A multi-state employer offers California employees two medical options: (1) a Blue Shield HMO and (2) a Blue Shield PPO indemnity plan. An employee in the PPO plan is denied coverage for a specialty drug and wants to file a regulatory complaint. Which California regulator should the employee contact, and under what authority?

Why this is the answer

Even where a single carrier (Blue Shield, Blue Cross, Anthem, etc.) issues both HMO and PPO products, regulatory jurisdiction follows the product, not the carrier. The PPO indemnity product is 'disability insurance' under Ins. Code § 106 — CDI regulates rates, forms, and consumer complaints. The HMO is a 'health care service plan' under Health & Safety Code § 1345 — DMHC regulates it under Knox-Keene. ERISA preempts STATE LAW remedies in some employer-plan disputes but does not eliminate the state regulator's jurisdiction over the insurance product itself — and the question asks who to contact regulatorily, not who to sue.