If you have a question about your health plan, first identify which type of plan you have. Then choose the appropriate agency or department to contact from the list below:

In Preferred Provider Organizations (PPO's), Exclusive Provider Organizations (EPO's), or Point-of-Service (POS) plans you belong to a network of providers.  For PPO and POS plans, sometimes you can go to a health care provider "outside" the network for a higher price. Indemnity plans were once common.  In an indemnity plan, you pay your provider and then submit a bill to the insurance carrier.  They then reimburse you part or all of the charges.  Sometimes trade, fraternal, church, or other small groups will form "association" plans.  Association plans offer members rates closer to group health rates rather than individual plans, even with a small number of participants.

Generally speaking, PPO, EPO, POS, indemnity, and association plans are regulated in California by the California Department of Insurance (CDI). However, the two largest PPOs in the state - Blue Cross of California's PPO and Blue Shield's PPO - are both regulated by the Department of Managed Health Care (DMHC). Consequently, while the majority of PPO plans in California may be regulated by CDI, the large majority of covered lives under PPOs in California are regulated by DMHC.

If you have a "non-Blue"  PPO, EPO, POS, indemnity, or association plan, you should contact: 

California Department of Insurance (CDI)

Consumer Services Division

300 South Spring Street, South Tower

Los Angeles, CA 90013

Consumer Hotline: 800-927-HELP (4357)

8:00 AM to 6:00 PM Monday to Friday except State holidays.

A Health Maintenance Organization (HMO) is a single network with all types of provider (general practitioners, oncologists, chiropractors, etc.) to provide comprehensive care.  You must see the providers inside the HMO network in order to be covered and cannot go outside the network.  If you are covered by an HMO, you should contact:

Department of Managed Health Care (DMHC)

Voice: 888-HMO-2219

FAX: 916-229-0465

TDD: 877-688-9891

Mailing Address:

Department of Managed Health Care

California HMO Help Center

980 Ninth Street, Suite 500

Sacramento, CA  95814-2725

http://www.hmohelp.ca.gov/

Employee Retirement Income Security Act (ERISA) is a Federal law that governs self-insured medical plans.  Some employers opt for "self-insured" plans.  In a self-insured plan, the employer maintains enough money to cover employee medical charges, and then hires a management company (often an insurance firm) to administer the program.  For COBRA or ERISA complaints or questions, contact:

Department of Labor (DOL)

866-444-3272

TTY: 877-889-5627

www.dol.gov/ebsa/erisa_enforcement.html