§ 53881. Marketing and Member Materials.

(a) The Evidence of Coverage, disclosure form, and any marketing brochure developed by or for a plan in a designated region and distributed to prospective members shall meet the requirements contained in Health and Safety Code, section 1363.1, and Title 10, section 1300.63(a), as to print size, readability, and understandability of text.

(b) Evidence of coverage and disclosure forms or member services guides distributed to eligible beneficiaries by a plan shall fully disclose the availability of and restrictions upon the services provided by the plan, and any exclusions from coverage. These materials shall, at a minimum, specify:

(1) The scope, access to, and availability of services, including service site locations and telephone numbers, and the service area authorized in that plan's contract.

(2) A description of the membership identification card issued by the plan, if applicable, and an explanation as to its use in authorizing or assisting members to obtain services.

(3) That members shall obtain all Medi-Cal health care services covered by the plan's contract through the plan's providers.

(4) That medical services required in an emergency may be obtained from specified plan providers or from non-plan providers, if necessary.

(5) The disenrollment process, and an explanation that disenrollment is possible only under the conditions specified in section 53891 and is effective only after the disenrollment transaction is completed by the Health Care Options Program as specified in section 53889.

(6) The plan's grievance process, including instructions on how to use it.

(7) That members have the right to a fair hearing, including instructions on how to request one.

(8) The interpreter, linguistic, and cultural services available through plan personnel.

(9) Any transportation services to service sites that are available through the plan or under the Medi-Cal program. This shall include a description of both medical and non-medical transportation services, and the conditions under which non-medical transportation is available to members.

(10) Information on the availability of and procedures for obtaining services at Federally Qualified Health Centers and Indian Health Service facilities.

(11) Information on the member's right to seek family planning services from any qualified provider eligible to provide family planning services under the Medi-Cal program, including providers outside the plan's provider network, how to access these services, and a description of the limitations on the services that beneficiaries may seek outside the plan.

(12) Information on the availability and procedures for obtaining nurse midwife and nurse practitioner services.

(13) Information concerning the availability of services covered under the State's California Children Services (CCS) program from providers outside the plan's provider network and how to access these services.

(14) An explanation of the disenrollment process for members qualifying for expedited disenrollment as specified in section 53889.

(15) Information on how to obtain minor consent services through the plan, and an explanation of those services.

(16) An explanation of an American Indian beneficiary's right to not enroll in a plan, not be restricted in their right to access Indian Health Facilities by a plan, and their right to disenroll from a plan without cause.

(17) The information specified in section 53895(b).

HISTORY

1. New section filed 7-1-96 as an emergency; operative 7-1-96. Submitted to OAL for printing only pursuant to Section 147, SB 485 (Ch. 722/92) (Register 96, No. 28).

2. Repealer of section and Note and new section and Note filed 3-4-97; operative 3-4-97. Submitted to OAL for printing only pursuant to Section 147, SB 485 (Ch. 722/92) (Register 97, No. 10).

3. Amendment of subsections (b), (b)(5), (b)(8), (b)(10)-(12) and (b)(14), new subsection (b)(17) and amendment of Note filed 12-19-2000 as an emergency; operative 12-19-2000. Submitted to OAL for printing only pursuant to section 147, SB 485 (Ch. 722/92) (Register 2000, No. 51).

Note

Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 14087.3, 14087.4 and 14408, Welfare and Institutions Code; and Sections 1363 and 1364, Health and Safety Code.