Health Insurance Information Service

Are the services you need covered?

The following services are not always covered by insurance plans or may have some annual limits:

• Emergency services
• Mental health services
• Laboratory tests
• Medical equipment/prosthetics
• Optical/vision care
• Pregnancy and pediatric care
• Preventive services/annual examinations
• Home health care
• Prescription drugs

Types of Insurance Plans

Preferred Provider Organizations (PPO)

You choose providers in the insurer's network to receive maximum benefits. You may see a provider outside the network, but you pay a higher share of the cost. You may be expected to make payment at the time of service for applicable co-insurance and deductible amounts.

Health Maintenance Organizations (HMO)

You choose a primary care physician or medical group to manage your health care. You must obtain a referral to access specialists. Preventative care is emphasized. No benefits are provided if you receive care from providers not included in the network.

Government-Sponsored Plans

• Covered California is an easy-to-use marketplace implementing the federal Patient Protection and Affordable Care Act in California.
• Medi-Cal is a medical assistance program for individuals in the State of California who are medically indigent and meet certain criteria. It is financed by state and National funding.
• Medicare is the U.S. Government's health insurance program for senior's age 65 and older and individuals with qualified disabilities.