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CA Department of Insurance
CA Department of Insurance
CA Department of Insurance

Health Insurer Provider Network Adequacy Waivers

Health Insurers are required to have adequate provider networks so that you can access your benefits. There are some cases in which health insurers are not able to meet the state's legal standards for network adequacy generally due to a shortage of providers or facilities in that geographic area. In many of those cases, insurers are required under the law to agree that policyholders can get out-of-network care and in-network prices if the consumer works with the insurer before scheduling these health care services. You can search the waivers granted by the Department, below, to see if this applies to you.

Insurance Companies

Aetna Open Choice PPO Network New
Aetna Savings Plus PPO Network New
Aetna Sutter PPO Network New
Anthem Blue Cross MY PPO Network New
Blue Shield PPO Network New
Cigna LocalPlus PPO Network New
Cigna OAP PPO Network New
Cigna PPO Network New
Health Net EnhancedCare IFP PPO Network New
Health Net IFP/IEX PureCare One EPO Network New
Health Net IFP PPO Network New
Health Net LRG/SBG PPO Network New
Health Net LRG Primary EPO Network New
Health Net MHN Behavioral Health Network New
Kaiser EPO Network New
Kaiser PPO/POS Network New
National Health PPO Network New
Nippon Aetna PPO Network New
Nippon PHCS PPO Network New
Premier Access PPO Network New 
UnitedHealthcare Core PPO Network New
UnitedHealthcare Navigate PPO Network New
UnitedHealthcare Select PPO Network New

 

The Department approves waivers (Alternate Access Delivery Systems) as needed as required by 10 CCR §2240.7(f). Please check this page for future waiver postings.

If you have any questions about these waivers or are having difficulty finding an in-network provider or facility you can contact our Consumer Hotline for help.

Please Note:

Emergency health care services must be available and accessible to policyholders twenty-four hours a day, seven days a week, within the service area. If you use emergency services that are out-of-network, they must be covered at in-network costs sharing rates. (Cal. Ins. 2594.3(a)(2), which incorporate Cal. Code Regs. tit. 28, §1300.67(g).)

 

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