Who We Are
The California Association of Health Plans (CAHP) is a statewide trade association representing public and private health care plans that provide coverage to more than 26 million Californians.
CAHP works to sustain a strong environment in which our member plans can provide access to products that offer choice and flexibility to the Californians they serve. Most of our member plans provide coverage to Californians through the individual and group markets. Many of our member plans partner with the state by participating in government programs that provide health care coverage to children and adults in need.
Our Mission – Advocating for Health Plans
The mission of CAHP is to serve our member health plans by creating and sustaining an environment that permits them to maintain viability and grow as organizations dedicated to coordinating or providing high quality, affordable and accessible health care to their members.
We do this by:
- Advocating for the interests of health plans and their members on legislative and regulatory issues.
- Educating policy makers, opinion leaders and regulators on the implications of policy concepts, and proposals.
- Promoting collaborative efforts among health plans, providers, purchasers, brokers, other health care associations and other stakeholders to assert policy toward the provision of high quality, affordable and accessible health care.
- Informing the media and the public about our philosophy and the benefits health plans provide.
- Asserting a strong political presence in the state Capitol.
- Promoting opportunities and forums for plan members to meet, exchange ideas and discuss critical issues affecting the industry and industry effectiveness.
Health Care 101
The California Association of Health Plans (CAHP) is proud to play a role in statewide efforts to improve our health care system so that all Californians can benefit. The public and private health care plans represented by CAHP serve nearly 26 million Californians. The association is committed to improving the health of California’s communities by promoting the growth of health plans dedicated to providing high-quality, affordable and accessible health care to their members.
In California, 93% of the population is enrolled in health care coverage, and 6.8% are uninsured, although this uninsured gap is quickly shrinking due to new policies supported by health plans that provide more Californians with access to health coverage. Most Californians get health insurance through their employers or organizations to which they belong. This is called employer-based or group insurance. The employers purchase insurance through plans such as those offered by members of CAHP and offer the coverage to their employees. Employees usually pay a portion of the costs.
More than 46% of Californians get health insurance through government programs that operate at the national, state and local levels. Examples include Healthy Families, Medicare, Medi-Cal and programs run by the Department of Veterans Affairs and Department of Defense.
For Californians who don’t have access to either group insurance or government programs, there is individual health insurance. They can purchase this insurance directly from a health plan.
The table below shows the numerical breakdown for the types of coverage Californians have.
|Employer or Group-Based||47%|
Health Insurance Protects Families
The purpose of health insurance is to help pay for medical care. People cannot predict what their medical bills will be in the future. In some years, the consumer may have low medical expenses. In other years, medical bills can be very large. With health insurance, consumers and their families are protected financially in the event of an unexpected serious illness or injury.
Consumers with health insurance also are more likely to have a regular doctor and more likely to get preventative medical care. As a result, they are likely to be healthier, which means they can enjoy a better quality of life and avoid major medical costs that can occur by waiting until they become seriously ill to seek care.
Glossary of Health Care Terms
Health Maintenance Organizations (HMOs):
Organizations that provide a wide range of comprehensive health care services for a specified group or individual for a fixed premium. Consumers generally pay a fee, known as a deductible or a co-payment, for physician services, prescriptions and other health care services. With an HMO, consumers can choose from a large selection of primary care physicians within their network. Once selected, most HMOs require that consumers’ medical visits begin with the selected physician and that the consumers stay in the HMO network. These plans are licensed by the Knox-Keene Act and the Department of Managed Care.
Point of Service (POS):
An HMO product that allows the enrollee to receive a service from a non-HMO provider at a higher cost to the enrollee. The higher cost can take the form of a deductible and/or a higher point-of-service charge.
Preferred Provider Organizations (PPOs):
Health plans that negotiate discounted fees with their “preferred providers:” hospitals, doctors and other health care providers. These plans then encourage enrolled members to use the preferred network of providers by offering lower co-payments and other incentives. Enrolled members also have the option of visiting physicians, hospitals and other health care providers outside the network of preferred providers but usually will pay more for out-of-network providers. These plans are licensed by the Knox-Keene Act and governed by the California Department of Insurance.
Primary Care Physician:
The physician who assumes responsibility for the comprehensive medical care of an individual on a continuing basis. The physician obtains professional assistance when needed for services he or she is not qualified to provide and coordinates the care provided by other professional personnel or specialists.
The physician who assumes responsibility for medical care of an individual for specialized services and generally on a limited basis, usually on referral from a primary care physician.
Provider is paid a fixed, per capita amount for each person served without regard to the actual number or nature of services provided to each person. Capitation is most common in contracts between plans and medical groups.
Fee For Service (FFS):
Provider is paid for each encounter of service rendered. Under fee for service arrangements, expenditures increase if the fees themselves increase, if more units of service are charged or if more expensive services are substituted for less expensive ones. Fee For Service is most common in traditional indemnity and PPO arrangements. There is no coordination through a primary physician.
A method of payment whereby an individual provider is paid a fixed salary without regard to the actual number or nature of services provided to each person. This form of payment is most common in staff model HMOs and in some medical groups. Groups and IPAs are likely to be paid by capitation. Hospital payment methodologies may vary.
