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Incarcerated Members

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)

The California Board of Corrections, United States Marshall Service, or the city or county where the member is detained usually provides medical treatment for the incarcerated person. Incarcerated persons may decline medical treatment if they can receive treatment at their own expense.

California law prohibits a health care service plan or disability insurer from denying a claim for hospital, medical, surgical, dental, or optometric services for the sole reason that the member is incarcerated, provided the member is otherwise entitled to reimbursement for such services under the plan contract and incurs an expense for services performed.

Coverage for Incarcerated Members

Incarcerated members are covered for medical treatment, including urgent and emergency care, provided the coverage is received as stated in the member's Evidence of Coverage (EOC) or Certificate of Insurance (COI). The member is responsible for obtaining any required referrals or prior authorizations. The member is also responsible for obtaining any necessary court approval, transportation or security costs.

Medical treatment that is required as a result of an injury sustained during confinement or mandated medical testing is not covered; this is the responsibility of the institution where the member is detained.

Last Updated: 10/29/2019