Tag Archives: California
Finally, A Simple Break Down Of How California Health Plans Work.
Finally, A Simple Break Down Of How California Health Plans Work.
Understanding California Health Plans
This may be the best explanation you ever get in order to understand the many options available to you for California health insurance. This is just a simplified view of the plans so make sure to look at the details of any prospective plan. At the end of the article, we will discuss the various plans that differ from this simplification but this break-down will help with 80% of the plans on the market. Now…
California health insurance plans break down into three main categories.
1. Office consultation. With most health insurance plans, you will have a copay or co-insurance to pay for office consultations. The copay or co-insurance are typically not subject to the main deductible of the plan. A copay is a fixed amount such as for an office visit. Co-insurance is a fixed percentage such as 30% for an office visit. An example of co-insurance would be:
Office Visit: 0 charge
Negotiated rate: $ 60 charge
Co-insurance: 30%
In this case, the subscriber would pay 30% of the negotiated rate of for a total of . The negotiated rate is the charge that an in-network doctor or provider has agreed to in order to participate in that network. This usually applies to PPO type plans.
The office copay or co-insurance is only for the consultation itself. If the doctor runs labs, performs procedures, or does other services in addition to the consultation, these charges are handled in the third section and will be in addition to the copay or co-insurance.
The office consultation is one of the key items when looking at your California health insurance quote for Individual Family or Small Group insurance. You will typically see “” or “30%” in the results.
A quick note. With HSA qualified high deductible plans, the office visit consultation is subject to the main deductible. This means you must meet the deductible before you get a copay or co-insurance benefit. You will get negotiated rates for seeing an in-network provider even if the benefit is subject to the deductible. For example, in the case above, you would pay the as part of your deductible. Some plans do not cover office visits at all. They tend to be the least expensive hospital or catastrophic coverage plans.
2. Prescription coverage and California health insurance. With most plans, prescription coverage is broken out separately from the main deductible in the form of copays. Almost all plans on the market today distinguish between Generic and Brand name.
Insurance companies have a Formulary, or list of drugs they deem to be effective and cost-effective.
The lower-priced drugs are Generic and typically you have a smaller copay (around on average) which is not subject to any deductible.
Brand formulary drugs are more expensive and tend to be the patented drugs that are heavily advertised and marketed. Essentially, they are newer drugs. Usually, these drugs are handled with a higher copay (average around ) after a separate brand name deductible is met. This deductible tends to run 0-750 annually (per member) for individual family California health insurance and 0-250 for California Small Group health coverage. The deductible is usually per person (in a family policy) and it resets January 1st regardless of when the plan starts. One you pay the brand drug cost up to the deductible amount, following brand formulary drugs will just require a copay ( for example).
There is sometimes a 3rd category call Brand Non-Formulary. This essentially means the drug is very expensive and there are less expensive alternatives. With most plans, you will have to pay a percentage of the cost so there can be quite a bit more out-of-pocket with Brand Non-Formulary.
You can reduce your cost by asking your doctor if there a Generic equivalent. Some plans do not cover Brand drugs at all so double check this as the trend towards very expensive medications (10’s of thousands of dollars) for more exotic conditions.
3. Pretty much everything else. Most other coverage benefits (labs, x-rays, emergency, surgery, hospital) are typically subject to the main deductible. This is another item listed when you request your California health quote. The average deductible amounts run from no deductible up to 00 on average. The deductible is typically per person (usually up to two people a family) and it resets January 1st as well. When you see “2 member max”, this means that if two people meet their deductible in a calendar year, the other family members do not need to.
One note…HSA Health Savings Account plan deductibles are cumulative. This means that the family deductible (for two or more people on one policy) is not met for any individual on the policy until the family deductible is met. For example, if the individual deductible is 00 and the family deductible is 00, one individual on the family plan would not meet the deductible till the 00 was met. Other family members would have their deductible satisfied as well. Essentially, all individuals on the family plan are working towards one 00 deductible.
Once you meet the deductible you either go into a co-insurance sharing percentage or the carrier takes over 100%. For example, if your deductible 00, and the co-insurance percentage is 30%, with a max out of pocket of 00. Let’s say you have an ,000 hospital charge (in-network for covered benefits). You would pay the first 00, then you would pay 30% until you hit another 00 out of pocket. Essentially, you will pay 00 (max out of pocket) and the carrier will pay the ,500. With some plans, the max out of pocket is in addition to the deductible. The Deductible and Out of Pocket Max are two other important items listed when you get your health insurance quote.
With the Office Visit, Prescription Coverage, Main deductible and Max out of Pocket, you now can read the health quote results with confidence.
