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Platinum Coverage

No deductibles and the lowest prices on services — two great reasons to go Platinum.

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Coverage

for pre-existing conditions

90%

of costs paid by your insurance company

Free

preventive care

No limits

on what your plan pays for covered services

Free

preventive children’s dental and vision

Choose Your Household Type

an individual
a family smiling together

$4,500

Out-of-Pocket Maximum

$0

Medical Deductible

$0

Pharmacy Deductible

$9,000

Out-of-Pocket Maximum

$0

Medical Deductible

$0

Pharmacy Deductible

Three Types of Plans to Choose From

(depending on location and company)

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HMO Plans

Get coordinated care from doctors and hospitals in the same network. Out-of-network services are only covered for urgent or emergency care.

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PPO Plans

Enjoy flexibility in selecting your doctors and hospitals in your plan's network. Out-of-network services are covered, usually at a higher cost.

a woman smiling at her phone

EPO Plans

See in-network specialists without getting a referral first, with monthly premiums that are usually lower than those of PPO plans. Restrictions apply to out-of-network services.

Every Plan Comes With

Free Preventive Care

Your health plan isn’t just there for you when you’re sick. Stay healthy with annual checkups, vaccines, screenings and more — all at no extra cost to you.

Free

From the first day you enroll

Transparent

All insurance companies offer the same preventive services

$0

Well-woman visits

Personalized

Free preventive care tailored to every age.

Keeping you healthy is the best medicine.

The same comprehensive benefits covered, but with the lowest copays of any metal tier.

a heart monitor beep inside of a stethescope

Preventive Care

Enjoy free services, like wellness visits and screenings.

a bear with a stethescope on its shoulders

Pediatric Care

Free vision care and preventive dental care for children.

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Follow-Up Care

Pay just $20 for a home health visit, or 10 percent of your bill.

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Doctor Visits

See your doctor for only $15.

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Other Services

Low copays on tests ordered by your doctor.

a pill bottle with a pill next to it

Pharmacy

No drug deductible. Your plan helps cover prescriptions from the get-go.

Frequently asked questions about Covered CA

Is Platinum right for me?

Platinum plans often have the highest monthly costs of all the coverage levels. When you receive care, however, your costs will be low. Platinum plans are a great option for people who use health services often. If you’re more interested in a plan with lower premiums but higher costs when you get care, the lower metal tiers (Gold, Silver and Bronze) may be your best bet.

Free preventive services in all Platinum plans include annual checkups, certain screenings, immunizations, prenatal care, children’s vision care and preventive and diagnostic children’s dental care.

What are copays, deductibles and coinsurance?

There are two kinds of Platinum plans: coinsurance plans and copay plans. The two plan types are very similar. In a coinsurance plan, for a few services, you’ll pay a percentage of a cost for services rather than a copay. For example, you’d pay 10 percent of your bill for skilled nursing care with a coinsurance plan; with a copay plan, you’d pay $150 per day up to 5 days.

Copays are the set amount you pay for a covered health care service, before the plan begins to pay.

Deductible is the name for the amount of money you have to pay in one year before your plan starts to pick up the costs for certain services. You don’t need to worry about a deductible with a Platinum (or Gold) plan: your plan will contribute to cost of care as soon as you access care.

Coinsurance is your share of costs for a covered health care service. It’s calculated as a percentage. With a Platinum plan, you pay for 10 percent of your hospital stay yourself, and your plan would pay 90 percent.

What if I want to schedule a Wellness Checkup?

Be sure the doctor or provider you want to see is participating in your health plan network. If you visit the provider before you receive your membership ID card, you may be asked to sign a statement agreeing to pay for the services if you can’t prove you have health insurance.

The provider may later send you a bill for the care. By the time you get a bill or claim from your provider, you will most likely already be entered into your health insurance company’s system. Once you have your membership ID card, simply contact your provider, provide them your membership ID card number and ask to have the bill resubmitted directly to your health insurance company.

Do I need to select a Primary Care Doctor?

Your plan may require you to have a primary care clinician. Your primary care clinician will help you navigate the health care system when you need assistance with specialty care, coordinating your care with other providers and helping you understand your treatment options. You can change your primary care clinician at any time.

What if I need to change my health insurance while getting treatment?

If your new health insurance does not work with your doctor, but you are getting treatment for a serious condition, call your new health insurance company to let them know about your treatment. Depending on what illness or condition you are receiving treatment for, your new health insurance company may be able to work with your current doctor while you finish treatment. Be sure to tell your current doctor that you have new health insurance.

How do I get prescriptions filled?

For questions about medications and getting your prescriptions filled, the first step is to contact your health insurance company to see if it has received your first payment and can issue you a membership ID card or a plan identification number. Ask which pharmacies you can use in order to get the pharmacy benefits of your health insurance plan.

What should I do if my income changes?

When the information that you put on your application changes during the year, you must report it. Changes to things like your address, family size and income can affect whether you qualify for Medi-Cal or get help paying for your health insurance through Covered California.

People with Medi-Cal must report changes to their local county office within 10 days of the change. If you have health insurance through Covered California, you must report changes within 30 days.

How do I make sure my preventative care is free?

Preventive care doctor visits are free, but if you bring up a health concern during the appointment, the visit may turn into a traditional doctor visit. That means you would have to pay a copay. The same could go for any tests that lead to more treatment or follow-up visits.

When can I start using services?

Services covered by your health insurance plan are ready to be used starting the next month after you make your first payment, even before your membership ID card has arrived.

Put a little Joy in your insurance experience.

Joy Olivier Insurance Agency Inc. has been helping Californians find the right health insurance. We love what we do and it shows. Come see why California is switching to Joy.

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