Health insurance is regulated at the State level and this will likely continue past the Health Reform law albeit with Federal coordination and oversight. There are two main departments involved in the regulation of California health insurance.
The first is the DOI or California Department of Insurance. www.insurance.ca.gov This is the primary regulator in charge of insurance in California. You can contact the DOI regarding carrier, agent, and coverage issues. You'll find guidelines on all facets of insurance with extensive information. At calhealth.net , we try to break some of this terminology down into layman's terms but the very detailed and comprehensive guidelines can be found at the DOI.
You can also find information and complaint
history on California carriers and agent. You
can also confirm the active license of either in
the State. There are performance reports on
carriers and by type of plans (PPO for example).
This is also the place to both research
complaints filed against carriers and agents or
to lodge your own.
There's also a Department of Managed Care www.dmhc.ca.gov which traditionally was established to regulate the HMO (Health Maintenance Organization) plans in the State. Over the past decade however, the carriers have started to register new plans (PPO and HMO) with the DHMC separately from the DOI. The DHMC now takes on very similar functions to the DOI when it comes to lodging complaints, researching plan and carriers information, and learning about options. It really comes down to which Department your particular plan was filed under and it's plan by plan these days.
For Medicare issues, you can contact the CMS
(or Center for Medicare and Medicaid Services)
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|4 People||$33k - $97k|
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