Glossary: Medi-Cal/HIPP

A trained expert who can help you understand and apply for benefit programs. Their goal is to help you develop a plan for your future and organize your financial life to run as smoothly as possible.

  • For questions about work and your Social Security benefits, use Social Security's "Find Help" tool to locate a WIPA project near you. You can also call the Ticket to Work Help Line at 1-866-968-7842 / 1-866-833-2967 (TTY/TDD). The Department of Rehabilitation (DOR) also has Work Incentives Planners (WIPs).
  • If you need assistance with your Medicare, the Health Insurance Counseling & Advocacy Program can help. HICAP provides free information and counseling to people with Medicare. You can call HICAP at 1-800-434-0222 or visit the HICAP website.
  • If you need assistance with Medi-Cal and have a disability, you can contact Disability Rights California at 1-800-776-5746 or visit their website. You may also be able to get help with Medi-Cal from a local legal aid organization. The Health Consumer Alliance website has a lot of useful information about Medi-Cal, including a web page that can direct you to a local legal organization for assistance.
  • If you have questions or need assistance with a program or benefit not listed here, contact an Independent Living Center. Independent Living Centers provide peer support and information on a wide range of topics for people with disabilities.

If you lose access to group health insurance that you got through your employer for certain reasons, including a job change, divorce, or job loss, there are laws that allow you to continue your group coverage temporarily. This is known as continuation coverage. You will usually have to pay the full costs of your continuation coverage, including any portion of the premium your employer may have paid for in the past. The federal continuation coverage law is called COBRA. Many states also have their own continuation coverage laws.

Health-insuring organizations that are organized and operated by a governing board appointed by the county’s Board of Supervisors. All Medi-Cal beneficiaries residing within the county are required to enroll unless they have a voluntary aid code, which allows them to enroll in fee-for-service Medi-Cal. The first plan was implemented in Santa Barbara County in 1983. Five County Organized Health Systems plans operate in eight counties: Monterey, Napa, Orange, San Mateo, Santa Barbara, Santa Cruz, Solano, and Yolo.

The amount an individual is responsible for paying for health care services before the insurer begins to pay.

Medi-Cal has a list of certain conditions, like AIDS, that they automatically consider high cost. For other conditions, Medi-Cal estimates how much it would cost them to pay for your condition. They then estimate how much it would cost them to pay for your private insurance premiums. Conditions that are more expensive for Medi-Cal to cover are high cost conditions.

A Medi-Cal program that requires most recipients to receive services within a network. Recipients are assigned a primary care provider who is responsible for managing their care. Also known as Medi-Cal Prepaid Health Plan.

The insurer who pays medical claims last when an individual has multiple sources of health coverage.

A regularly scheduled payment to an insurer or health care plan.

The first insurer to pay medical claims when an individual uses multiple sources of health coverage.

Health coverage through a private company that pays for medical expenses. A monthly premium must be paid for this coverage by the individual or family covered, by an employer, or by an association. The individuals covered by private health plans must also make payments such as copayments or coinsurance each time they use certain medical services.

In some cases, the federal government may help low to middle-income families pay for private health coverage through tax subsidies if they are in very specific situations and do not have other affordable health coverage alternatives.

A health insurance policy from a private insurer, Health Maintenance Organization (HMO), or self-insured trust.

A spouse, domestic partner, or parent whose employer-sponsored health plan premiums are paid for by Medi-Cal/HIPP. Medi-Cal/HIPP pays premiums for qualifying family members when it is cost effective to enroll the family member in the employer-sponsored plan.

A health insurance plan that supplements a primary insurance plan. Health care costs not covered by the primary plan can be submitted to the secondary payer, which often covers some or all of the deductibles, copayments, and other services not covered by the primary insurance provider.

A plan that covers an individual’s medical expenses with company funds set aside to pay health claims. In general, self-insured plans are subject to federal, but not state, health coverage laws. Ask your employer or plan to find out if you are in a self-insured plan.