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

Consumer Rights and Responsibilities

You have a right to:

  • Be treated with courtesy and respect.
  • Get quality health care.
  • Get care from qualified medical personnel.
  • Choose a primary care doctor or pediatrician you trust, and change doctors if you are not satisfied.
  • Get an interpreter when English is not your first language.
  • Get an appointment when you need one.
  • Understand your health problem.
  • Understand the risks and benefits of your treatment choices.
  • Get a second opinion about a diagnosis or treatment.
  • Choose or refuse treatment.
  • Have your health information protected.
  • Get a copy of your medical records.

Learn the rules for your policy:

  • Read your health plan's Summary of Benefits to learn what is covered and what is not covered (excluded).
  • Your insurance only pays for care that is medically necessary. This is defined in your insurance policy.
  • Your plan may not pay for care that is experimental or investigational. But if you have a serious illness and feel that you need an experimental or investigational treatment, you can ask for an independent medical review.
  • You may need to get pre-approval from your health plan for some kinds of care.
  • You do NOT need pre-approval for emergency care.
  • Health plans must cover Essential Health Benefits. These include specific treatments or services mandated by the State.
  • For more information about the rules for plans regulated by the California Department Managed Health Care (HMOs and certain PPOs), go to
  • Self-insured plans follow different rules. For more information, see your policy or go to
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