What Role Does Your California Health Insurance Agent Or Broker Play?
What Role Does Your California Health Insurance Agent Or Broker Play?
First, what is the difference between a broker and an agent?
These terms are often interchanged in conversation. Officially, an Agent is an individual or company that acts on behalf of the carriers to market, sell, and service insurance. The Agent has a contract with the carrier in order to transact this business. A broker is person who also contracts with carriers but officially acts on behalf of the client. In practical terms, they are not that different when dealing with California health insurance.
For example, Goodacre Insurance Services is a California agent but our goal is to find the right plan for a individual or company across the major carriers. If Blue Cross has the right option and better pricing for a given person or company, then that’s where we will go. We are independent agents which is important because we do not have interest in pushing one particular company or plan. We do have knowledge from dealing with the carriers every day in terms of which companies are easier to deal with, more stable, or better priced. There are dozens of plans on the market so this can really be important. Just looking a rate quote and benefit summary is only half of the story when choosing health insurance. Some plans exclude certain benefits or apply caps to other types of coverage. We know the lay of the land and I would personally not want to purchase health insurance just based on a rate quote.
Some companies (though not the majors) use “captured agents”. This is a person who sells only one carrier’s insurance plans. They are essentially employees for that company. I would avoid such companies as they may not have the best interest of the client at heart. If a company cannot quote multiple carriers, beware. The major carriers in California are Blue Cross of California, Blue Shield of California, Health Net, Pacificare, and Kaiser. Beyond these five, we do not feel very secure about the others.
How are agents or brokers paid? Agents are paid a commission by the carriers for policies issued and in force. The commission tends to be about the same from carrier to carrier. This commission does not affect the rate. The insurance rate you will get through an agent/broker is the same as you would get going directly through the carrier. The benefit of the agent relationship is that they navigate the carriers to expedite processing, help with service issues once enrolled, and act a third party. Again, a carrier’s main interest to keep you enrolled as policy subscriber but your interest may actually lie with another carrier or plan. An independent broker can help bridge the two at no additional cost to you. Also, the carriers are big companies. Some of the reps are very knowledgeable and others are…let’s face it…newer. By dealing with California health insurance daily, we are a wealth of information and guidance that you may not get by going directly.
What to expect from your broker/agent and especially Goodacre Insurance Services?
Goodacre Insurance Services provides service across three main areas.
California health plan selection.
This really is the most difficult part and it is the reason that people put off getting health insurance. There are many plans and the language is pretty technical. Most people glaze over when they see the brochures or instant quote results. Let’s face it….health insurance is not a common purchase. Typically, people have not needed to shop health insurance in years…if ever. Goodacre Insurance Services has been dealing solely with California health insurance for over a decade now. I can guarantee that with a few targeted questions, the plan selections can be narrowed down significantly. We want you to be informed. On a daily basis, we hear from our clients that they wish they would have called earlier rather than try to navigate the volumes of information provided the plans. Let us help. We do not sell. We listen, advise, and then it’s up to you what you wish to do.
California application and enrollment.
The health application is one more reason that people procrastinate. There are sections in there are mandated by law but which are thoroughly confusing such as the HIPAA qualification. Small Group can be equally difficult in terms of qualification for Small Group health coverage in California. We are happy to walk you through the application once a plan has been decided on. This is also the time to ask about the process, payment options, cancellation options, time table for enrolling in coverage. Based on your situation, we can give you a benchmark of what to expect for a normal processing.
Health Insurance Service and Membership.
Once the plan is in effect, we are your point of contact for membership issues, claims, and future changes. We go in at the end of each month and make sure that faxed changes, additions, and requests have been processed correctly. The carriers are pretty good but 1 out of 100 requests do not show in the system. You do not want to be that one with such a critical issues as health insurance. We can also advise for ways to reduce costs when the rate increase occur based on your changing health insurance needs.
Keep in mind that you can always contact the carrier directly if you choose but why would you? Let us do the work for you since there is no additional cost to you.
Agents and brokers are required to have a license and continuing education by the California Department of Insurance. You can always research an agent’s history, carrier contracts, and other information through them. There are different types of licenses. The two most common are Life/Health which is used to transact California health insurance and Property and Casualty is used to transact insurance such as auto or home insurance. Some agents do both health and P&C but it is increasingly difficult to this well and keep up with the ever-changing industries. This is why we choose to concentrate on health insurance solely. We know the carriers, the plans, and changes in the market. This makes us invaluable to you.
As we say on the phone here at Goodacre Insurance Services…”How can I help you out”.
