The California Insurance Exchange (Marketplace) is called Covered California, California Health Benefit Exchange. Covered California is administered by the State of California.
General information about the Covered California can be found at: https://www.coveredca.com/.
PATIENTS
Covered California is essentially a marketplace for individuals and small businesses with up to 100 employees to shop for health insurance if they do not already have insurance coverage from another source. If they have insurance from another source (such as employment, retirement benefits, or spousal benefits), they do not need to obtain it from the Marketplace.
Learn More: Health Reform & My Patients
The San Francisco AIDS Foundation released a guide to health insurance plans available through the Covered California marketplace that helps people living with HIV and/or hepatitis C (HCV) select the plan that best suits their needs:
Plan selection guide: http://bit.ly/CoveredCaliforniaGuide
Formulary analysis: http://bit.ly/CoveredCaliforniaFormularies
HIV PROVIDERS
Providers must contract with each of the plans in the marketplace individually in order to fully participate in Covered California.
This process is similar to enrolling in insurance or managed care organization provider networks. See below for a list of insurers participating in the state marketplace, and information on contacting them.
As an HIV provider, you may qualify for the designation, of an “Essential Community Provider (ECP).” The Qualified Health Plans participating in the Insurance Exchange (Marketplace) are required to contract with a minimum number of ECPs and Specialists to ensure network adequacy.
Visit our Provider Resources Section for more specific instructions to assist you in contacting health plans.
REPORTING PROBLEMS
The state office of insurance is primarily responsible for examining and addressing issues with the plans offered within the state Exchange (Marketplace), and the companies that offer them. If you are experiencing problems as a medical provider with the plans or companies in the state exchange, or if your patients are experiencing problems with the plans or companies in the state exchange, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any other problems related to the Affordable Care Act, please report these problems to the state office of insurance:
California Department of Insurance
Consumer Services Division
300 South Spring Street, South Tower
Los Angeles, CA 90013
800-927-4357
www.insurance.ca.gov/
Complaints: www.insurance.ca.gov/contact-us/0200-file-complaint/
Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.
QUALIFIED HEALH PLANS PARTICIPATING IN THE EXCHANGE
Below is a list of the Qualified Health Plans that have publicly announced that they will offer plans in Covered California.
This list is being routinely updated, and may change as insurers join or leave the Exchange. Please check back for updates.
Anthem Blue Cross of California
Plan Website: https://www.anthem.com/ca/health-insurance/home/overview
Provider Enrollment: http://www.anthem.com/ca/home-providers.html
Plan types offered: Individual
Blue Shield of California
Plan Website: https://www.blueshieldca.com/home?seorefer=http%3A//www.google.com/url%3Fsa%3Dt%26rct%3Dj%26q%3Dblue%2520shield%2520of%2520california%26source%3Dweb%26cd%3D1%26sqi%3D2%26ved%3D0CCsQFjAA%26url%3Dhttps%253A%252F%252Fwww.blueshieldca.com%252F%26ei%3DXtcOUv-ALdK84AO0uoGIBA%26usg%3DAFQjCNH7_JG7tgJBVoscobaoq0bdt0MEGA
Provider Enrollment: https://www.blueshieldca.com/producer/news/providernetwork/home.sp
Plan types offered: Individual, SHOP
Chinese Community Health Plan
Plan Website: http://www.cchphmo.com/
Provider Enrollment: http://www.cchphmo.com/providers-working-cchp
Plan types offered: Individual, SHOP
Health Net
Plan Website: https://www.healthnet.com/portal/provider/content.do?mainResourceFile=/content/provider/unprotected/html/national/claims_procedures/california.html
Provider Enrollment: https://www.healthnet.com/portal/provider/content/iwc/provider/unprotected/working_with_HN/content/features.action
Plan types offered: Individual, SHOP
Kaiser Permanente
Plan Website: https://healthy.kaiserpermanente.org/html/kaiser/index.shtml
Provider Enrollment: http://www.kaiserpermanentejobs.org/default.aspx
Plan types offered: Individual, SHOP
LA Care Health Plan
Plan Website: http://www.lacare.org/
Provider Enrollment: http://www.lacare.org/providers
Plan types offered: Individual
Molina Healthcare
Plan Website: http://www.molinahealthcare.com/Pages/index.aspx
Provider Enrollment: http://www.molinahealthcare.com/members/common/en-us/abtmolina/compinfo/pages/contactus.aspx#
Plan types offered: Individual
Sharp Health Plan
Plan Website: https://www.sharphealthplan.com/
Provider Enrollment: https://www.sharphealthplan.com/index.php/providers/
Plan types offered: Individual, SHOP
Valley Health Plan
Plan Website: http://www.valleyhealthplan.org/en-us/Pages/default.aspx
Provider Enrollment: https://www.valleyhealthplan.org/en-us/Contact%20Us/Pages/default.aspx
Plan types offered: Individual
Western Health Advantage
Plan Website: http://www.westernhealth.com/
Provider Enrollment: http://www.westernhealth.com/providers/provider_faqs.cfm#go1
Plan types offered: Individual, SHOP