If your private insurance has ended but Medi-Cal still shows it as active, you can clear it using the DHCS OHC Removal or Addition Form on the Department of Health Care Services Other Health Coverage page at dhcs.ca.gov/services/other-health-coverage. Requests submitted through the form are processed within 36 to 72 hours.1Medi-Cal Rx. Adding or Removing Other Health Coverage for Medi-Cal Members You can also call the Medi-Cal Telephone Service Center at (800) 541-5555, or go through your county eligibility worker if you receive Medi-Cal through the county.
Why the Old Coverage Has to Come Off
Other Health Coverage (OHC) is what DHCS calls any private insurance a Medi-Cal member holds: employer plans, union coverage, individual policies, dental, vision, and Medicare supplemental insurance. Medi-Cal is the payer of last resort under federal and state law, so any other insurance has to pay first.2Medicaid and CHIP Payment and Access Commission. Third Party Liability Providers are required to exhaust a member’s OHC before billing Medi-Cal.3Medi-Cal. Other Health Coverage Guidelines for Billing
When the state’s eligibility system still lists a plan that no longer exists, it tells providers to bill that carrier first. The carrier has no active policy, so nothing pays, and the Medi-Cal claim gets rejected in the meantime. Pharmacies see this constantly: a prescription that should run through Medi-Cal gets bounced because the system returns an OHC code for coverage the member no longer has. Removing the stale code restores Medi-Cal as the primary payer.
When You Need to Submit the Form
Submit a removal request whenever your private coverage has ended but the record still shows it. The common triggers:
- You lost or left a job and your employer plan ended.
- Your COBRA continuation coverage has run out.
- A divorce or family status change took you off a spouse’s or parent’s policy.
- Your private insurer cancelled the policy, stopped offering plans in California, or you didn’t renew.
- DHCS records show coverage you never actually had, often from a data-matching error where another source reported coverage in your name.4Santa Clara County Social Services Agency. SSBS Responsibility for OHC
Three Ways to Submit
Online Through the DHCS Website
The quickest option is the form on the DHCS Other Health Coverage page at dhcs.ca.gov/services/other-health-coverage. DHCS directs both members and providers to this form for adding or removing OHC.1Medi-Cal Rx. Adding or Removing Other Health Coverage for Medi-Cal Members
By Phone
Call the Medi-Cal Telephone Service Center at (800) 541-5555 or (916) 636-1980, Monday through Friday, 8 a.m. to 5 p.m., excluding holidays.5California Department of Health Care Services. Other Health Coverage A representative can process the removal over the phone. This is useful if you don’t have a termination letter in hand and need the record corrected quickly.
Through Your County Eligibility Worker
If you get Medi-Cal through your county rather than through SSI/SSP, your county eligibility worker handles OHC updates. Bring or mail written proof that the insurance terminated to your county welfare department. The worker keeps a copy in your case file and sends a completed form with the termination date to DHCS. If you receive SSI/SSP and call DHCS directly, the Department’s Health Insurance Section will verify the termination with the carrier for you.6California Department of Health Care Services. Verification of Other Health Coverage
Information to Have Ready
Whichever route you use, gather these details before you start:
- Your 14-character Medi-Cal Benefits Identification Card (BIC) number.7Medi-Cal. Eligibility – Recipient Identification Cards
- The exact name of the insurance carrier listed on your Medi-Cal file.
- The policy or group number from your old card or termination notice.
- The type of coverage: medical, dental, vision, pharmacy, or Medicare supplement. Each type may have a separate entry.
- The exact date coverage ended.
Proof That the Coverage Ended
DHCS needs some form of documentation. The strongest proof is a letter of coverage termination from the insurance company, or a letter from the carrier stating you were never a member if the entry is a mistake.8Los Angeles County Department of Mental Health. RMD Bulletin Other acceptable documents include a termination notice from your former employer’s HR department, a final COBRA expiration notice, or a letter from the plan administrator confirming the end date.
If you don’t have a formal termination letter, ask your former insurer for one. Most carriers can produce it on request. If the carrier is slow to respond or has gone out of business, DHCS staff or a county eligibility worker can verify the termination with the carrier directly.6California Department of Health Care Services. Verification of Other Health Coverage
Processing Time and How to Confirm
Requests submitted online or by phone are processed within 36 to 72 hours.1Medi-Cal Rx. Adding or Removing Other Health Coverage for Medi-Cal Members Requests routed through a county eligibility worker can take a little longer because of the extra step.
The fastest way to check is to have your provider run your BIC through the Automated Eligibility Verification System. If no OHC carrier code comes back, the removal worked and Medi-Cal is your primary payer again.3Medi-Cal. Other Health Coverage Guidelines for Billing You can also confirm at the pharmacy: if your prescription processes through Medi-Cal without being bounced to a third party, the entry is gone.
If the Code Is Still There After 72 Hours
Call the Telephone Service Center at (800) 541-5555 and ask for a status update. Often the holdup is incomplete information, like a mismatched carrier name or a missing termination date, and you can fix it on the call.
If DHCS denies the request or won’t act on it, you can request a state fair hearing. Any Medi-Cal member who disagrees with a decision affecting benefits, including a refusal to update coverage information, can request a hearing through the California Department of Social Services, State Hearings Division.9Medicaid.gov. Understanding Medicaid Fair Hearings Call the State Hearings Division toll-free at (800) 743-8525 or submit a request online at the CDSS website.10California Department of Social Services. State Hearing Requests The state generally must issue a decision within 90 days of receiving the request.
If a Provider Is Submitting for You
Providers, including pharmacies, can fill out and submit the DHCS OHC removal form on a member’s behalf with the member’s consent, given in person or over the phone.1Medi-Cal Rx. Adding or Removing Other Health Coverage for Medi-Cal Members Providers without online access can call the Telephone Service Center at (800) 541-5555 during business hours to process the update.3Medi-Cal. Other Health Coverage Guidelines for Billing With the 36-to-72-hour turnaround, submitting at the point of care can clear the block before the next visit or refill.