The federal government pays benefits planners in communities around the country to help people think ahead about work incentives and benefits issues. CWIC'S are benefits planners who are trained by the Social Security Administration to assist beneficiaries with programs including Supplemental Security Income (SSI), and Social Security Disability Insurance (SSDI) in addition to other related programs.

Group health coverage through COBRA, Cal-COBRA, or OBRA.

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.

A condition defined by Medi-Cal as one which results in average monthly medical expenses that equal or exceed twice the monthly health insurance premium. For example, if an individual’s monthly health coverage premium is $300, their medical costs must be greater than $600 per month to be considered a high-cost condition.

Health insurance for Californians who are unable to obtain coverage in the individual health insurance market, usually due to pre-existing condition exclusionary periods.

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.

See Medi-Cal Managed Care.

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.

Coverage that is not funded by local, state or federal government. Private health coverage can be paid for by an individual, employer, or association.

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, co-payments, 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.