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California Health Insurance Guide
Health Insurance Resources for CA State Residents
If you have a job in California, your insurance may be provided by your employer
or your spouse or partner’s employer. If your employer doesn’t offer health
insurance or you are self-employed, you have the option of buying comprehensive
major medical coverage from any company that is licensed to sell health
insurance in the state. As a California resident, you have access to several types of health insurance
and medical care plans. Depending on your circumstances and needs, there are
pros and cons to each type of health insurance available in California.
Individual care or group health insurance plan options include:
- PPO (Preferred Provider Organizations)
A PPO consists of a network of health care providers you can choose from. If you
go outside the network, your plan will cover less of the cost or none of it all.
PPOs are regulated by either the California Department of Insurance (CDI) or the
California Department of Managed Health Care (DMHC), depending on whether the
policy is issued by a licensed insurance company or a managed care plan. PPOs
can also be self-funded. have a network of providers and under these plans you must use them
except in emergencies (as defined by your plan). You are typically required to
choose a primary care physician who will coordinate any referrals to
specialists. Depending on your plan, you may have to make a co-payment whenever
you use a covered service. The DMHC regulates all California HMOs.
- Fee-for-Service Insurance (Indemnity Policies)
This type of insurance lets you choose your health care providers with a few
limitations. You pay the deductible before any covered benefits are reimbursed.
Indemnity policies may also require a co-payment for services. They may be
purchased by individuals or offered as part of a group plan. It is regulated by
the California Department of Insurance (CDI).
- Single Employer Self- Insured Plans
These plans are popular with labor unions, municipalities, school districts and
similar large employers. Most of these plans are covered by federal ERISA laws.
Whether you purchase an individual or group health insurance plan in California,
it will be subject to medical underwriting. You will need to show proof of
qualifying creditable coverage toward a year-long waiting period for preexisting
conditions for an individual plan and six months for a group policy. Small group
policies require guaranteed-issue coverage regardless of any preexisting
condition.
If you have been turned down for insurance because of a pre-existing condition
including HIV or AIDs, and are ineligible for coverage under COBRA, Cal-COBRA or
HIPAA, your options include Medi-Cal, State-sponsored or administered health
coverage or California’s major risk medical insurance plan.
Request free California
health insurance quotes
designed for your individual health needs.
California Department of Insurance (CDI)
The CDI ensures that consumers are protected; that the insurance marketplace is
fostered to be vibrant and stable; that the regulatory process is maintained as
open and equitable; and that the law is enforced fairly and impartially. The
Department's statewide toll-free consumer Hotline, 800-927-HELP (4357), provides
callers with immediate access to current information on insurance issues. Along
with assisting consumers with specific insurance concerns, the Department
publishes free brochures to help consumers become aware of their rights and to
aid them in making informed insurance decisions. These publications can be
requested by calling toll-free 800-927-HELP (4357). Visit the California
Department of Insurance online at:
Website:
www.insurance.ca.gov
Twitter: CDInews
California Department of Insurance Consumer Services Division
300 South Spring Street, South Tower
Los Angeles, CA 90013
Phone: (916) 322-3555
http://www.insurance.ca.gov/contact-us
California Department of Insurance Fraud Division
Information concerning suspected insurance fraud should be directed to the
addresses below. Click here for further information regarding the types of fraud
investigated by the Fraud Division.
9342 Tech Center Drive, Suite 100
Sacramento, CA 95826
fraud@insurance.ca.gov
California Department of Health Care Services (DHCS)
The Department of Health Care Services’ (DHCS) mission is to preserve and
improve the health status of all Californians. DHCS works closely with health
care professionals, county governments and health plans to provide a health care
safety net for California’s low-income and persons with disabilities.
DHCS programs are designed to:
- Deliver health care services to low-income persons and families who meet defined
eligibility requirements;
- Emphasize prevention-oriented health care measures that promote health and
well-being;
- Ensure access to comprehensive health services through the use of public and
private resources;
- Ensure appropriate and effective expenditure of public resources to serve those
with the greatest health care needs.
Contact Info for DHCS
P.O. Box 997413
Sacramento, CA 95899-7413
Phone: (916) 445-4171
http://www.dhcs.ca.gov
The California Major Medical Risk Insurance Program
The Major Risk Medical Insurance Program (MRMIP) is a program administered by
the Managed Risk Medical Insurance Board (MRMIB) which provides health insurance
for Californians unable to obtain coverage in the individual health insurance
market because of their pre-existing conditions.
hhttp://www.mrmib.ca.gov
California Major Medical Insurance Program Application and Handbook
http://www.mrmib.ca.gov/MRMIB/MRMIPBRO.pdf
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization
of insurance regulators from the 50 states, the District of Columbia and the
five U.S. territories. The NAIC provides a forum for the development of uniform
policy when uniformity is appropriate. NAIC members are the elected or appointed
state government officials who along with their departments and staff regulate
the conduct of insurance companies and agents in their respective state or
territory.
http://www.naic.org
Insurance Information Institute (I.I.I.)
The mission of the Insurance Information Institute (I.I.I.) is to improve public
understanding of insurance -- what it does and how it works.
Contact Info for (I.I.I.)
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org
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