Using Your Plan

Thank you for choosing Covered California!

After enrolling, new members will receive a welcome letter and a brochure from Covered California. You will also get an enrollment package and membership ID card from your health insurance company.

Your health insurance through Covered California can help you cover medical costs for the following services:

1. Doctor visits.
2. Prescription drugs.
3. Emergency services.
4. Pediatric care, including dental and vision.
5. Laboratory services.
6. Maternity and newborn care.
7. Hospitalization.
8. Preventive and wellness care.
9. Rehabilitation.
10. Mental health and substance abuse services.

Before You Receive Your Membership ID Card

You can use services covered by your health insurance plan starting the next month after you make your first payment, even before your membership ID card has arrived.

If you haven’t already, be sure the provider (a doctor or other health service provider) you want to see is participating in the health plan network you have selected. If you visit the provider before you receive your membership ID card, you may be asked to sign a statement agreeing to pay for the services if you cannot prove you have health insurance.

The provider may later send you a bill (a “claim”) for the care. It is likely that by the time you get a bill or claim from your provider, you will already be entered into your health insurance company’s system. Once you have your membership ID card, simply contact your provider, provide them your membership ID card number and ask to have the bill resubmitted directly to your health insurance company.

Changing Health Insurance While Getting Treatment

If your new health insurance does not work with your doctor, but you are getting treatment for a serious condition, call your new health insurance company to let them know about your treatment. Depending on what illness or condition you are receiving treatment for, your new health insurance company may be able to work with your current doctor while you finish treatment. Be sure to tell your current doctor that you have new health insurance.

For help talking to your health insurance company, contact the Health Consumer Alliance, which offers free local assistance. Call (888) 804-3536 or visit http://healthconsumer.org.

Getting Prescriptions Filled

If you have questions about medications and getting your prescriptions filled, the first step is to contact your health insurance company to see if it has received your first payment and can issue you a membership ID card or a plan identification number. Ask which pharmacies you can use in order to get the pharmacy benefits of your health insurance plan. You will not be able to get a membership ID card if you have not yet paid your first payment for your health insurance.

If you need prescription medications urgently and you have completed the Covered California enrollment application process, selected a health plan, and made your first payment, you may be able to receive some medications even if you do not yet have a membership ID card. Contact your health insurance company for more information.

Free Preventive Care

Your health plan is not just for when you or your family members are sick. It’s also important to understand and use the preventive care that is available to you when you are well. These preventive checkups, like annual physicals and receiving vaccinations are available at no added cost to you and, more importantly, can help you stay healthy.

Most health plans offer many preventive services without charging you a copay or coinsurance when you visit a doctor in your network. This is true even if you haven’t met your yearly deductible. Call your health plan directly to find out if the preventive services below for adults, women and children are available to you.

Preventive Care for Adults

1. Annual adult wellness exams.
2. Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked.
3. Alcohol misuse screening and counseling.
4. Aspirin use to prevent cardiovascular disease for men and women of certain ages.
5. Blood pressure screening.
6. Cholesterol screening.
7. Colorectal cancer screening for adults over 50.
8. Depression screening.
9. Diabetes (Type 2) screening for adults with high blood pressure.
10. Diet counseling for adults at higher risk for chronic disease.
11. HIV screening for everyone ages 15 to 65, and other ages at increased risk.
12. Immunization vaccines for adults, including:
    • Haemophilus influenzae type b.
    • Hepatitis A.
    • Hepatitis B.
    • Herpes Zoster.
    • Human papillomavirus.
    • Influenza (flu).
    • Measles, mumps and rubella.
    • Meningococcal disease.
    • Pneumococcal disease.
    • Tetanus, diphtheria and pertussis.
    • Varicella.
13. Obesity screening and counseling.
14. Sexually transmitted infection prevention counseling for adults at higher risk.
15. Syphilis screening for all adults at higher risk.
16. Tobacco use screening for all adults and cessation interventions for tobacco users.
17. Skin cancer counseling for persons at high risk.
18. Lung cancer screening for persons at high risk.
19. Hepatitis C screening for persons at high risk.
20. Falls in older adults, counseling, preventive medication and other interventions for community-dwelling adults age 65 and older who are at increased risk for falls.
21. Statin preventive medication for adults 40 to 75 at high risk.