Community rating differs from the current method of “underwritten” ratings for setting health insurance rates. With underwritten ratings, health status is taken into consideration in determining the rate. This helps keep costs down. With community ratings only specified factors, such as age, family status and geography and not health status, can be taken into consideration when setting rates.
The portion of charges the consumer pays to the provider for covered health care services in addition to any deductible.
Consolidated Omnibus Budget Reconciliation Act (COBRA):
Act that gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce and other life events. Qualified individuals may be required to pay the entire premium for coverage of up to 102 percent of the cost to the plan.
A fixed amount which is deducted from eligible expenses before benefits from the insurer are payable.
Employee Retirement Income Security Act (ERISA):
Administered by the U.S. Department of Labor, Employee benefits Security Administration. ERISA regulates employer sponsored pension and insurance plans (self-insured plans) for employees.
Exclusions and/or limitations:
Conditions or circumstances spelled out in an insurance policy which limits or exclude coverage benefits.
Health Insurance Portability and Accountability Act of 1996 (HIPPA):
HIPAA amended the Employee Retirement Income Security Act (ERISA), to provide new rights and protections for participants and beneficiaries in group health plans. HIPAA includes protections for coverage under group health plans and patient privacy. These protections limit exclusions for preexisting conditions, prohibit discrimination against employees and dependents based on their health status and allow a special opportunity to enroll in a new plan to individuals in certain circumstances. For individuals, HIPAA includes protections that guarantee access to individual policies for people who qualify and guarantee renewability of individual policies. HIPAA also gives consumers the right to access their health information and limits who can look at and receive a person’s health information.
A requirement that health plans issue coverage to individuals regardless of pre-existing medical conditions, age or other factors. Forced coverage without regard to medical history could lead to people dropping insurance when they’re healthy and resuming coverage only when they are ill or expect to incur health expenses, thus causing medical and health care coverage costs to skyrocket.
Term used to describe a provision where a consumer’s health insurance cannot be cancelled if they become sick.
Health Savings Accounts (HSAs):
Federal accounts created by the Medicare bill signed into law on December 8, 2003. These accounts are designed to help individuals save for future qualified medical and retiree health expenses on a tax-free basis.
Requiring all individuals to purchase or obtain some type of medical coverage.
A federally funded, state-run program that provides health insurance coverage to individuals and families with limited incomes and resources.
California’s Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources. Medi-Cal is supported by federal and state taxes.
Medi-Cal Managed Care:
Medi-Cal programs that have networks of providers, including doctors, pharmacies, clinics, labs and hospitals. Consumers must use the providers in the network when they need health care.
A federal health insurance program for people age 65 and older, some disabled people younger than age 65 and people with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant).
A medical condition a consumer has prior to enrolling in any new group health plan.
President & CEO
Charles Bacchi is the President & CEO for the California Association of Health Plans (CAHP) representing 46 health plans providing coverage to over 26 million Californians. For the last 14 years Mr. Bacchi served in leadership positions at CAHP, as Executive Vice President and Vice President of Legislative Affairs, leading the Association’s advocacy before the California Legislature, the California Health Benefit Exchange, Department of Health Care Services, and the Department of Managed Health Care on behalf of CAHP’s health plan members.
A veteran of California’s political community, Mr. Bacchi has over 25 years of experience in California’s legislative, advocacy, and trade association arenas. Under the Affordable Care Act, health plans play a critical role in offering millions of Californians access to health care. As state policymakers crafted California’s approach to ACA implementation, Bacchi played a prominent role as the health plan voice on a range of issues, including translation of the ACA into state law, the start-up of Covered California, and the expansion of the state’s Medicaid program, Medi-Cal.
Media Contacts for CAHP Member Plans
Aetna / CVS Health
AIDS Healthcare Foundation
Alameda Alliance for Health
General Media Line
Alignment Health Plan
Anthem Blue Cross
Blue Shield of California
Nicolette Worley Marselian
Central California Alliance for Health
831-430-5500 ext 4179
Chinese Community Health Plan
Young Soo Cho
Contra Costa Health Plan
Health Net of California
Health Plan of San Joaquin
Health Plan of San Mateo
Heritage Provider Network
Inland Empire Health Plan
Inter Valley Health Plan
Kern Health Systems
L.A. Care Health Plan
Molina Health Care
On Lok Lifeways
Oscar Health Plan
San Francisco Health Plan
Santa Clara Family Health Plan
SCAN Health Plan
(Havas Formula for SCAN )
Scripps Health Plan
Sharp Health Plan
SIMNSA Health Plan
Sutter Health Plus
Valley Health Plan
Western Health Advantage
Your Plan Your Advocate
Our Your Plan Your Advocate campaign highlights how health plans are advocating to make quality health care more affordable and accessible.
CAHP Fact Sheet: Say No to SB 598: A Prescription for Low-Value Healthcare
CAHP Fact Sheet: Medi-Cal Managed Care Plans Making A Difference For Enrollees Through Cal-AIM