Claims Payment Policies and Practices
Qualified Health and Dental Plan Issuers have provided information to help you understand what is needed for a claim to be paid, or why a claim was denied.
Click the links below to see the information the issuers have provided.
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Aetna CVS Health
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Anthem Blue Cross
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Blue Shield of California Qualified Health Plan
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Blue Shield of California Qualified Dental Plan
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CCHP Health Plan
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California Dental Network
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Dental Health Services
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Delta Dental
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Health Net
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Kaiser Permanente
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LA Care Health Plan
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Molina Healthcare
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Oscar
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Sharp Health Plan
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Valley Health Plan
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Western Health Advantage
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Consumer Information
- Information on Cost-Sharing and Payments With Respect To Out-of-Network Coverage
- Enrollee Rights Information Under Title I of the Affordable Care Act
Quality Ratings
Claims
Data and Enrollment
Financial Information
Rate Booklet
- 2024 Regional Rate Sheets
- 2023 Regional Rate Sheets
- 2022 Regional Rate Sheets
- 2021 Regional Rate Sheets
- Covered California's Health Insurance Companies and Plan Rates for 2022
- 2020 Health Plan Rate Booklet
- 2019 Health Plan Rate Booklet
- 2021 Family Dental Rate Booklet
- 2020 Family Dental Rate Booklet
Contracts
- 2017-2023_QDP_Contract_8.-1-22_Clean-Final
- 2023-2025_QHP-IND_Att-1_8-1-22_Clean-Final
- 2023-2025_QHP-IND_Att-2_8-1-22_Clean-Final
- 2023-2025_QHP-IND_Att-3_8-1-22_Clean-Final
- 2023-2025_QHP-IND_Att-4_8-1-22_Clean-Final
- 2023_QHP-IND_Benefit-Design-Off-Exchange Silver_8-1-22
- 2023-2025 QHP-IND_Contract_8-1-22_Clean-Final
- 2023-2025 QHP-CCSB_Att-1_8-1-22_Clean-Final
- 2023-2025_QHP-CCSB_Att-2_8-1-22_Clean-Final
- 2023-2025_QHP-CCSB_Att-3_8-1-22_Clean-Final
- 2023-2025_QHP-CCSB_Contract_8-1-22_Clean-Final
- 2023_QHP-CCSB_Att-5_8-24-22_Clean-Final
- 2022-Amend QHP-IND Contract 8-9-21_Clean-Final
- 2022-Amend_QHP-IND Att-7_8-9-21_Clean-Final
- 2022-Amend_QHP-IND_Att-14_12-16-21_Clean-Final
- 2022-Amend_QDP Contract_8-9-21_Clean-Final
- 2022-Amend_QDP Att-3 8-9-21_Clean-Final
- 2022-Amend_QDP Att-7 8-9-21_Clean-Final
- 2022-Amend_QDP Att-14 8-9-21_Clean-Final
- 2022-Amend_QHP-CCSB Contract 8-9-21_Clean-Final
- 2022-Amend_QHP-CCSB Att-3 8-9-21_Clean-Final
- 2022-Amend_QHP-CCSB Att-7 8-9-21_Clean-Final
- 2022-Amend_QHP-CCSB Att-14 8-9-21_Clean-Final
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- QHP Model Contract for 2017-2021 – Amended for 2021
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- QDP Model Contract for 2017-2021 – Amended for 2021
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- CCSB Model Contract for 2017-2021 – Amended for 2021
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- CCSB Attachment 3 2017-2021 – Amended for 2021
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- CCSB Attachment 7 2017-2021 – Amended for 2021
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- CCSB Attachment 14 2017-2021 – Amended for 2021
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- Attachment 7 for the Individual Market 2017-2021 – Amended for 2021
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- Attachment 14 for for the Individual Market 2017-2021 – Amended for 2021
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- QHP Model Contract for 2017-2020 – Amended for 2020
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- QDP Model Contract for 2017-2020 – Amended for 2020
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- CCSB Model Contract for 2017-2020 – Amended for 2020
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- Attachment 7 for 2017-2020 – Amended for 2020
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- Attachment 14 for 2017-2020 – Amended for 2020
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- QHP Model Contract for 2017-2019 – Amended for 2019
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- QDP Model Contract for 2017-2019 – Amended for 2019
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- CCSB Model Contract for 2017-2019 – Amended for 2019
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- Attachment 7 for 2017-2019 - Amended for 2019
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- Attachment 14 for 2017-2019 – Amended for 2019
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- QHP Model Contract 2017-2019 – Amended for 2017 and 2018
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- QDP Model Contract 2017-2019 – Amended for 2017 and 2018
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- CCSB Model Contract 2017-2019 – Amended for 2017 and 2018
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- Attachment 7 – Amended for 2017 and 2018
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- QHP Model Contract for 2017-2019
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- QDP Model Contract for 2017-2019
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- CCSB Model Contract for 2017-2019
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