With the cost of health care rising dramatically it is very important for everyone to have medical insurance. You can either opt to buy individual medical insurance or go in for group medical insurance that is provided by most of the employers. However when you buy individual medical insurance then you should make sure that you are taking it from an agent or broker who has a license from the State of California.
Types of policies
Medical insurance pays for the costs that are incurred while diagnosis and treatment of a disease. In California there are different types of medical insurance plans available. It is very important that you know about all the plans so that you can select the one that suits your needs and conditions.
Indemnity policy: With this policy you can choose any doctor who you want to see. There are a few restrictions that you are supposed to follow. You might have to pay the deductible before your policy covers the other costs. Besides this you might also have to pay a co-payment for the medical expenses that are covered by the policy. You can easily approach the California Department of Insurance to clarify any doubts regarding this plan.
Preferred Provider Organization: You get the maximum befit of this policy when you tend to stay within the network of PPO. However you can also have options where you can opt to go out of the network but these would cost you. Before you use your policy you should make sure that the specialist or the doctor who has been recommended comes under the PPO network. You can also contemplate taking help from the DMHC that are specified on the Blue Cross or the Blue Shield PPO medical plans. You can get in touch with the DMHC or the California Department of Insurance for clarifying doubts about this policy.
Health Maintenance Organization: With this policy you are required to take assistance from HMO providers. However there are some exceptions in emergency cases. The choice of your basic care physician is significant as he or she is directly responsible for your health care. Beside this the primary care physician can also provide you referrals for doctors within the HMO. When taking this policy your options are often restricted to a geographic area within the network of the HMO. Whenever you use the HMO services you can be charged a small amount of co-payment.
Self-insured Medical Plans: If you are working for a big name employer or work for a school district or have union affiliation or work for a municipality and they offer you a medical insurance plan then it would come under the self-insured entity. Any insurance company or a TPA administers these plans. The federal ERISA laws dominate these plans.
Multiple Employer Welfare Arrangements (MEWAs): if your employer is a member of a trade, professional or industry association then he can offer you a MEWA medical plan. However at present there are only 10 MEWAs that are operating with the CDI certificate because of the regulation passed that no new MEWAs can form and operate or even apply for the CDI certificate.
In case you have taken group medical insurance and face any incident of termination or your job is converted into a part-time job then you can take the help of Consolidated Omnibus Budget Reconciliation Act (COBRA). This is a federal law according to which you can get an extension in your policy for a period of 18 months. In California this law is applicable to a group that has 2-19 people covered. This law is not applicable to individual policies, besides only indemnity policies, PPOs, HMOs, and church plans are included under this law.
There is another law called as HIPPA, which helps people who have lost their group policies to get individual medical insurance policies. You can apply for this within a period of 63 days after your Cal-COBRA policy has expired. These are not conversion polices.
The California medical insurance is either marketed as individual or group insurances. In case your employer does not provide you with group insurance then you can opt for the individual insurance plans. There are a number of people who are contract employees or work as self-employees or work for small employers and hence cannot have group medical insurance. You can obtain individual medical insurance by getting in touch with a licensed agent or broker. When you do so you are required to complete an application wherein you are required to provide details about your medical history. An underwriter reviews this history and if you meet the criteria then you are given the policy.
Some of the companies offering California medical insurance are mentioned here.
They have been giving out health insurance for the past 12 years and hence have developed a standing in the insurance sector. Their representatives are well versed with all the medical insurance terms and conditions and would explain everything to you before you sign up for any insurance. They themselves do not sell you medical insurance but would educate you on the insurance topics. The rates are the same whether you buy it from them or from any other source. They are independent brokers and are representatives of a number of companies. When you decide to apply through them then they would recommend you different options that would suit your needs. You can pick from any one of the options that you like. They are authorized agents of Blue Cross California and Blue Shield California.
EveryHealthPlan.com They are an online medical insurance service agency and provide information to the people who are looking for some kind of information on medical insurance. They provide search tool for various medical insurance companies. Since, they are not owned by any insurance company, they provide authentic information about different companies to their customers. This can help people in making a decision about which insurance policy is the best for them.