California Code of Regulations
Title 10 - Investment
Chapter 5 - Insurance Commissioner
Subchapter 2 - Policy Forms and Other Documents
Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code
Subarticle 4 - Basic Medical Benefits
Section 2220.23 - Basic Medical Service Benefits
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
A benefit for expenses incurred for professional calls of doctors, covering home, office and hospital calls or one or more of such types of calls, shall be deemed not sufficient to be of real economic value to the insured if:
(a) More than the first three home calls, the first three hospital calls, or the first three office calls as the case may be, (counting as a call for such purpose at least one such call actually made during any one twenty-four hour period), are eliminated from the benefit; or
(b) The benefit limits payment for call made and otherwise compensable to fewer than one per twenty-four hour period; or
(c) The amount payable per compensable call is less than $6.00 per home call and less than $6.00 per office or hospital call; or
(d) Compensation provided for expenses of covered calls (whether resulting from each separate accident or sickness or occurring in each separate policy year) is limited:
This section does not prohibit a provision which provides that physician's calls are not covered for a period after a surgical procedure is performed if the policy form provides a surgical benefit for the surgical procedure performed.
