For on-exchange policies, please visit your carrier's website:
Chinese Community Health Plan (CCHP)
For off-exchange policies, please view your carrier's application agreement below:
Chinese Community Health Plan (CCHP) Application Agreement
Conditions of application – Please carefully read the following:
I. General Conditions
Chinese Community Health Plan (CCHP) reserves the right to reject any application for enrollment.
I understand that I have no coverage under this application until notified by CCHP that I am accepted.
If I am accepted, this application will become part of the agreement between CCHP and myself. Enrolled family members and I agree to be bound by the arbitration clause in the CCHP contract instead of trial by a court or jury.
I understand that willful misrepresentation can result in rescission of my coverage. CCHP can only rescind for a material misrepresentation or omission if the misrepresentation or omission is willful.
II. Acknowledgment and Agreement:
I hereby subscribe for myself and any enrolled dependents to the health plan designated here and agree to abide by all terms, conditions and provision of this Individual Membership Contract. I have read and understand the terms on this application and my signature below indicates my acceptance of these terms and that the information entered in this Application is complete, true and correct. I agree to notify CCHP promptly of any facts or circumstances which arise before the effective date of coverage under CCHP which make any of the statements supplied herein incorrect. I understand that coverage may be cancelled if CCHP demonstrates I have been fraudulent or intentionally misrepresented material fact in my application.
III. Disclosure of Personal and Health Information
CCHP understand the importance of keeping your and your dependents’ personal and health information private. CCHP protects this information in electronic, written, and oral forms when used throughout our company. CCHP will not disclose this information without your authorization except as permitted by law.
For the purpose of administering your CCHP coverage, CCHP is permitted by state and federal law to obtain your and your dependents’ health information from a healthcare provider, insurer, insurance support organization, health plan, or your insurance agent. Also, by state and federal law, CCHP is permitted to disclose your and your dependents’ health information to a healthcare provider, insurer, insurance support organization, health plan, or your insurance agent.
A complete explanation of CCHP policies and procedures (“Notice of Confidentiality and Privacy Practices”) for preserving the confidentiality of your personal and health information is available and will be furnished to you upon request by calling the Customer Service Department or by accessing CCHP’s website.
IV. Arbitration Agreement:
I understand that (except for Small Claims cases) any and all disputes, including claims of medical malpractice (that is as to whether any medical services rendered under the health plan were unnecessary or unauthorized or were improperly, negligently, or incompetently rendered), which may arise under the agreement between me and my dependents enrolled in the plan and CCHP and any of its affiliates shall be determined by submission to binding arbitration as provided by California law. Any such dispute will not be resolved by a lawsuit or resort to court process except as applicable law provides for judicial review of arbitration proceedings. ALL PARTIES TO THIS CONTRACT, BY ENTERING INTO IT, ARE GIVING UP THEIR CONSTITUTIONAL RIGHT TO HAVE ANY SUCH DISPUTE DECIDED IN A COURT OF LAW BEFORE A JURY, AND INSTEAD ARE ACCEPTING THE USE OF BINDING ARBITRATION. For more information regarding binding arbitration, please refer to your Evidence of Coverage.