Cal. Code Regs. tit. 10 § 2698.300

Current through Register 2024 Notice Reg. No. 45, November 8, 2024

Section 2698.300 - Deductible and Copayment

(a) Benefits shall be subject to such required copayments and deductibles as the Board may authorize subject to the following limits:

(1) The copayment shall not exceed 25 percent of the cost of covered services.

(2) Notwithstanding the provision contained in subsection (1), the Board may authorize health plans not utilizing a deductible to charge an office visit copayment of up to twenty-five dollars ($25).

(3) The deductible shall not exceed $500 annually for a household, which consists of a subscriber and any enrolled dependents or of a dependent subscriber.

(4) The sum of the copayment and deductible shall not exceed $2,500 annually for a subscriber or dependent subscriber or $4,000 annually for a subscriber and enrolled dependents.

(b) When a subscriber's or dependent subscriber's selected participating health plan is a plan that has contracts with certain listed providers from whom care is to be received for non-emergency conditions, and there are additional subscriber payments to providers other than those listed, such additional subscriber payments shall not be subject to the limits of this section.

Cal. Code Regs. Tit. 10, § 2698.300

1. New section filed 12-20-90 as an emergency; operative 12-20-90 (Register 91, No. 11). A Certificate of Compliance must be transmitted to OAL by 4-19-91 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 12-20-90 order transmitted to OAL on 4-18-91 and filed 5-17-91 (Register 91, No. 27).
3. Editorial correction of printing error in subsection (b) (Register 91, No. 27).
4. Amendment of subsections (a)(1) and (a)(3) and amendment of NOTE filed 11-26-96 as an emergency; operative 1-1-97 (Register 96, No. 48). A Certificate of Compliance must be transmitted to OAL by 5-1-97 or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 11-26-96 order transmitted to OAL 3-3-97 and filed 3-31-97 (Register 97, No. 14).
6. Amendment filed 8-4-2003 as an emergency; operative 8-4-2003 (Register 2003, No. 32). Amendments to remain in effect for 180 days pursuant to section 21, chapter 794, Statutes of 2002 (AB 1401). A Certificate of Compliance must be transmitted to OAL by 2-2-2004 or emergency language will be repealed by operation of law on the following day.
7. Certificate of Compliance as to 8-4-2003 order transmitted to OAL 1-23-2004 and filed 3-1-2004 (Register 2004, No. 10).
8. Amendment of subsection (a), new subsection (a)(2) and subsection renumbering filed 1-14-2009; operative 2-13-2009 (Register 2009, No. 3).

Note: Authority cited: Sections 12711 and 12712, Insurance Code. Reference: Section 12718, Insurance Code.

1. New section filed 12-20-90 as an emergency; operative 12-20-90 (Register 91, No. 11). A Certificate of Compliance must be transmitted to OAL by 4-19-91 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 12-20-90 order transmitted to OAL on 4-18-91 and filed 5-17-91 (Register 91, No. 27).
3. Editorial correction of printing error in subsection (b) (Register 91, No. 27).
4. Amendment of subsections (a)(1) and (a)(3) and amendment of Note filed 11-26-96 as an emergency; operative 1-1-97 (Register 96, No. 48). A Certificate of Compliance must be transmitted to OAL by 5-1-97 or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 11-26-96 order transmitted to OAL 3-3-97 and filed 3-31-97 (Register 97, No. 14).
6. Amendment filed 8-4-2003 as an emergency; operative 8-4-2003 (Register 2003, No. 32). Amendments to remain in effect for 180 days pursuant to section 21, chapter 794, Statutes of 2002 (AB 1401). A Certificate of Compliance must be transmitted to OAL by 2-2-2004 or emergency language will be repealed by operation of law on the following day.
7. Certificate of Compliance as to 8-4-2003 order transmitted to OAL 1-23-2004 and filed 3-1-2004 (Register 2004, No. 10).
8. Amendment of subsection (a), new subsection (a)(2) and subsection renumbering filed 1-14-2009; operative 2-13-2009 (Register 2009, No. 3).