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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Bright Health Care
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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
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
- Data on Enrollment
- Data on Disenrollment
- Data on Rating Practices
- Data on Denied Claims
- Data on Appeals
Financial Information
Rate Booklet
- 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_Issuer_Model_Contract_8.1.22.pdf
- 2023-2025_QHP_IND_Att-1_Appendix-A_8-1-22_Clean_7-19_v
- 2023-2025_QHP_IND_Att-2_Performance-Standards-with-Penalties_8-1-22
- 2023-2025_QHP_IND_Att-3_Performance-Standards-and-Expectations_8-1-22
- 2023-2025_QHP_IND_Att-4_8-1-22_Clean
- 2023_QHP_IND_Att-5_Off-Exchange Silver_8-1-22
- 2023-2025 QHP_IND_Model-Contract_Final_Clean_8-1-22
- 2023-2025_ QHP_CCSB_Attachment-1_Clean_8-1-22
- 2023-2025_CCSB_Att-2_Performance-Standards-With-Penalties_8-1-22
- 2023-2025_CCSB_Att 3_Performance-Standards-and-Expectations_8-1-22
- 2023-2025_QHP_CCSB_Model-Contract_8-1-22
- 2023_Attachment-5_CCSB
- QHP Individual Market Model Contract for 2017-2022 - Amended for 2022
- QHP Individual Market Attachment 7 for 2017-2022 - Amended for 2022
- QHP Individual Market Attachment 14 for 2017-2022 - Amended for 2022
- QDP Model Contract for 2017-2022 - Amended for 2022
- QDP Attachment 3 for 2017-2022 - Amended for 2022
- QDP Attachment 7 for 2017-2022 - Amended for 2022
- QDP Attachment 14 for 2017-2022 - Amended for 2022
- CCSB QHP Model Contract for 2017-2022 - Amended for 2022
- CCSB Attachment 3 for 2017-2022 - Amended for 2022
- CCSB Attachment 7 for 2017-2022 - Amended for 2022
- CCSB Attachment 14 for 2017-2022 - Amended for 2022