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Insurance Options through Covered CA
Covered CA is an insurance marketplace for Californians providing affordable public and private healthcare options for individuals or small businesses. Covered CA has standardized the benefits so that a client can make accurate comparisons among the health plans offered in their geographic service area.
Covered CA requires additional standards for health plans to receive certification as a Covered CA Health Plan. Covered CA Health Plans must:
- Be licensed and in good standing with the State.
- Obtain a Certification of Authority as an insurer.
- Participate in Covered CA's competitive active purchaser solicitation; which includes evaluation based on quality, price, and accessibility.
Covered CA considers member satisfaction scores, accreditation, and third-party rankings when certifying health plans. Covered CA health plans are subject to routine quality checks to evaluate performance, healthcare quality, and outcomes. These measures are consistent with the Code of Federal Regulations CFR§155.200, designed to continually improve quality. Covered CA monitors health plan performance and annually recertifies plans that continue to meet the required standards. Industry organizations also monitor and evaluate health plan quality.
Provider Network Directories
The client can search for doctors and hospitals using provider network directories by type or specialty care services, name, gender, language(s) spoken, etc.
HMO, PPO, and EPO Networks
Most health plans are building custom networks for Covered CA. PPO and EPO plan networks are often larger, and feature thousands of doctors and hospitals.
Customized Networks
Some health plans also offer narrow, tailored, or selected networks. Each of these networks is a subset of one of the carrier's main networks. They are often specific to a certain geographic area and include doctors, hospitals, and medical groups that meet criteria for cost efficiency and access.
CalHEERS Network Directory
The CalHEERS online directory is a centralized database of all the doctors that participate in any one or more of the networks associated with Covered CA Health Plans.
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