2005 California Welfare and Institutions Code Sections 10020-10025 CHAPTER 1.5. HEALTH CARE INSURANCE

10020.  No person having private health care coverage shall be
entitled to receive the same health care furnished or paid for by a
publicly funded health care program.
   As used in this chapter, "publicly funded health care program"
shall mean care or services rendered by a local government or any
facility thereof, or health care services for which payment is made
under the California Medical Assistance Program established by
Chapter 7 (commencing with Section 14000) of Part 3 of this division
by the State Department of Health Services or by its fiscal
intermediary, or by a carrier or other organization with which the
State Department of Health Services has contracted to furnish such
services or to pay providers who furnish such services.
   As used in this chapter, "private health care coverage" means any
of the following:
   (a) Service benefit plans under which payment is made by a carrier
under contracts with physicians, hospitals, or other providers of
health services rendered to employees or annuitants or family
members, or under which, under certain conditions, payment is made by
a carrier to the employee or annuitant or family member.
   (b) Indemnity benefit plans under which a carrier agrees to pay
certain sums of money, not in excess of actual expenses incurred, for
health services to or on behalf of a person who is a plan member or
a third party beneficiary under the plan.
   (c) Individual practice prepayment plans which offer health
services in whole or in part on a prepaid basis, with professional
services thereunder provided by individual physicians who agree,
under such conditions as may be prescribed by the board, to accept
the payments provided by the plans as full payment for covered
services rendered by them.
   (d) Service benefit, indemnity benefit, and individual practice
prepayment plans as defined in subdivisions (a), (b), and (c) which
are offered by trust funds regulated by the United States Department
of Labor.
   If such person receives health care furnished or paid for by a
publicly funded health care program, the carrier of his private
health care coverage shall reimburse the publicly funded health care
program the cost incurred in rendering such care to the extent of the
benefits provided under the terms of the policy for the services
rendered.
10022.  Each publicly funded health care program that furnishes or
pays for health care services under this division to a person having
private health care coverage shall be entitled to be subrogated to
the rights that such person has against the carrier of such coverage
to the extent of the health care services rendered.  Such action may
be brought within three years from the date that service was rendered
such person.
10024.  Every contract or agreement for private health care coverage
entered into or renewed after January 1, 1972, is deemed to provide
for payment to a publicly funded health care program for the actual
cost that such program incurs in rendering health care services to
any party or beneficiary of such contract or agreement to the extent
of the benefits provided under the terms of the policy for the
services rendered.
10025.  The state shall not reimburse any local government or any
facility thereof, under Medi-Cal or under any other health program
where the state pays part or all of the costs, for care provided to a
person covered under any disability insurance, health insurance, or
prepaid health plan.
   In local programs fully or partially funded by the state, state
participation shall be reduced in an amount proportionate to the cost
of service provided to a person violating Section 10020.