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.
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.
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).)