Health Insurance

In California, your dependents can typically continue health coverage by electing state continuation coverage (Cal-COBRA) through the deceased's employer or by enrolling in a new plan via Covered Cali...

To switch your California health plan during open enrollment, you must research, select, and enroll in a new plan before the January 31 deadline. Your new coverage will typically begin on the first da...

Lawfully present immigrants in California can apply for and purchase health insurance through Covered California, the state's official health insurance marketplace. The process requires submitting an ...

To get coverage for fertility preservation in California before starting treatment, you must obtain a formal recommendation from your doctor and immediately file an urgent prior authorization request ...

You can determine if your health plan is regulated by the DMHC or CDI by checking your plan's official documents, which are legally required to disclose the regulator. The type of plan you have, such ...

Under California law, you have strong rights to control who sees your medical information, often exceeding the protections offered by the federal HIPAA law. Your healthcare providers and health plans ...

Under California law, you have the right to inspect and receive copies of medical records held by your health insurance plan by submitting a formal written request. Here is the procedure for accessin...

Under California law, most health plans must cover maternity and newborn care as essential health benefits. To get coverage, you must understand your plan's rules, get necessary pre-authorizations, an...

Under California and federal law, most health plans must cover specific preventive services at no cost when you use an in-network provider. This includes services like annual check-ups, immunizations,...

Choosing the right metal tier requires balancing your monthly premium with your expected out-of-pocket costs for medical services. The best plan depends on your income, health needs, and how much fina...

To offer group health insurance through Covered California for Small Business, you must first confirm your business's eligibility, gather required documentation, choose your plans and contribution lev...

As a gig worker in California, your primary path to obtaining health insurance is through Covered California, the state's official health insurance marketplace. This single platform will determine if ...

After your Medi-Cal eligibility is approved, you will receive a packet by mail prompting you to choose a managed care health plan within 30 days. If you do not actively choose a plan, the state will a...

To get an exception for a step therapy requirement, you must have your prescribing doctor submit an exception request directly to your health insurance plan. Here is how to navigate the process. Step...

In California, your health insurer can only rescind your coverage for fraud or intentional misrepresentation, so you have strong legal grounds to challenge an improper rescission. You can fight this a...

To report your California health plan for failing to provide timely access to a specialist, you must first file a formal grievance with the plan itself, and then file a complaint with the appropriate ...

You can find free help for your health insurance dispute from California's state regulators and non-profit consumer advocacy groups. These organizations can guide you through the appeals process and h...

To file a formal complaint about the quality of care, you must first submit a grievance directly to your health plan and follow their internal process. If unresolved, you can then escalate the complai...

To dispute an incorrect medical bill in California, you must formally challenge the charges with both the medical provider and your health insurance plan. The process involves requesting detailed reco...

California law requires most state-regulated health plans to cover medically necessary behavioral health treatment for autism spectrum disorder (ASD). This coverage must be comparable to what the plan...

Under California law, most health plans must cover medically necessary gender-affirming care. If your claim is denied, you have a right to a multi-step appeals process, including an independent state ...

To get coverage for acupuncture or chiropractic care included in your benefits, you must first follow your plan's authorization process and, if denied, use the state-mandated grievance and Independent...

Under California law, you have a right to get a medical appointment within a specific timeframe, and you can enforce this right by filing a grievance with your health plan and a complaint with the sta...

Under California law, you have the right to a second medical opinion from a qualified professional, and your health plan is generally required to cover it. The process involves formally requesting the...

Under California law, most health insurance plans must cover all FDA-approved contraceptive methods without charging you a copay, deductible, or coinsurance. If your plan attempts to charge you, you h...

In California, you can generally remain on your parent's health insurance plan until your 26th birthday. Turning 26 is a qualifying life event that gives you a Special Enrollment Period to purchase yo...

To cancel your Covered California plan, you must report your new job-based insurance online or by phone to terminate your coverage and subsidies. This prevents you from paying for two plans and having...

Moving to California is a qualifying life event that grants you a Special Enrollment Period to sign up for a new health plan. You generally have 60 days from the date of your move to enroll. Here is ...

You must report a significant change in your income to Covered California within 30 days of the change. The procedure involves updating your application online or by phone, which will automatically ad...

To transition from Covered California to Medicare, you must enroll in Medicare during your Initial Enrollment Period and then actively cancel your Covered California plan to stop your premium tax cred...

During a California divorce, court orders protect existing health insurance, and after it is final, both parents are responsible for the children's coverage while a dependent spouse must secure a new ...

Your primary health insurance options after a layoff are continuing your employer's plan through COBRA, buying a new plan through Covered California, or enrolling in Medi-Cal. You must act within 60 d...

In California, your health plan is generally required to cover telehealth services to the same extent that it covers the same services delivered in person. Follow these steps to ensure your telehealth...

Under California law, your health plan must provide a qualified medical interpreter for your appointments at no cost to you. You should request this service directly from your health plan as far in ad...

To access mental health or substance use disorder care, you must use your health plan's process, but California law ensures your insurer cannot unfairly limit or deny medically necessary treatment. Th...

Under California law, you may have the right to continue seeing a doctor who has left your insurance network for a limited time if you have a qualifying medical condition. To do this, you must formall...

Under California law, your health plan must cover emergency services at any hospital, regardless of its network status. Here are the steps to ensure you are only responsible for your in-network cost-s...

To get an exception to your health plan's drug formulary, your doctor must submit a formal request to the plan explaining why the non-formulary medication is medically necessary for your treatment. Th...

Getting prior authorization requires your doctor to submit a request to your health plan, which then must review it for medical necessity within state-mandated timelines. Here is the step-by-step pro...

To confirm if a doctor or hospital is in your health plan's network, you must verify their status directly with both your health plan and the provider's office. California law requires your health pla...

Under California law, you are protected from surprise bills for emergency services. You are only responsible for paying your in-network cost-sharing amounts, and the out-of-network provider cannot leg...

To file a formal complaint, you must first submit a grievance directly to your health plan. If the issue remains unresolved, you then file a complaint with the correct state regulator: the Department ...

If your health insurer denies your internal appeal based on medical necessity, you can request a free Independent Medical Review (IMR) from the state. The final decision from the IMR is legally bindin...

To file an internal appeal, you must formally submit a written request to your health insurance company within 180 days of receiving their denial notice. Here is how to navigate the process: Step 1: ...

To prove your income and residency for Covered California, you typically need recent pay stubs or a tax return for income, and a California driver's license or utility bill for residency. You only nee...

You must add your newborn to your health plan during a Special Enrollment Period, which is typically 60 days from the baby's date of birth. Once added, coverage will be effective retroactive to their ...

To continue your health coverage through Cal-COBRA, you must formally elect coverage by returning the election form within 60 days and then make your first premium payment. Here are the exact steps to...

You determine Medi-Cal eligibility primarily based on your household's income, and you can apply online, by mail, or in person through a single application process. Here is the step-by-step process t...

In California, you can get health insurance outside of open enrollment if you experience a specific "qualifying life event." These events generally involve a change in your household, loss of other he...

To apply for health insurance through Covered California, you must complete an application and select a plan during the open enrollment period, which typically runs from November 1 to January 31. The ...