Health Net Must Continue Coverage for Trial Lawyers Association, Appeals Court Rules
A state appeals court has ruled that Health Net of California must continue health care insurance coverage for the San Francisco Trial Lawyers Association, the Contra Costa Times reports (Silber, Contra Costa Times, 12/22).
The dispute involves the Thousand Oaks-based health insurer's plan to terminate health policies for the association, among other groups. Health Net maintains that the associations do not have at least 1,000 members, which is the legal threshold required for insurers to renew coverage for professional organizations (California Healthline, 10/27).
The ruling upheld a preliminary decision by a lower court in September 2003 that found Health Net did not offer evidence to support its claim that it would be illegal to provide coverage for the association. The court also said Health Net failed to address arguments that the law does not prohibit contracting with groups with fewer than 1,000 members.
Under the Court of Appeal ruling, Health Net can request arbitration to resolve the matter, or the case will return to a lower court for trial. The insurer also can ask the Department of Managed Health Care for clarification on the law (Contra Costa Times, 12/22).