•A Quick Introduction To California Health Insurance And Pre-existing Conditions, Waiting Periods, And Exclusions
It's important to look at a carrier's policies and restrictions regarding pre-existing conditions, waiting periods and exclusions as they can differ from company to company. This is just an overview in layman's terms.
First...what is a pre-existing condition. The official definition reads as follows:
Pre-existing Condition
Any illness or health condition for which you have received medical advice or treatment during the six months prior to obtaining health insurance. Group healthcare...
•Back To The Basics... More Information On The Max Out Of Pocket
The official definition for California health insurance plans:
Out-of-Pocket Maximum
The most you will have to pay in a year for deductibles and coinsurance for covered benefits.
You will sometimes see this referred as Out-of-Pocket Maximum, Copay Maximum, or Max out of Pocket depending on the health carrier. They all mean the same thing. They let you know how much you will have to pay in a catastrophic health situation up to your lifetime max (which is usually in the millions...or should be...
•Company Size, Enrollment, And Pricing in the California Group Health Insurance Market
Questions often arise in the California health insurance acquisition process concerning size of the company and available benefits for small businesses and the effect the size of a company may have on the premiums and the products available.
Companies 2-5 employees
The minimum size required in California to qualify small for Small Business coverage is to show 2 eligible employees minimum. Both eligible employees do not usually have to enroll in the plan if one is able to waive the plan offer...
•Compare The Major California Health Insurance Carriers
Five Critical Criteria used to compare California carriers.
1. Health Plan pricing in the market. Ultimately, benefits need to be priced well relative to other similar plans on the market. Also, the plans have to make sense financially in today's world of ever-increasing cost. Some large multi-line carriers like Principle offer extremely rich benefits that have completely priced themselves out of the market. There's a "sweet spot" where plan design meets the consumer's budget and that has to...
•Discount Plans in the California Health Insurance Market
Over the last 10 years, as California health insurance costs have increased significantly, there has been an explosion in both the availability and marketing of so-called discount health plans as we term them in the industry. It's important to understand how they work and more importantly, how they do NOT work.
First a quick refresher on the whole point of health insurance protection to begin with. Health insurance is coming full circle back to its original design and intent. Originally,...
•Options For Non-Maternity Plans on the California Individual Health Insurance Market
What are some current plans that work well when maternity coverage is not needed? Maternity is one of the single biggest determinants on health plan cost when researching individual health insurance plans in the California market. It's easy to see why when a simple delivery can run $10,000 and an uncomplicated C-section can run $20,000. Maternity is probably the only health care service you can actually plan on to some extent. No one plans for a broken bone. Health care costs have spiraled up...
•Paying For Individual Health Plans For Employees
Many employers in California do not realize that paying for employee's individual health insurance policies presents many problems. There can be liability for the employer in doing so. Let's look at the implications and understand why providing Small Group health insurance to your California employees is important.
First, we need to understand the differences between Small Group health or employer sponsored health insurance and individual/family or private insurance. Small Group is quite...
•Primary Care Physicians and Your California HMO Health Plan
First, the official definition of the Primary Care Physician:
Your Primary Care Physician (“PCP”) is the doctor you choose to provide basic health care. In an HMO, your PCP must refer you to a specialist if you need to see one.
Primary Care Physician is a term that applies with HMO Plans. PPO style plans do not use PCP's. It is important for HMO members to understand how care is handled through their Primary Care Physician to get the most out of their plans.
When do you chose a PCP?
One...
•The Tonik Health Plan Copay and You
Let's take a look at the office copay for Tonik health insurance plans. Tonik was designed to give people access to coverage for the things they use most and keep cost down. The office copay definitely fits in this category. First, what does the term copay mean.
First, what is a copay? Officially, a copay is the fixed portion of charges you pay to your provider for covered health care services in addition or separate from any deductible. For example, $20 for an office visit or $15 for a...
•Understanding the Tonik Health Plan Deductible
Let's check out deductibles in Tonik health insurance plans first since that is such an important part of any health plan. A deductible is an amount that you must pay first for certain benefits before the carrier starts to kick in.
For example, if you blow your knee out and it's $15,000 to repair (which isn't too far off) and your Tonik health plan has a $1500 deductible, you will need to pay the first $1500 of that $15,000 bill towards your deductible.
How in-network affects the...
•What is Difference Between California Small Group and Large Group Health Insurance
"Group coverage" is used loosely to describe health insurance plans that are employer sponsored but there is a distinction between "Small Group" and "Large Group" health benefits which is important. Your company's options can be quite different under these two umbrellas so let's take a look at the how they differ both in terms of qualification and treatment under the law.
What is "Small Group" in terms of employer-sponsored health insurance In the State of California, Small Group health...
•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...
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