California Government Code 22859 – (a) A health benefit plan or contract may not provide any of the …
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(a) A health benefit plan or contract may not provide any of the following:
(1) An exception for other coverage where the other coverage is entitlement to Medi-Cal or medicaid benefits.
Terms Used In California Government Code 22859
- Contract: A legal written agreement that becomes binding when signed.
- Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
- Person: includes any person, firm, association, organization, partnership, limited liability company, business trust, corporation, or company. See California Government Code 17
(2) An exception for Medi-Cal or medicaid benefits.
(3) A benefits reduction if the person has entitlement to Medi-Cal or medicaid benefits.
(4) An exception for enrollment because of an applicant’s entitlement to Medi-Cal or medicaid benefits.
(b) Each health benefit plan shall be considered in determining the third-party liability for medical expenses incurred by a Medi-Cal or a medicaid recipient.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)