Preventive Care for Women

1. Anemia screening for pregnant women.
2. Breast cancer genetic test counseling (BRCA) for women at higher risk.
3. Breast cancer mammography screenings every one to two years for women over 40.
4. Breast cancer chemoprevention counseling for women at higher risk.
5. Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women.
6. Cervical cancer screening.
7. Chlamydia infection screening for younger women and other women at higher risk.
8. Contraception.
9. Domestic and interpersonal violence screening and counseling.
10. Folic acid supplements for women who may become pregnant.
11. Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes.
12. Gonorrhea screening for all women at higher risk.
13. Hepatitis B screening for pregnant women at their first prenatal visit.
14. HIV screening and counseling.
15. Human papillomavirus (HPV) DNA test every three years for women with normal cytology results who are 30 or older.
16. Osteoporosis screening for women over age 60, depending on risk factors.
17. Rh incompatibility screening for all pregnant women and follow-up testing for women at higher risk.
18. Sexually transmitted infections counseling.
19. Syphilis screening for all pregnant women or other women at increased risk.
20. Tobacco use screening and interventions, including expanded counseling for pregnant tobacco users.
21. Urinary tract infection or other infection screening for pregnant women.
22. Well-woman visits.
23. Preeclampsia prevention and screening for pregnant women with high blood pressure.
24. Urinary incontinence screening for women yearly.

Preventive Care for Children

1. Wellness exams.
2. Autism screening for children at 18 and 24 months.
3. Behavioral assessments for children up to 17 years old.
4. Blood pressure screening for children up to 17 years old.
5. Cervical dysplasia screening for sexually active females.
6. Depression screening.
7. Developmental screening for children under age 3.
8. Dyslipidemia screening for children from 1 to 17 years old at higher risk of lipid disorders.
9. Fluoride chemoprevention supplements.
10. Gonorrhea preventive medication for the eyes of all newborns.
11. Hearing screening for all newborns.
12. Height, weight and body mass index measurements for children up to 17 years old.
13. Hematocrit or hemoglobin screening.
14. Hemoglobinopathies or sickle cell screening for newborns.
15. HIV screening for adolescents at higher risk.
16. Immunization vaccines for children from birth to age 18, including:
    • Diphtheria, tetanus and pertussis.
    • Haemophilus influenzae type b.
    • Hepatitis A.
    • Hepatitis B.
    • Human papillomavirus.
    • Inactivated poliovirus.
    • Influenza (flu).
    • Measles, mumps, rubella.
    • Meningococcal disease.
    • Pneumococcal disease.
    • Rotavirus.
    • Varicella.
17. Iron supplements for children ages 6 to 12 months at risk for anemia.
18. Lead screening for children at risk of exposure.
19. Medical history for all children up to 17 years old throughout development.
20. Obesity screening and counseling.
21. Oral health risk assessment for young children up to 10 years old.
22. Phenylketonuria (PKU) screening for newborns.
23. Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk.
24. Tuberculin testing for children up to 17 years old at higher risk of tuberculosis.
25. Vision screening.
26. Tobacco use prevention for school-age children.
27. Alcohol, tobacco, and drug use assessments for adolescents.
28. Bilirubin concentration screening for newborns.
29. Blood screening for newborns.
30. Fluoride varnish for all infants and children as soon as teeth are present.
31. Hepatitis B screening for adolescents at high risk, including adolescents from countries with 2 percent or more Hepatitis B prevalence, and U.S.-born adolescents not vaccinated as infants and with at least one parent born in a region with 8 percent or more Hepatitis B prevalence: 11–17 years.
32. Hypothyroidism screening for newborns.

Whom to Contact

Contact Covered California to:

• Report any changes to the information in your application, such as, changes to your income and address. You may also add or remove dependents. These changes can affect your financial help in the form of Advanced Premium Tax Credits (APTC), so it is very important to report them within 30 days of when the change occurred.
• Find out if you or a member of your family is eligible for Medi-Cal.
• Get coverage through Covered California if you have Medi-Cal now but will be losing that coverage.
• Update information such as citizenship, proof of residency and income verification.
• Make changes to your health coverage.
• Find out when and if you can enroll.
• See if you are eligible to enroll during special enrollment due to a qualifying life event.
• Cancel your coverage.

Contact your health insurance company to:

• Make a payment, online or by phone.
• Request a new membership ID card.
• Ask a question about billing and payments.
• Learn more about benefits and eligibility.
• Get help finding doctors or other providers.
• Find out how claims for services were paid.
• Change primary care physicians.

How to Report Concerns

If you are not satisfied after speaking to your health insurance company and would like to file a complaint, you can call the California Department of Managed Health Care at (888) 466-2219. If your health insurance is Health Net PPO, call the California Department of Insurance instead, at (800) 927-4357.

Free local assistance is available to help you if you have concerns about your health insurance company. The Health Consumer Alliance can help you work with your health insurance company, the Department of Managed Health Care and the Department of Insurance.

Contact the Health Consumer Alliance at (888) 804-3536 or visit http://healthconsumer.org.