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Combined Evidence of Coverage and Disclosure Form Effective January 1, 2024Anthem Blue Cross Traditional Basic Plan Health Maintenance Organization (HMO)Contracted by the CalPERS Board of Administration
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How to fill out losing your medi-cal coverage
How to fill out losing your medi-cal coverage
01
Contact your local Medi-Cal office or health insurance marketplace
02
Provide necessary information such as your name, address, and Medi-Cal identification number
03
Fill out any required forms or documents
04
Submit the forms and wait for confirmation of your coverage termination
Who needs losing your medi-cal coverage?
01
Individuals who no longer qualify for Medi-Cal due to changes in income or household size
02
Individuals who have found other health insurance coverage options
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What is losing your medi-cal coverage?
Losing your medi-cal coverage means no longer being enrolled in the California Medi-Cal program for healthcare coverage.
Who is required to file losing your medi-cal coverage?
Individuals who are no longer eligible for the California Medi-Cal program must file to report their loss of coverage.
How to fill out losing your medi-cal coverage?
To fill out losing your medi-cal coverage, individuals must contact the California Medi-Cal program or use the online portal to report their loss of coverage.
What is the purpose of losing your medi-cal coverage?
The purpose of losing your medi-cal coverage is to update the California Medi-Cal program on changes in eligibility status and ensure accurate healthcare coverage.
What information must be reported on losing your medi-cal coverage?
Individuals must report their loss of coverage date, reason for loss of coverage, and any new healthcare coverage options they may have.
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