28 CA ADC § 1300.61.3


      28 CCR s 1300.61.3

      Cal. Admin. Code tit. 28, s 1300.61.3


      CALIFORNIA CODE OF REGULATIONS
      TITLE 28. MANAGED HEALTH CARE
      DIVISION 1. THE DEPARTMENT OF MANAGED HEALTH CARE
      CHAPTER 2. HEALTH CARE SERVICE PLANS
      ARTICLE 5. ADVERTISING AND DISCLOSURE
      This database is current through 06/09/06, Register 2006, No. 23.

      s 1300.61.3. Deceptive Advertising.

      Without limitation upon the meaning of subdivision (a) of Section 1352.1 
      and subdivisions (a) and (c) of Section 1361 of the Act, an advertisement 
      or other consumer information is untrue, misleading or deceptive if:

      (a) It represents that reimbursement is provided in full for the charge 
      for services, unless the payment by the plan fully satisfies the liability 
      to the provider.

      (b) It represents that reimbursement is provided for the customary charges 
      for services, unless the actual experience of the plan is that there is no 
      balance billed for covered services.

      (c) It represents that the plan, solicitor firm or solicitor or any 
      provider or other person associated therewith is licensed or regulated by 
      the Department of Managed Health Care or other governmental agency, unless 
      such statement is required by law or regulation or unless such statement 
      is accompanied by a satisfactory statement which counters any inference 
      that such licensing or regulation is an assurance of financial soundness 
      or the quality or extent of services. The phrase "a federally qualified 
      health maintenance organization" and equivalent terms shall not be deemed 
      deceptive advertising when used to refer to an organization which is so 
      qualified under the Health Maintenance Organization Act of 1973. The 
      display, on a plan contract which supplements Medicare with hospital or 
      medical coverage, of the particular emblem approved by the federal 
      Department of Health and Human Services and indicating that such contract 
      meets the certification requirements of 42 U.S.C. 1395ss and the 
      regulations of the Health Care Financing Administration thereunder, or, in 
      lieu of such emblem, of such information, if any, regarding certification 
      as may be approved in writing as to form and content by the Director, 
      shall not be deemed deceptive when (1) the Director has found that such 
      contract complies with the provisions of the Act and these rules and by 
      written notification has authorized the plan to so display such emblem or, 
      in lieu of such emblem, such expressly approved information, if any, 
      regarding certification and has not revoked such authorization, and (2) 
      such contract, and any related disclosure form, evidence of coverage, 
      printed material, and advertising, contains no untrue information 
      regarding the emblem and does not otherwise violate this subsection.


      


      Note: Authority cited: Section 1344, Health and Safety Code. Reference: 
      Sections 1352.1, 1360 and 1361, Health and Safety Code. 


       HISTORY 
         
      1. New subsection (c) filed 6-2-78; effective thirtieth day thereafter 
      (Register 78, No. 22).

      2. Amendment filed 8-12-82; effective thirtieth day thereafter (Register 
      82, 
      No. 33).

      3. Change without regulatory effect amending subsection (c) filed 
7-18-2000
      pursuant to section 100, title 1, California Code of Regulations (Register
      2000, No. 29).

      4. Change without regulatory effect amending subsection (c) filed 
      11-21-2002
      pursuant to section 100, title 1, California Code of Regulations (Register
      2002, No. 47).
      28 CA ADC s 1300.61.3

      END OF DOCUMENT

      (C) Copyright 2006, Result Oriented Marketing, Inc.
      For Further Assistance Visit : www.mcmillanlaw.us and www.fearnotlaw.com