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82 California Attorney General Reports and Opinions 1 (1999)

handle is hein.sag/sagca0082 and id is 1 raw text is: ATTORNEY GENERAL'S OPINIONS Opinion No. 98-611-January 20, 1999 Requested by: MEMBER OF THE CALIFORNIA STATE SENATE Opinion by: BILL LOCKYER, Attorney General Anthony S. Da Vigo, Deputy THE HONORABLE LIZ FIGUEROA, MEMBER OF THE CALIFOR- NIA STATE SENATE, has requested an opinion on the following question: May a corporate entity licensed as a health care service plan enter into an agreement with a network of providers of cosmetic medical services, a specialty not covered by any of the entity's health benefit plans, according to the terms of which the entity would (1) refer its enrollees to a participating provider, or to a provider selected by the enrollee from a directory of participating providers, for medical services at a discounted rate and (2) collect and forward to the provider the fees for such medical services after deducting an administrative fee? CONCLUSION A corporate entity licensed as a health care service plan may not enter into an agreement with a network of providers of cosmetic medical services, a specialty not covered by any of the entity's health benefit plans, according to the terms of which the entity would (1) refer its enrollees to a participating provider, or to a provider selected by the enrollee from a directory of participating providers, for medical services at a discounted rate and (2) collect and forward to the provider the fees for such services after deducting an administrative fee. ANALYSIS A corporate entity licensed by the Department of Corporations as a health care service plan under the Knox-Keene Health Care Service Plan Act of 1975 (Health & Saf. Code, § 1340 et seq.; Act)' offers a variety of full service and specialized health care service contracts. It operates under the Act's requirements serving the legislative purposes set forth in section 1342: It is the intent and purpose of the Legislature to promote the delivery of health and medical care to the people of the State of California who enroll in, or subscribe for the services rendered by, a health care service plan or specialized health care service plan by accomplishing all of the following: 1 Unidentified section references prior to footnote 2 are to the Health and Safety Code. (Matthew Bender & Co., Inc.) January 1999 I