Different Types of Health Insurance in California
Different Types of Health Insurance in California
Whether you buy group or individual health insurance in California, the options you have regarding the different types of health insurance are generally the same. In some groups you can even choose from available plans. These different types are traditional health insurance, health maintenance organizations (HMOs), and preferred provider organizations (PPOs).
California goes beyond the Federal requirements for offering health insurance to its residents. Examples of this include Industry Advantage plans (IAHP), short-term health policies, Insurance for high risk Individuals and special plans for children and teens.
Additional Health Insurance in California
The traditional health care delivery system is based on a fee-for-service type of arrangement. In a fee-for-service system, you pay or each itemized medical service you receive. In the days of the frontier, “Doc” often received a chicken as payment. Today, physicians are paid with money, lots and lots of it. Fee-for-service health insurance recognizes this practice and is designed to reduce or even eliminate your duty to pay directly for your medical care. Traditional health insurance comes in three parts:
California has four basic options for choosing a health care plan:
- 1. Health through an employer or association
- 2. Health Insurance through Income eligibility such as Medicaid
- 3. Health care for high risk individuals such as those that have had cancer or a heart attack
- 4. Private Insurance
Hospitalization
Hospitalization covers defined expenses incurred while in the hospital. Generally, the insurance will pay for all of the covered services rendered by the hospital staff. However, if the insurance benefit is an indemnity payment, the payment will be for a fixed sum regardless of the actual expenses incurred. This fixed sum will usually be far below the daily charge actually made by the hospital.
Medical/surgical
This part of a traditional health plan covers the expensive costs of medical care other than the bill from the hospital. Services such as doctor visits, treatment charges, etc., are covered here. Medical/surgical usually has a deductible and requires co-payments by the insured (payments you make for charges not covered by the insurance), typically 20 percent of the doctor’s fee.
Catastrophic or major medical
There are usually lifetime maximum payments that hospitalization and medical/surgical plans will pay, after which the well runs dry. Unfortunately, these maximums may not be sufficient to pay for all of the care required if a major illness or injury should strike, since such afflictions can eat up hundreds of thousands or even millions of dollars worth of health services. Thus, catastrophic coverage adds to your umbrella of protection in an amount sufficient to protect you from the horrendous expenses of such serious and prolonged illnesses. These policies also fill in some of the gaps not covered by hospitalization or medical/surgical.
Health Maintenance Organizations or Private Insurance in California
The health maintenance organization (HMO) is a relatively new player in the health insurance game, although it has been around in a limited fashion since the 1930s. The idea behind an HMO is to pay one premium and receive all of your health care at no or a nominal additional cost. The point is to save money compared to traditional health plans that cost more to purchase and require more out-of-pocket payments from the insured. What you, the insured, give in exchange for reduced cost is a substantial loss of your freedom to choose who will take care of your health needs.
Preferred Provider Organizations
Preferred provider organizations (PPOs) seek to give both the benefits of traditional health plans and the money savings of HMOs. They do this by paying higher benefits as a reward for your using the doctors or hospitals they preselect for that purpose.
Disability Insurance
Disability insurance does not pay for health care; rather it pays for lost wages caused by a disabling injury or illness.
How Health Insurance Is Priced
Ask anyone how health insurance is priced and you will get a simple answer: expensively! Beyond that, there are underwriting criteria used by health insurance providers, whether they are for-profit or, like Blue Shield/Blue Cross, nonprofit.
Underwriting Criteria
Age
The older you are, the more likely you are to get sick; therefore, the higher your health insurance premiums will be.
Number of people covered
Many people buy family coverage rather than individual policies. This means that there will be adults as well as minor children protected by the same plan. Some companies will charge based on the size of the family. Others charge a basic family rate without regard to the number of members.
Gender
Unlike life insurance, where women get the better end of the bargain than men, in health insurance women often pay higher premiums. This is based on health insurance industry statistics which indicate that the female of the species tends to need medical care more often than the male.
Health history
Insurance operates on statistical probabilities. If you have had a poor health history, statistically you are more likely to have a more expensive health care future. This, in turn, means that you will pay higher premiums-if you can get health insurance at all.
Occupation
The more likely you are to suffer injury or illness because of the work you do, the more likely the health insurance industry will be to charge excessively for benefits. This may be well and good for professional deep-sea divers. But the industry has begun to stretch the concept into areas that have nothing to do with the inherent danger of the work.
Lifestyle
In your application for health insurance you will be asked questions about your personal habits. Your answers will have a lot to do with the cost of your premiums. If you smoke, you will probably pay more for health insurance. If you drink to excess, you will probably pay more for health insurance. If you are known to be under a great deal of stress, you may pay more for health insurance. California does reward the health care Insurance consumer with lower premiums if they have practiced good health policies.
