California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 4 - Certification Standards for Health Care Organizations › Section 9779.3 - Obligations of Employer Covered by a Contract with a Health Care Organization

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) When an insurer
					 or employers, a group of self-insured employers, or self-insured employers have
					 contracted with a health care organization certified pursuant to Section
					 4600.5 of the
					 Labor Code the employer shall provide information to all employees who are
					 eligible to be enrolled in the health care organization as follows:
(1) a new employee shall be provided with the
					 choice of enrolling in an HCO or designating the employee's own personal
					 physician or personal chiropractor no later than 30 days following the
					 employee's date of hire.
(2) a
					 current employee shall be provided with the choice of enrolling in an HCO or
					 designating the employee's own personal physician or personal chiropractor no
					 later than 30 days before the initial enrollment period ends;
(3) an employer must provide information
					 concerning the HCO it is offering to its employees no later than 30 days prior
					 to the final date for enrollment. Information shall be provided in written
					 form, in no less than twelve (12) point typeface, and in a language
					 understandable to employees. The information provided must include, at a
					 minimum, the following:
(i) the name of the
					 HCO offered;
(ii) the corporate or
					 business name of all entities which own or control the HCO offered; and
					 indication of relationship, if any, of the HCO to workers' compensation carrier
					 or self-insured employer;
(iii) the
					 services offered by the HCO;
(iv) a
					 complete listing of all primary treating physicians, specialist physicians, and
					 clinics participating in the HCO who would be reasonably accessible to the
					 employee for the provision of occupational health services. Primary treating
					 physicians who are not accepting new patients must be clearly
					 identified;
(v) If the HCO is also
					 the provider of group health coverage for non-occupational health services, the
					 HCO policy regarding enrollees' ability to use their personal physician (for
					 non-occupational health services) for treatment of work injuries.
(vi) any provider risk-sharing arrangements
					 related to utilization of services.
(4) Within fifteen days following enrollment,
					 the HCO must provide to each enrollee complete information regarding HCO
					 services and processes, including but not limited to:
(i) the services offered, including
					 interpreters services, how such services are obtained, hours of
					 services;
(ii) the definition of
					 emergency care, how to obtain out-of-service treatment, how to obtain
					 after-hours services;
(iii) case
					 management and medical management processes, selection of the primary treating
					 physician, and method for obtaining second opinions, change of physician, or
					 referrals to chiropractors, physical therapists, or specialists;
(iv) the grievance and dispute resolution
					 procedures;
(v) additional services
					 offered, including return to work, health and safety, patient assistance, and
					 patient education.