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California Health Insurance
Health insurance holds universal importance when it comes to protecting your health and your family’s healthcare needs. Buying good health coverage is expensive but it is requires a thorough review of all potential risks and its effect on your finances. However, nearly 47 million Americans remain insured, as the U.S. lawmakers continue to bring down the medical expenses for an average working family. A major portion of these uninsured working families prefer to forego health insurance, unaware of the outcome of huge medical expenses of an unanticipated event. Indeed, your employer’s health insurance is always there to protect you and your family against these unexpected circumstances. However, for those families who are not covered under their employers’ group plan, many states provide low-cost health insurance programs to them.
In 2008, California was ranked as the 24th healthiest state to live in according to America’s Health Rankings. The state’s health rankings showed improvement from its 25th spot and 23rd spot in 2007 and 2006 respectively. On the whole, California continues to be a good and healthy place to live in, as long as you have appropriate health coverage in place. However, even though the public health funding is strong, affordable health insurance needs to be easily accessible to the uninsurable Californian residents.
The state of California, having the highest population of more than thirty six million citizens, has both private-market and public health insurance alternatives. The private-market health insurance comprises of numerous types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide inexpensive health coverage to the uninsurable residents of California who meet specific eligibility requirements of age, income and health status.
The California Department of Insurance is responsible for regulating all types of insurance sold in the state of California including health insurance policies offered by private-market health insurers or public health coverage programs. However, approximately 18.5% of the population remains uninsured, as state strives to improve the standards of healthcare quality for its citizens. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, approximately 34.1% of uninsured Californian residents come under the above 200% FPL category.
Shopping for affordable health plan for your family can truly be exhausting and perplexing. In the wake of high health care costs, you need the guidance of a licensed health insurance agent/broker, when it comes to gaining from health insurance benefits.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of California. These regulations apply to all insurance companies offering individual or family health insurance in California:
Medical Underwriting | Yes |
Pre-Existing Condition Exclusion Period | 12 months |
Look Back Period | 12 months |
Look Back Standard | Objective |
Mandatory Benefits | Cancer screening for women including breast cancer screening and cervical cancer screening, minimum IP mastectomy stay as determined by the surgeon, reconstructive surgery after mastectomy, screening, diagnosis and treatment of osteoporosis, infertility diagnosis and treatment (except in vitro fertilization), direct access to OB/GYNs, OB/GYNs as primary care providers, depression parity, eating disorder parity |
Market Rate Restrictions | NA |
Guaranteed Issue Options | NA |
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of California. These regulations apply to all insurance companies offering small group health insurance in California:
Small Group Size | 2-50 |
Employee Qualifications | Must work for at least 6 months out of the year, and work 20 hours per week for coverage |
Guaranteed Issue | Yes |
Premium Rating Factors | Rate Bands |
Rate Adjustment Factors | 10% |
Look-Back Period | 6 months |
Pre-existing condition exclusionary period | 6 months |
Mandatory Benefits | Same as individual |
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of California. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:
Mini-Cobra Option | Yes |
Eligible Group Sizes | 2-19 |
Extension of Benefits Period - Standard | 36 months |
Extension of Benefits Period - Disabled | 36 months |
Maximum Premium Increase | 110% for regular plans and 150% for disability plans |
State Legislation Reference | California Insurance Code Section 10128.50 – 10128.59 known as the California Continuation Benefits Replacement Act (Cal-Cobra) |
Additional Notes | Individuals not eligible for Cal-Cobra include those that are eligible for Medicare or have other medical insurance. The Cal-Cobra acceptance deadline is 60 days following the individual’s last day of coverage under the group’s health plan. |
State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of California to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of California is summarized in the chart below:
Plan Name | The Major Risk Medical Insurance Program (MRMIP) |
Website | |
Phone Number | 916-324-4695 |
HIPPA Eligibility Required? | No |
Available Carriers | Anthem Blue Cross of California, Blue Shield of California, Contra Costa Health Plan, Kaiser Permanente |
Pre-Existing Condition Waiting Period | 3 months |
Enrollment Periods | Waiting List, enrollment cap of 7,100 members |
Premium Limits | Between 125% and 137.5% of standard rate |
Lifetime Maximum Benefit | $750,000 |
Special Notes | Cannot be eligible for both Part A and Part B of Medicare, unless eligible solely because of end-stage renal disease. |
Children’s Health Insurance Program
Through shared funding from the federal government, the State of California provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
Program Name | Healthy Families Program |
Website | |
Phone Number | 800-880-5305 |
Apply Online | Yes |
Age Limits | Under 19 |
Insurance Carrier | Anthem Blue Cross of California, Blue Shield of California, Aetna, Kaiser Permanente, Health Net, PacifiCare, United Health Care and Celtic |
Length of Coverage | 12 months |
Residency Requirements | California residents, U.S. citizen, U.S. non-citizen national, eligible qualified immigrant |
Other Eligibility Requirements |
|
Pre-Existing Condition Exclusions | Yes |
Cost | Costs $4 to $17 for each child, or no more than $51 for a family. Members also pay a co-payment (usually $5) when they go to the doctor or get other services. Some services are free. |
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of California:
Governing Agency | Medi-Cal |
Website | |
Phone Number | 800-541-5555 |
Residency Requirements | California resident |
Federal Poverty Line Income Limits | Age < 1: Up to 200% FPL |
Additional Resources
California Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines California’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
California: At-A-Glance
Provides exclusive health data of the California state. Statehealthfacts.org, a project of the Henry J. Kaiser Family Foundation, is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.
