The local initiative that establishes a program shall offer health care coverage through the program, and all health care services shall be provided to participants by a provider operated by the county or by a provider with whom or with which the county or the local initiative has contracted to provide health care services, except for emergency or out-of-area care or instances in which a required specialized service is not contracted for by the county or the local initiative.
Chapter 4Benefits
Section § 131530
This law mandates that a local health program must provide health care coverage through county-operated providers or those contracted by the county or local initiative. Services include all types of health care except in emergencies, out-of-area situations, or when specialized services are not contracted.
local health program health care coverage county-operated providers contracted providers emergency care out-of-area care specialized services health care services local initiative participant services
Section § 131531
This law ensures that eligible employees receive health care services through a specific program. The services should closely match those offered to adults under the Healthy Families Program. However, they must at least include all basic health care services as defined in other specific regulations.
The health care services provided through the program to eligible employees shall, to the extent practicable, be substantially similar to the benefits offered to adults under the Healthy Families Program pursuant to Chapter 5 (commencing with Section 12693.60) of Part 6.2 of the Insurance Code, but shall include at least all of the basic health care services included in subdivision (b) of Section 1345 and in Section 1300.67 of Title 28 of the California Code of Regulations.
eligible employees health care services Healthy Families Program basic health care services substantially similar benefits California Code of Regulations Chapter 5 Insurance Code Title 28 Section 1345 Section 1300.67 program benefits health care program adult benefits health coverage requirements
