State of California California Department of Consumer Affairs

Health Benefits Program (Types)

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HEALTH BENEFITS PROGRAM (TYPES)

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Managed care health plans generally fall into three categories as follows:


Health Maintenance Organization (HMO)

Members are restricted to seeing HMO physicians. Usually, doctor visits outside the plan are not covered. The patient's primary physician will control patient access to specialists. Doctors may be employed by the HMO or practice independently. HMO's are regulated by the Department of Managed Health Care.


Department of Managed Health Care
California HMO Help Center
7667 Folsom Boulevard, Suite 102
Sacramento, CA 95826


Mailing address for complaints:
California HMO Help Center
980 Ninth Street, Suite 500
Sacramento, CA 95814-2725
(888) 466(HMO)-2219
(877) 688-9891 TDD
(916) 229-0465 Fax
www.hmohelp.ca.gov


Assistance is available 24 hours per day, 7 days a week for consumers who need assistance with their HMO. Call center staff can assist consumers with a variety of issues including (but not limited to) quality of care, prescriptions, preventative testing, and information regarding the DMHC's complaint process.



Publications available: The California Patient's Guide: Your Health Care Rights and Remedies



Point-of-Service (POS)

A Preferred Provider Organization is basically a group of doctors who negotiate discounts with insurers. Unlike HMO's, there may be no restrictions on seeing specialists; however, members pay higher costs if they see non-PPO physicians. These plans are regulated by the Department of Insurance.



Preferred Provider Organization (PPO)

A Preferred Provider Organization is basically a group of doctors who negotiate discounts with insurers. Unlike HMOs, there may be no restrictions on seeing specialists; however, members pay higher costs if they see non-PPO physicians. These plans are regulated by the Department of Managed Health Care.


Department of Managed Health Care
California HMO Help Center
7667 Folsom Boulevard, Suite 102
Sacramento, CA 95826


Mailing address for complaints:
California HMO Help Center
980 Ninth Street, Suite 500
Sacramento, CA 95814-2725
(888) 466(HMO)-2219
(877) 688-9891 TDD
(916) 229-0465 Fax
www.hmohelp.ca.gov


Assistance is available 24 hours per day, 7 days a week for consumers who need assistance with their HMO. Call center staff can assist consumers with a variety of issues including (but not limited to) quality of care, prescriptions, preventative testing, and information regarding the DMHC's complaint process.



Publications available: The California Patient's Guide: Your Health Care Rights and Remedies



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