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Health insurance california
Having a proper health insurance is almost inevitable these days, considering the ever rising costs of health care services and drugs. The occurrence of an injury or prolonged illness can topple you financial stability if you dont have a cover for the expenses related with the treatment. If your employer doesnt provide you with enough cover, you should look for an individual plan just to be on the safer side. In California, you can purchase exclusive medical coverage through a broker who is approved by the state of California.
Available health insurance plans in California:
A health insurance plan compensates for the costs of diagnosis and treatment for conditions covered in the plan. According to the varying needs, there are policies available with varying costs and features. As there are a wide range of plans on offer, you should be careful while selecting the right one for you and it is advisable that you familiarize yourself of the nature of the different plans available. The following are the types of plans that are available in California.
Indemnity (Fee-for-service) policies: The distinct feature with the indemnity policies is the freedom it provides the policy holder to choose the doctor or hospital of his/her choice. Most of such plans will have a deductible, the amount of which you may be able to choose.Indemnity plans are regulated by the California Department of Insurance (CDI), whom you may contact for any assistance in health insurance matters whenever you feel so.
Preferred Provider Organizations (PPOs): You may choose from a list of insurance providers, approved by PPO. If you acquire health care services from only those included in the list, your financial benefits will be maximum. If you avail service from a physician or hospital which is not included in the list, then the plan may either cover only a portion of the expenses or none at all depending on the agreement in the contract. In California, PPOs are regulated either by the CDI or DHMC (Department of Managed Health Care) depending on the issuer of the policy.
Health Maintenance Organizations (HMOs): Those insured under the HMO, are required to receive health care services from those who are affiliated with HMO. Generally, the insured person chooses a primary care physician who treats and decides the future course f action and refers the patient to get specialized treatment, if necessary, to doctors and hospitals within the HMO. As the regions that the HMOs operate are restricted, the coverage may be limited in case of treatments received from a source out of HMO network or area of coverage.
Self-Insured health Plans: Popular among big employers, labor unions, school districts and other municipalities, they provide funds to pay for the health care of their members. Usually, a third party administrator (TPA) manages the processing of the plans and the payments.
Multiple Employer Welfare Arrangements (MEWA): Employers who are members of associations like those in trade and industry are given permission by MEWA to develop trust funds which will be used to provide health insurance to their employees. Legislation was passed to regulate the functioning of MEWAs following repetitive complaints about their misappropriation of claims in the 80s and 90s. Only those MEWAs who were eligible for a certificate of compliance from the government were allowed to function and as a result only about ten MEWAs function are functioning now. It is illegal for a new MEWA to be started and provide health care benefits.
Healthcare coverage provided by the state: For those who are ineligible for a health insurance due to income restrictions or pre existing illness or conditions, and for employers with less than 50 workers under them, there are specially designed programs of the state of California.
The Major Risk Medical Insurance Program or MRMIP is designed to provide health care benefits to those who dont qualify for a health insurance otherwise.This is a partially subsidized plan which provides health care cover through contracted health insurance companies and plans. The insured are to pay a portion of the premium. According to a state legislation, a limit of 36 months is in place for one to be under this plan, after which period, they are given a chance to buy guaranteed health coverage through indemnity policy, PPO or HMO.
Healthy Families Program: Specially developed for the benefit of children of poor parents, under the Healthy Families Program, low cost coverage for general health, dental and vision care are provided.
Access for Infants and Mothers Program (AIM): AIM is designed to provide health care coverage to pregnant women. It offers exclusive package which includes inpatient and outpatient care for the participants. It is particularly intended for low to moderate income groups of women.
Supplemental Health Insurance Policies: Supplemental policies should be seen only as an addition to your major health insurance policy and not as a substitute to a conventional healthcare plan.They may cover for limited amounts such as a daily amount if you are hospitalized or a lump sum amount in the event of you being diagnosed with a particular disease like cancer. A supplemental policy may also be designed to cover for the expenses for the treatment of the particular disease.
Complaints and inquiries: You may avail the assistance of the California Department of Insurance in case you have any complaints against your insurance company or any inquiries related to health insurance policies or laws. CDI may be contacted thro the toll free number 1-800-927-4357.
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