The first department issues and manages licenses for health insurance companies in California and the second one deals with all the matters related to job-based health insurance coverage nationally.
If you are currently facing problems with your insurance coverage or you are looking for proper health insurance services or you don't know whom to contact, the following information will help you understand whom to approach in given situation and what to expect. The California and federal health insurance regulations offer you all the protection you need. In order to exercise your rights effectively you need to be familiar with these regulations.
California Department of Insurance
The California department of insurance regulates all kinds of insurance contacts. Of course, the regulations are applicable only to those insurances purchased in the state of California or those that need to be registered in the state due to some other legal reasons. Obviously this includes health insurance also. Therefore, you can obtain a list of health insurance companies having license to do business in the state and also the kind of coverage they offer from the California department of insurance or visit the department's website.
Also, if you have a grievance with a particular health insurance company you can fill-up required complaint forms and submit to the department. For example, if the insurance company refuses to pay for certain procedure that is believed to be included in the coverage, you can approach the department to find out what the regulations say on that particular issue. However, contacting the department in these situations is not mandatory. Proper legal representation is advised.
U.S. Department Of Labor
It is important to note that when it comes to health insurance that is job-based, U.S. Department of Labor has stipulated regulations that are applicable. So, if you have problems with insurance or with your employer, you may contact the department through the Labor's Employee Benefits Security Administration which is the relevant section of the department that handles these claims or issues.
For instance, it is important to know that for bigger companies having more than certain number of employees, it is mandatory on the part of employer to provide continuous coverage for a certain period of time even after you leave the job or till you are hired by another employer. If you feel this or any other rule has been violated by either your employer or the insurance company, it is always advisable to contact the Labor's Employee Benefits Security Administration in order to file a claim Last, but not the least, remember that the state of California offers coverage plans for those with pre-existent conditions that get rejected by health insurance companies due to the same conditions. Enquire with the California Department of Insurance about this coverage and the requirements to be eligible if you happen to fall under this category.
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