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California Insurance Coverage Matrix

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California Insurance Coverage Matrix California Health Care Options Matrix www.CoverageForAll.org PRIVATE HEALTH INSURANCE PUBLICLY SPONSORED PROGRAMS Small Individuals with Individuals Recently Low-Income Children in Low- Pregnant Women, Immigrants Adults in Businesses Individuals Pre-Existing, Adults without Covered by an Employer Families & Income Families or Infants, & Moderate Awaiting Legal Need of Cancer Other Programs (2-50 & Families Severe, or Chronic Dependents Health Plan Medically-Needy Undocumented Children Income Children Status Screening & Resources Demographic Employees) Medical Conditions IMPACT U.S. Uninsured COBRA/Cal-COBRA U.S. Uninsured MRMIP Medi-Cal Healthy Kids Medi-Cal County Medical Restricted 800-409-8252 Indian Health (Major Risk Medical California’s Medicaid Program (County-Based Programs) California’s Medicaid Program www.california-impact.org Help Line Help Line Insurance Program) 800-952-5253 Contact Your County’s Children’s Health 800-952-5253 Services Program Medi-Cal Services 800-234-1317 Then convert to a plan under: 800-234-1317 California’s Medicaid 916-930-3927 800-289-6574 888-747-1222 Initiative 888-747-1222 (CMSP) Program Breast and www.mrmib.ca.gov www.medi-cal.ca.gov www.cchi4families.org www.medi-cal.ca.gov Contact local county social www.ihs.gov services agency 800-952-5253 Cervical Cancer Group Plans HIPAA Individual Plans www.medi-cal.ca.gov California Association Health Insurance Portability & Accountability California Association Due to changes in the program, Or contact local county www.cmspcounties.org Treatment Medicare of Health Underwriters of Health Underwriters CaliforniaKids AIM Act MRMIP has opened up a waitlist. social services agency 818-755-9700 Access for Infants & Mothers Program (Age 65 and up) 800-322-5934 866-4-USA-DOL 800-322-5934 www.dhs.ca.gov Family PACT 800-MEDICARE www.cahu.org www.cahu.org www.californiakids.org 800-433-2611 Genetically (Family planning) www.dol.gov Pre-Existing www.aim.ca.gov (BCCTP) 800-633-4227 Handicapped 916-650-0414 800-824-0088 www.medicare.gov AIM www.familypact.org Condition Insurance Access for Infants & Mothers Kaiser Permanente Persons Program www.dhs.ca.gov HIPP Healthy Families (Search: BCCTP) Plan (PCIP) 800-433-2611 Child Health Plan (KPCHP) 800-880-5305 (GHPP) For local programs Health Coverage Health Insurance Premium Payment Federal program run by www.aim.ca.gov 800-464-4000 Program 916-327-0470 www.dhcs.ca.gov info.kp.org/childhealthplan/ 888-747-1222 contact Tax Credit the Managed Risk Medical www.healthyfamilies.ca.gov 800-639-0597 www.dhs.ca.gov WISEWOMAN 866-628-HCTC Insurance Board(MRMIB) NOTE: Only available to Northern www.dhcs.ca.gov/services/ 800-511-2300 California Residents. 866-628-4282 866-717-5826 ghpp www.cdph.ca.gov/ www.irs.gov programs/WISEWOMAN www.PCIP.ca.gov Children Health and Disability Prevention VA Medical Bene!ts Package (CHDP) 877-222-8387 Call your local CHDP provider www.va.gov www.dhs.ca.gov/pcfh/cms/chdp/ Di!erent plans cover COBRA: Coverage available for 18–36 months Di!erent plans will MRMIP: O!ers a variety of medical Medi-Cal: O!ers health, dental, Healthy Kids: Doctor's visits, Immunizations, Medi-Cal: Prenatal, pregnancy, and delivery care. CMSP: Program availability Restricted Medi-Cal: Covers IMPACT: Provides men with Partnership for di!erent medical depending on qualifying events. Bene"ts are cover di!erent medical services provided by HMOs and vision, and prescription coverage. Dental & vision care, Prescriptions, Surgery, Mothers are covered up to 60 days after delivery. varies by county; medically- emergencies, pregnancy- radical prostatectomy, services. what you had with your previous employer. services. PPOs and has a 3 month exclusion Treatment for special health Hospitalization necessary physician and related care (prenatal external beam radiation Prescription period for pre-existing conditions. problems, like breast cancer, AIM: Comprehensive medical care for mother hospital-related services; and delivery), kidney therapy, hormone Assistance Sometimes coverage Cal-COBRA: Coverage available for 36 months There may also be a There is a $75K annual limit, $750K kidney problems, nursing home CaliforniaKids: Medical (outpatient only), provided (not just maternity); mothers covered depending on county, may dialysis, treatment for therapy, watchful 888-4PPA-NOW is limited to $1M in a depending on qualifying events. Bene"ts are lifetime maximum of lifetime limit, coinsurance up to needs, and AIDS. preventive, dental, and vision care, emergency up to 60 days after delivery; after birth, infant is provide coverage for other breast and cervical waiting, brachytherapy, 888-477-2669 lifetime; often $5M and what you had with your previous employer. bene"ts, for example 25% for PPO and HMO, and $500 room ($1,000 annual limit), behavioral health automatically enrolled in Healthy Families Program services such as dental and cancer. chemotherapy, counseling www.pparx.org some