California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 5 - Advertising and Disclosure › Section 1300.61.3 - Deceptive Advertising

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Without limitation upon the meaning of subdivision (a) of
					 Section 1352.1 and subdivisions (a) and
					 (c) of Section
					 1361 of the Act, an advertisement
					 or other consumer information is untrue, misleading or deceptive if:
(a) It represents that reimbursement is
				  provided in full for the charge for services, unless the payment by the plan
				  fully satisfies the liability to the provider.
(b) It represents that reimbursement is
				  provided for the customary charges for services, unless the actual experience
				  of the plan is that there is no balance billed for covered services.
(c) It represents that the plan, solicitor
				  firm or solicitor or any provider or other person associated therewith is
				  licensed or regulated by the Department of Managed Health Care or other
				  governmental agency, unless such statement is required by law or regulation or
				  unless such statement is accompanied by a satisfactory statement which counters
				  any inference that such licensing or regulation is an assurance of financial
				  soundness or the quality or extent of services. The phrase "a federally
				  qualified health maintenance organization" and equivalent terms shall not be
				  deemed deceptive advertising when used to refer to an organization which is so
				  qualified under the Health Maintenance Organization Act of 1973. The display,
				  on a plan contract which supplements Medicare with hospital or medical
				  coverage, of the particular emblem approved by the federal Department of Health
				  and Human Services and indicating that such contract meets the certification
				  requirements of 42 U.S.C.
				  1395ss and the regulations of the Health Care
				  Financing Administration thereunder, or, in lieu of such emblem, of such
				  information, if any, regarding certification as may be approved in writing as
				  to form and content by the Director, shall not be deemed deceptive when (1) the
				  Director has found that such contract complies with the provisions of the Act
				  and these rules and by written notification has authorized the plan to so
				  display such emblem or, in lieu of such emblem, such expressly approved
				  information, if any, regarding certification and has not revoked such
				  authorization, and (2) such contract, and any related disclosure form, evidence
				  of coverage, printed material, and advertising, contains no untrue information
				  regarding the emblem and does not otherwise violate this subsection.
1. New
					 subsection (c) filed 6-2-78; effective thirtieth day thereafter (Register 78,
					 No. 22).
2. Amendment filed 8-12-82; effective thirtieth day
					 thereafter (Register 82, No. 33).
3. Change without regulatory
					 effect amending subsection (c) filed 7-18-2000 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2000, No. 29).
4. Change without regulatory
					 effect amending subsection (c) filed 11-21-2002 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2002, No. 47).
Note: Authority cited: Section
						1344,
						Health and Safety Code. Reference: Sections
						1352.1,
						1360
						and
						1361,
						Health and Safety Code.