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 AWH Sharp
- Aetna AWH SoCal
- Aetna Managed Pharmacy
- Aetna Open Choice PPO
- Aetna Savings Plus
- Aetna Sutter Health
- Anthem Blue Cross PPO Network
- Blue Shield PPO Network
- Cigna LocalPlus PPO Network
- Cigna OAP PPO Network
- Cigna + Oscar LocalPlus Network
- Cigna + Oscar OAP Network
- Cigna PPO Network
- Health Net EnhancedCare IFP PPO Network
- Health Net IFP/IEX PureCare One EPO Network
- Health Net IFP PPO Network
- Health Net LRG/SBG PPO Network
- Health Net LRG Primary EPO Network
- Health Net PureCare IFP PPO Network
- Kaiser EPO Network
- Kaiser PPO Network
- Nippon PHCS Network
- Nippon PPO Network
- United Healthcare Core PPO Network
- United Healthcare Navigate PPO Network
- United Healthcare Select PPO Network
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).)
