Health Care Benefits: California

Federal law and guidance on this subject should be reviewed together with this section.

Author: Jayne Zanglein, Western Carolina University

Summary

• California chose to establish a state-based Marketplace under the Affordable Care Act. See Health Insurance Marketplaces Under the ACA.
• California has an individual health insurance mandate. See Individual Health Insurance Mandate.
• Same-sex marriage is legal nationwide. California also recognizes same-sex domestic partnerships. See Same-Sex Partner Benefits.
• California health insurance mandates apply to fully insured group health plans. See Scope of Mandates.
• Group health plans that allow dependents to enroll must include other dependent coverage. See Dependent Coverage.
• Certain group health plans must provide basic health care services, including basic health care for children. See Basic Health Care Services.
• Group health plans must cover certain women's health benefits. See Women's Health Care Services.
• Group health plans must cover testing and vaccines for COVID-19 and other diseases, and for human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). See Testing and Vaccinations; HIV/AIDS Testing and Vaccines.
• Group health plans must cover prostate cancer screening for men. See Prostate Cancer Screening Coverage.
• Health insurance policies must cover, without cost sharing, colorectal cancer screening tests and required colonoscopies. See Colorectal Cancer Screening Coverage.
• Group health plans must provide parity for mental health and substance use disorder benefits. See Mental Health and Substance Use Disorders.
• Group health plans must provide coverage for the treatment of diabetes. See Diabetes-Related Services and Supplies.
• Group health plans must provide coverage for certain specified health providers. See Coverage for Specified Providers.
• Group health plans must provide coverage for certain illnesses, services and supplies. See Other Coverage Requirements.
• Employers have notification requirements related to employer-sponsored health coverage and flexible spending accounts (FSAs). See Notice Requirements.
• San Francisco has requirements pertaining to Health Care Benefits. See Local Requirements.