Employee Eligibility

Eligibility requirements for employees looking to enroll in CaliforniaChoice® through their employer are below. For a complete listing of requirements, download our Underwriting Guidelines

Employee Eligibility at Enrollment
  • As an eligible employee, you are required to be actively working an average of 30+ hours per week over the course of a month, at the employer's regular place of business or, 20+ hours per normal work week for at least 50% of the weeks in the previous calendar quarter.
  • Ineligible employees include:
    • 1099 employees
    • Commissioned employees
    • Permanent employees eligible for medical health care coverage offered by or through labor union
    • Part-time employees
    • Seasonal employees
    • Temporary or substitute employees
    • Employees on a leave of absence not categorized as FMLA, Workers Compensation, or Military

Coverage for Your Spouse


You must be legally married in order for your spouse to be eligible for coverage through CaliforniaChoice.

Coverage for Your Domestic Partner


For a Domestic Partner to qualify, you and your Domestic Partner must:
  • Both have filed a duly executed Declaration of Domestic Partnership with the Secretary of State and will provide copies to CaliforniaChoice within 60 days of its issue.
  • Agree to notify CaliforniaChoice immediately upon termination of domestic partnership.

Coverage for Dependent Children


Your children are eligible for Medical, Dental, Vision, and Chiropractic coverage if they are:
  • Born to, a step-child or legal ward of, adopted by, or have an established parent-child relationship with the eligible employee, employee spouse, or domestic partner.
  • Under age 26 (unless disabled, disability diagnosed prior to age 26)*.
For Ameritas Dental only, your children must be:
  • Born to, a step-child or legal ward of, adopted by, or have an established parent-child relationship with the eligible employee, employee spouse, or domestic partner.
  • Financially dependent upon the employee per IRS guidelines.
  • Unmarried or not involved in a domestic partnership
  • Under age 26 (unless disabled, disability diagnosed prior to age 26)*.
*Dependents who are incapable of self-support because of continuous mental or physical disability that existed before the age limit are eligible for coverage until the incapacity ends. Documentation of disability will be requested. Once the child reaches the age limit for coverage, verification of eligibility will occur annually at the child's birthday.

Continuity of Care


If you are in the middle of treatment and your current physician is not contracted with the Health Plan you wish to select, please contact our Customer Success Center at 800.558.8003 for assistance.
SUPPORT
Address

721 South Parker, Suite 200
Orange, CA 92868

Office Hours

Monday - Friday 8:00 am to 5:00 pm PST

Customer Service

Phone: (800) 558-8003
Fax: (714) 558-8000
Email: CustomerService@CalChoice.com

Sales

Phone: (800) 542-4218
Fax: (800) 500-9088
Email: Sales@CalChoice.com

Department of Insurance License

#0B42994

SUPPORT
Address

721 South Parker, Suite 200
Orange, CA 92868

Office Hours

Monday - Friday 8:00 am to 5:00 pm PST

Customer Service

Phone: (800) 558-8003
Fax: (714) 558-8000
Email: CustomerService@CalChoice.com

Sales

Phone: (800) 542-4218
Fax: (800) 500-9088
Email: Sales@CalChoice.com

Department of Insurance License

#0B42994