Cal. Health & Safety Code §§ 1367 through 1374.195: Knox-Keene Health Care Service Plan Act of 1975 — Standards – California
Status: EnactedYear Enacted: 1975
Year Amended: 2018
File: Download
A health care service plan that issues, sells, renews, or offers health care service plan contracts for health care coverage in this state, including a grandfathered health plan, but not including specialized health care service plan contracts that provide only dental or vision services, shall provide an annual rebate to each enrollee under that coverage, on a pro rata basis, if the ratio of the amount of premium revenue expended by the health care service plan on the costs for reimbursement for clinical services provided to enrollees under that coverage and for activities that improve health care quality to the total amount of premium revenue.
Key Issues:
Affordable Care Act (ACA)
Provider Payment
Benefit Design
Shared Risk or Risk-Based Payment
Health Savings Account (HSA) or Health Reimbursement Account (HRA)
PHARMACEUTICALS
PRICE AND QUALITY TRANSPARENCY
Quality Measure
ACA Marketplace
Network Adequacy
Utilization Review
Pharmacy Regulation
Rate Regulation
Cost-Sharing or Out-of-Pocket Costs
Prior Authorization
HEALTHCARE SYSTEM REFORM
Drug Formulary
HEALTHCARE COSTS
Scope of Practice
Competition
Gag Clause or Non-Disclosure Agreement
Cost Containment
HEALTHCARE MARKETS
Provider Network
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