One of the most important things you can do as a health care consumer is to engage in preventive care. Not only will you be able to spot serious diseases at an early stage, thereby increasing your chances of effective treatment and cure, but you should be able to save money as well, since it is usually far less expensive to treat a disease when it’s a molehill rather than a mountain.
About The Author:
Medical-Ins.com is a leading broker of health insurance in California. We provide detailed information and cost breakdowns of Blue Cross, PacifiCare California and many more. Visit our site for a free quote and to help sort through the various health insurance plans to find the more affordable option for your family.
Understanding California Health Plan Deductibles
Understanding California Health Plan Deductibles
First, the official definition:
Deductible
The amount you must pay for medical services each year before your insurance begins paying.
Now what does that mean?
The deductible is an amount you will pay first before you get help from the carrier. Keep in mind that with a PPO plan, you will get discounted PPO rates which can lower the costs by 30%-60% even though you have a deductible to meet. It’s very important to always stay in-network to keep your costs down.
Exceptions to deductibles. Most traditional plans on the market allow copays for office visits and prescription before you meet your deductible. For example, if there is a copay for office visit, you will pay the right away rather than having to pay the full doctor visit subject to the deductible.
Prescription coverage is frequently broken out separately from the main deductible. There may be a separate deductible from Brand name drugs. This means that with a 0 brand deductible and brand copays, you would pay the first (resets each Jan 1st) 0 of your drug costs and then you would get copays afterward. The brand RX deductibles on the California individual family market typically run from 0-0 depending on the plan. On the California Small group market, the deductibles run from to 0 on average.
Some plans, such as the popular HSA (Health Savings Account) plans do not break out office visit and prescription from the main deductible. The deductible are all inclusive. There are a few other plans on the market which include the office and/or rx as part of the deductible so make sure to look at the plan detail when running your California health quote. The trade off with the HSA plans is that they can be much less expensive. If you are saving 0-00 annually or more, that pays for a lot of office visits and medication cost.
Deductible are handled in two ways when multiple family members are on one policy. Except for HSA plans, deductible are usually per person when you have more than one family member on a policy. You will typically see a “2 member max” statement around the deductible. This means that if two people in a family hit their deductible, the other family members do not need to. This is to protect against a catastrophic health situation where every family member had large bills in one year and the resulting out of pocket could be 10’s of thousands.
HSA’s or Health Savings Account plans on the other hand are cumulative deductibles. You essentially double the single person deductible and the entire family (2 or more people) is working towards one family deductible. Depending on the situation, this works to your favor or not. If one person in a family has large bills, he or she has a larger deductible to meet than if he/she were on an individual deductible plan. However, if multiple members have bills, it can be work to their advantage. Ultimately, the premium savings on an annual basis should more than compensate for the large deductible and that has been the attraction of HSA plans.
Out of network providers. Keep in mind that the discounted PPO rate for a given charge is what will be applied to a deductible if you use out of network providers. For example, let’s say you have a 0 deductible. If you have a 0 charge for an out of network provider, and the PPO contracted rate for that procedure is 0, the carrier will typically only apply the 0 to your deductible. Try to stay in-network with PPO plans.
After your deductible is met in a calendar year, with most plans, you then start to share the costs with the carrier for future medical charges in the form of co-insurance or copays according to the benefits of the policy.
Ways To Conserve From Car Insurance California
Ways To Save From Car Insurance California
Purchasing California car insurance is expensive. But with a little trick as well as devotion, you can find the right car insurance The golden state that is both inexpensive as well as provides excellent protection.
Right here are the methods to save for your can insurance coverage California:
Study
Check several websites that use can insurance The golden state. This is most likely the finest way to obtain the cheapest car insurance rate given that each firm follows its own price. See to it you understand what type of coverage you are seeking so as not to dive on the very first and also most affordable car insurance you have actually laid your eyes on. Keep in mind that most affordable could not be the most effective so make sure you weigh the claims and also the cost you need to pay.
Safe driving
It always pays to be a great driver. And what a far better method to gain from this is to get a lower The golden state car insurance prices. California can insurance provider compensate safe motorists with unique car insurance rates. To become qualified on this, you need to get a tidy record both on traffic violation and insurance coverage case. If in situation you only have a couple of traffic violation, you can take the defensive driving training course. This is to get rid of and clean your website traffic document.
The only disadvantage is you have to await several years to enjoy the reduced California car insurance rate. That means you have to stay away from website traffic offenses for a long time! But if safety and security is currently in your system, this would certainly be simple for you to do. After all, it is you who will certainly gain if you drive safely also without receiving any The golden state car insurance discount rate.
