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Knox-Keene Health Care Service Plan Act of 1975
Practical Law Glossary Item w-023-7692 (Approx. 3 pages)
Glossary
Knox-Keene Health Care Service Plan Act of 1975
Also known as the Knox-Keene Act.
A California law that is administered by the state's Department of Managed Health Care (DMHC) and that regulates health plans licensed in California (Cal. Health & Safety Code § 1340 et seq.). The Knox-Keene Act requires plans to provide coverage for seven broadly defined categories of "basic health care services," which include:
- Physician services, including consultation and referral.
- Hospital inpatient and ambulatory care services.
- Diagnostic laboratory and diagnostic and therapeutic radiologic services.
- Home health services.
- Preventive health services.
- Emergency care services.
- Hospice care.
The Knox-Keene Act and its implementing regulations also require health plans to comply with certain requirements under the Public Health Service Act (PHSA) and Affordable Care Act (ACA) (see Practice Notes, Preventive Health Services Under the ACA, Other Than Contraceptives and Affordable Care Act (ACA) Overview).