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DMHC Regulates Health Plans and Helps Health Plan Members and Providers

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Californians have the strongest patient's rights laws in the nation. DMHC’s Help Center is available to explain your health care rights and help you understand how to use your health care benefits. The Help Center can also resolve problems you may have with your health plan.

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Ensuring prompt and fair payment of health care providers is critical to the stability of California's health care delivery system.  The DMHC’s Provider Complaint Unit can assist California physicians; hospitals and other licensed health care providers resolve disputed claim issues with payers.

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The DMHC licenses and regulates California health plans and strives to streamline the process health plans must follow to comply with the law. This section has all the information and forms plans need to ensure compliance.

What's New

On August 22, 2014 the DMHC issued the letters below to the following plans regarding limitations or exclusions of abortion services:

Request for Proposals No. 14MC-SA005 – California Health Consumer Assistance Partnership

Wednesday, August 13, 2014

The California Department of Managed Health Care (DMHC) is soliciting proposals from qualified Community-Based Organizations (CBOs) capable of performing Consumer Assistance Partnership (CAP) services as specified in this RFP. The overall purpose of this RFP is to provide direct assistance to consumers with enrollment into health coverage, assist consumers with filing of complaints and appeals, and to provide consumers with educational materials and information about health coverage and health care reform.  Proposals must be received by 4:00 p.m. on September 23, 2014.  More...

Mental Health Parity and Addiction Equity Act (MHPAEA)

Thursday, July 31, 2014

The federal MHPAEA was enacted in 2008 to ensure parity between mental health and/or substance use disorders (MH/SUD) benefits and medical/surgical benefits covered by a health plan. On November 13, 2013 the federal government issued its final regulations to implement the MHPAEA. No later than January 1, 2015, full service health care service plan contracts that offer MH/SUD benefits must provide these benefits in compliance with the final regulations. The DMHC is working to ensure that health plans comply with the law. More …

Disability Access

Monday, July 14, 2014
The DMHC works to ensure Californians with disabilities have the necessary information to successfully navigate the changing health care system. In conjunction with the Western University of Health Sciences, Harris Family Center for Disability and Health Policy, the DMHC developed the following educational materials for individuals with disabilities, including physical, developmental, intellectual and sensory disabilities. These materials are available for download and distribution. More ...

Fraud Complaint Form

Wednesday, May 14, 2014
In light of the rapidly changing health care market, the DMHC wants to make sure consumers are protected from deception or fraudulent marketing practices. The DMHC Fraud Complaint form is available to report scams or deceptive practices in the marketing and sale of health insurance products. The form is available in 15 languages. More ...

 

Learn About...

  • DMHC
  • Rate Review
  • Consumer Assistance
  • Independent Medical Review (IMR)
  • Medical Loss Ratio

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