Update in a timely manner
Lots of automobile insurer in California and also even in various other states in the USA base their insurance coverage rates on your background. Failure to upgrade your policy also for one day could cost you additional dollars. Make certain you upgrade on time to make sure that you can avoid greater California car insurance price.
Monitor your odometer
Don’t obtain it wrong. You don’t need to limit your driving. Well, if obtaining car insurance price cuts suggests more to you, you can drive occasionally. But what we are trying to say below is that a number of car insurer in California base their prices on the annual gas mileage analysis. If you love to drive for miles, you must not be shocked if you get high car insurance price than those that drive much less.
Capitalize on reduced vehicle insurance
Price cuts on car insurance would be able you to conserve money. As well as there are several methods to get it. Here are the different ways to get reduced automobile insurance:
1. Discount rates on excellent motorist. Yeah it is currently pointed out yet you have to understand that everyone, no matter the age can receive an excellent motorist discount rate offered he/she keeps a tidy driving document.
2. Discount rates of multi-car proprietor or multi-driver. If you have 2 motorists with the very same car insurance plan, you can get this discount. A lot more if both of these motorists have clean records.
3. Discount on having safety and security as well as anti-theft devices. If you care sufficient for your automobile, your can obtain a reward. Many car insurance provider in The golden state offer discounts on chauffeurs who have mounted security and anti-theft tools.
Exactly How To Obtain Cheap Car Insurance Coverage Online In California
Just How To Get Affordable Auto Insurance Online In California
The legislation in the state of The golden state relating to car insurance coverage quotes is beneficial to the consumer. Each insurance provider has to provide either a toll-free number for quotes otherwise have an internet site where possible clients can use a type to get a no-obligation quote. This suggests that a driver in The golden state can effortlessly get in touch with various insurance coverage business to obtain a suggestion of what they would certainly charge for insurance policy.
The Net is really becoming the recommended method of getting quotes for auto insurance coverage. The golden state homeowners can check out the sites of various insurers at their leisure in their quest of the cheapest insurance policy. They supply their individual as well as important details and within moments they have a quote.
It is very important to keep in mind that also though the quote that is provided offers the customer a concept of what they would be dealing with in car insurance coverage premiums, there is still space for negotiation with the insurer. The reason is that virtually every auto insurer in The golden state uses discounts to their clients.
The discount rates vary and also include a decrease in premiums for defensive driving as well as chauffeur’s training programs. A percent price cut is frequently supplied if the insured drives below a proposed number of miles per year as well as also you can commonly save money if you have a cars and truck security system installed such as an auto alarm system.
When trying to find costs online, be particular to indicate, if readily available, which discounts you believe you qualify for. Additionally visit the website of your present health and wellness or life insurance firm, as well as see if they happen to use auto insurance policy. Several firms that use a variety of insurance policy items will certainly provide a substantial discount to their clients who purchase greater than one type of policy from them. If feasible, you should purchase all your insurance coverage products from one firm to guarantee you will delight in the largest price cut possible.
Although numerous people feel comfortable driving with the minimum quantities of car insurance needed by legislation in California, that’s not the situation with all chauffeurs. For someone searching for a complete insurance coverage car insurance quote in The golden state they require to initially know what sort of policy will best match their current requirements. The solution will certainly hinge on both their past driving history in addition to the vehicle they are driving currently.
If you have actually had a difficult driving past that’s consisted of a number of collisions that were your fault as well as speeding tickets you need to anticipate to pay more for full insurance coverage car insurance. You should be forthright when describing your driving history as every insurance policy business in the state of California will access your driving record via an Automobile Report. If it reveals you were much less than candid on your application it might indicate you won’t be offered insurance coverage.
Individuals that drive a newer automobile must have physical damage coverage. This is available in the form of accident as well as detailed insurance coverage as well as offers complete protection needs to your automobile be damaged. The insurance coverage typically prolongs past simply damages that is the outcome of a crash, yet also criminal damage, burglary as well as even flooding.
Without insurance drivers are sadly a reality of life everywhere, including The golden state. Although insurance coverage against without insurance vehicle drivers is optional, it needs to be included when you are looking for a full coverage car insurance quote. Define that you want this coverage so the agent you are handling will certainly include it for you.
Many individuals include additionals onto their automobiles consisting of stereo or DVD players. If you have done this, inquire about a cyclist that will cover the expense of having those changed ought to they be stolen or harmed. This will likely raise the price of your car insurance quote, yet it’s best to be totally shielded.