California Department of Insurance
California has two state government agencies which regulate health insurance. The California Department of Insurance is responsible for regulating indemnity and PPO plans, while the California Department of Managed Health Care regulates HMO plans. The following is a description of the services offered by the California Department of Insurance:
If you are looking for health insurance coverage, they have lists of insurance agents and insurance companies licensed to sell indemnity and PPO plans in California. Go here to find out if your insurance company or agent is licensed in California.
If you are having trouble resolving a claims dispute with your insurer, you can file a complaint with the Department of Insurance. Instructions on how to file a complaint can be found here.
California Department of Insurance
Consumer Services Division
300 South Spring Street, South Tower
Los Angeles, CA 90013
Phone: 800-927-HELP or 213-897-8921
California Department of Managed Health Care
California has two state government agencies which regulate health insurance. The California Department of Insurance is responsible for regulating indemnity and PPO-type health plans, while the California Department of Managed Care regulates HMO plans. The following is a description of the services offered by the California Department of Managed Health Care:
If you are looking for health insurance coverage, this office has a list of all managed care plans available in California.
If you are having trouble resolving a claims dispute with your insurer, you can file a complaint with the Department of Managed Health Care. The Department requests that you first make every effort to resolve the dispute on your own before contacting their HMO Help Center. Call them at 888-466-2219 for urgent complaints, or print and mail a complaint form to the address below.
California Department of Managed Care
980 Ninth Street, Suite 500
Sacramento, CA 95814-2725
Phone: (888) 466-2219
U.S. Department of Labor
If you get your insurance through your job, your plan is also regulated by the U.S. Department of Labor's Employee Benefits Security Administration (EBSA). They make and enforce the rules that your employer must follow when offering health insurance coverage to employees - for example, your employer cannot single out an individual employee to exclude her from the plan because she (or one of her dependents) has a costly illness. Also, if there are 20 or more employees at your job, you should be offered COBRA continuation coverage when you leave your job. The EBSA works to make sure that all of this happens and your rights are protected.
If you have concerns about your employer's practices in administering your job-based health coverage - for example, if you think you should have been offered COBRA continuation coverage, but were not, or if you feel that you were wrongly terminated from your health plan - contact your regional EBSA office.
U.S. Department of Labor Employee Benefits Security Administration
San Francisco Regional Office
71 Stevenson Street, Suite 915
San Francisco, CA 94105
Francis Clisham - Director
Phone: 415-975-4600
Fax: 415-975-4589
Los Angeles Regional Office
1055 East Colorado Blvd., Suite 200
Pasadena, CA 91106-2341
Billy Beaver - Director
Phone: 626-229-1000
Fax: 626-229-1098
Calfornia Major Risk Medical Insurance Program (MRMIP)
The California Major Risk Medical Insurance Program offers coverage to individuals who have been rejected for individual policies because of preexisting health conditions. For more details on MRMIP eligibility requirements, contact MRMIP by phone or download a .pdf version of their brochure here. The brochure also includes information on premium rates and coverage. MRMIP coverage is limited to 36 months ONLY - however, once you have exhausted your MRMIP eligibility, you will be guaranteed the right to buy a policy in the individual market.
California Major Risk Medical Insurance Program
P.O. Box 2769
Sacramento, CA 95812-2769
Phone: 800-289-6574 OR 916-324-4695
Buying Individual Policies in California
Unfortunately, California law allows insurers offering individual policies to reject applicants for having preexisting medical conditions UNLESS they are "HIPAA eligible" OR have exhausted a full 36 months of MRMIP coverage. "HIPAA eligible" individuals are people who have left job-based group coverage AND have elected and fully exhausted any COBRA or state-operated continuation coverage they were offered. If you are not "HIPAA eligible" and have a preexisting medical condition, you should apply to the MRMIP program first before attempting to buy an individual policy in California.
Healthy Families - the state Children's Health Insurance Program
Healthy Families provides health insurance coverage for children under age 19 whose family meets certain income guidelines.Premiums are quite reasonable - as low as $4/month, with a maximum of $45/month for all children in a family.
Healthy Families
Phone: 1-800-880-5305
Email: HealthyFamilies@MAXIMUS.com
Please read on to learn more about health insurance options in California, including the Health Insurance Counseling and Advocacy Program and Medi-Cal.
