Your State Government's Oversight of Health Insurance in California
The California State Government is in charge of developing, implementing and overseeing insurance requirements and regulations within the state. In fulfilling this mission, the State Government generally chooses to balance the rights of consumers with a business environment that promotes a robust economic growth rate. Within the area of health insurance, the State Government must serve three major constituent groups: consumers, insurance companies, and independent brokers.
The State Government's primary control factor for assuring a fair health insurance system is the licensing and review of insurance providers and independent brokers. For insurance providers, the State Government prepares minimum standards for insurance products and performs routine financial statement reviews, ensuring taxation requirements are met. For insurance brokers, the State Government establishes professional and licensing qualifications, manages broker license testing and license issuance, sets and reviews continuing education needs, and collects broker license fees. The State Government is also responsible for identifying and investigating insurance fraud, especially as it pertains to consumers or when it is harmful to the state's business environment.
For health insurance consumers, the State Government publishes public information and consumer guidelines to help residents understand their best health insurance options. The State Government is also available to help consumers file insurance appeals with their health insurance provider when there is a dispute over policy coverage or terms. And, the State Government is responsible for managing the Federal Medicare program within the state where subsidized health insurance is available to children without health insurance and low income families, seniors, or the self-employed.