|
|
Other Health Coverage (OHC)
MC recipients are required to report and utilize any other health insurance that is available. Federal law prohibits MC from paying for services which are covered by the client’s private or group health insurance or health plan. The California Department of Health Care Services (DHCS) Third Party Liability and Recovery Division (TPLRD) has implemented electronic health data exchanges among the health care providers, consumers of health care and government agencies to obtain other health coverage information for MC recipients through an automated data match process.
OHC is defined as benefits for health related services or entitlements for which a MC recipient is eligible under any:
- Private, group or indemnification insurance program
- Other state or federal medical care program
- Other contractual or legal entitlement
Note: Individuals can be approved for MC and OHC; the OHC will be billed as the primary coverage and MC will be billed as secondary coverage. Due to the confidentiality of Minor Consent Services, MC will not report OHC nor bill private insurance carriers for such services
Related Topics
Overview of the Managed Care Two-Plan Model
Health Care Options Enrollment Contractor
Managed Care for Mental Health Services
Coordinated Care Initiative - Cal MediConnect
Health Insurance Premium Payment (HIPP) Program
Removal of OHC Codes for Victims of Domestic Violence
OHC for Foster Care/Adoption Assistance Children
Repayment for Medical Services