plans have no limit. $5M. annual deductible. The annual AIM: Comprehensive medical care program (requires approval), and prescription up to age 1. vision; bene"ts vary by and more. COBRA Subsidy: 15 months of partially-subsidized out-of-pocket max is $2,500/$4000 for mother provided (not just drugs. Healthy Families: Physician, emergency and county. Please refer to social Family PACT: Provides These factors a!ect the coverage. There is a maximum individual or family. MRMIP enrollees maternity); mothers continue preventive care; prescription drugs; inpatient services agency in county of comprehensive family BCCTP: Women can get California monthly premium and look-back and exclusion cannot enroll in PCIP. coverage up to 60 days after KPCHP: Hospital care, Hearing & vision tests, and outpatient medical, mental, and substance residence. planning services. screening and treatment for Children’s Services deductibles. HIPAA: Bene"ts are based on program selected. period of 12 months for delivery; after birth, infant is Laboratory/X-ray services for no charge. abuse hospital service; family planning and breast and cervical cancer. www.dhcs.ca.gov/services/ccs/ There is no expiration of coverage. pre-existing conditions PCIP: Covers broad range of bene"ts, automatically enrolled in Healthy Doctor o#ce visits, Prescriptions, Urgent care, maternity care; medical transportation; durable GHPP: Special care center Pre-Existing Health Pages/default.aspx There is a maximum on enrollees who do not including primary and specialty Families Program up to age 1. Emergency visits, and Mental health care medical equipment; physical, occupational, services, hospital stay, Conditions Covered WISEWOMAN: Screening Or contact local county look-back/exclusion of 6 HIPP: Bene"ts are the same as what you have prior coverage. care, hospital care, and prescription (outpatient 20 visits/year) for a fee. See below outpatient medical care, and intervention for Coverage and speech therapy; home health care and social services agency months for pre-existing had with your previous employer. HIPP is a drugs. There is a deductible of Pre-Existing Health for cost. nursing care. pharmaceutical services, cardiovascular diseases and conditions on enrollees premium assistance program. Limits on Pre-Existing $15/000 in-network/$3,000 out-of- Conditions Covered surgeries, nutrition products education about their signs, who do not have prior Health Conditions May network, brand name Rx deductible CHDP: Immunizations; dental, vision, hearing, Pre-Existing Health Conditions Covered and medical foods, durable symptoms and prevention. Women-Infant- coverage. Pre-Existing Health Conditions Covered Apply of $500/$500, and an annual and nutrition screening; tests for illnesses like medical equipment, and Children(WIC) out-of-pocket max of $2,500/$4,000 anemia, TB and others as needed; health and other services. Pre-Existing Health 888-WICWORKS Pre-Existing Health individual or family. tobacco education; WIC referral for children Conditions Covered 888-942-9675 Conditions Covered up to age 5. www.wicworks.ca.gov Pre-Existing Health Conditions Covered Pre-Existing Health Conditions Covered GUARANTEED GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED GUARANTEED COVERAGE COVERAGE COVERAGE NOTE: Government programs COBRA: Available for employees who work for Eligibility is subject to MRMIP: Must have been CA Medi-Cal: Pregnant women and Healthy Kids: Eligibility varies by county. Must Medi-Cal: If you are pregnant, your income can be CMSP: Must be U.S. citizen or IMPACT: Male California residents up to 200% FPL. look at each family’s Company size 2–50 businesses with 20 or more employees. You have 60 medical underwriting. Resident for at least 12 months. children ages 0–1: 200% FPL (add $638 not be eligible for no-cost, full-scope Medi-Cal legal resident between Restricted Medi-Cal: Income over 18 years old. Have little or circumstance to determine employees. days from date of termination to sign up for COBRA Must have a pre-existing per member if household has 11+ or Healthy Families. Undocumented children ages of 21–64. Must not be limits for pregnant no insurance, income up to 200% AIM: Income limit of 200%–300% FPL. Must eligibility. coverage. If you are denied health condition as evidenced members). Children ages 1–5: 133% FPL are eligible. be pregnant less than 31 weeks, be a California eligible for Medi-Cal. Must women and children ages FPL, and have abnormal DRE, 0–1: 200% FPL; children Eligible employees must coverage for a medical by a declination letter within (add $424 per member if household resident for at least 6 months, with legal reside in county where PSA or diagnosed with prostate work at least 30 hours a Cal-COBRA: Available for employees who work for condition, you may be the last 12 months, or o!ered has 11+ members). Children ages 6–18: CaliforniaKids: Must be children ages 0–18 applying. In CMSP counties, ages 1–5:133% FPL; cancer. Income and assets tests may immigration status, must not be receiving children ages 6–18: 100% week.
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