Health Insurance

28 Learn the rules for your policy. • Read your health plan’s Summary of Benefits to learn what is covered and what is not covered (excluded). • Your insurance only pays for care that is medically necessary. This is defined in your insurance policy. • Your plan may not pay for care that is experimental or investigational. But if you have a serious illness and feel that you need an experimental or investigational treatment, you can ask for an independent medical review. See page 31. • You may need to get pre-approval from your health plan for some kinds of care. • You do NOT need pre-approval for emergency care. • Health insurers must cover Essential Health Benefits. See page 6. • For more information about the rules for plans regulated by the California Department of Insurance visit www.insurance.ca.gov . • For more information about the rules for plans regulated by the California Department of Managed Health Care, go to www.dmhc.ca.gov. • Self-insured plans follow different rules. For more information, go to your human resources department or visit www.dol.gov/ebsa.