care service plans are engaged in the business of insurance. Smith v. PacifiCare Behavioral Health (2001) 93 Cal.App.4th 139, 157-158 Rush Prudential HMO, Inc. v. Moran (2002) 536 U.S. 355, 367-370 4
Requires health care service plans with binding arbitration clauses to provide in clear and understandable language a disclosure that: (1) States whether the plan uses binding arbitration to settle disputes, including medical malpractice; (2) Appears as a separate article in the agreement and is prominently displayed in the enrollment form; (3) States whether enrollee is waiving jury trial rights to medical malpractice, delivery of services under the plan, or both; and (4) Is displayed immediately before the signature line for the group representative and immediately before the signature line for the individual enrollee. 6
Burks v. Kaiser Foundation Health Plan (2008) 160 Cal.App.4th 1021 Imbler v. PacifiCare (2002) 103 Cal.App.4th 567 Malek v. Blue Cross of Cal. (2004) 121 Cal.App.4th 44 Medeiros v. Superior Court (2007) 146 Cal.App.4th 1008 Pagarigan v. Superior Court (2002) 102 Cal.App.4th 1121 Robertson v. Health Net of Cal. (2005) 132 Cal.App.4th 1419 Rodriguez v. Blue Cross of Cal. (2008) 162 Cal.App.4th 330 Smith v. PacifiCare Behavioral Health of Cal., Inc. (2001) 93 Cal.App.4th 139 Zembsch v. Superior Court (2006) 146 Cal.App.4th 153 Zolezzi v. PacifiCare of Cal. (2003) 105 Cal.App.4th 573 7
Shernoff Bidart Echeverria LLP mbidart@shernoff.com 8
