California Health Insurance (CA)

Health insurance has always been a delicate topic. Shopping for a health insurance policy is difficult and requires a fair understanding of the health insurance laws in your state. However, when it comes to protecting your family against illnesses or injuries, you need to have an estimation of your budget and your family's health care needs. California provides various alternatives for health coverage shopping.

HealthInsuranceFinders.com offers free California health insurance quotes for group or individual plans and information resources on affordable California health insurance plans. Whether you are looking for information on low-cost health insurance in California or an online quote from major California health insurance companies, you will find everything you need here, in one convenient location.

California (CA)
Individual Health Insurance Regulations

Learn more about California Individual Health Insurance

In California, medical underwriting is allowed without restriction. Medical underwriting enables insurance companies to look back into the medical history of their prospective members. Insurance companies offering (individual or family) California health insurance plans may deny coverage based on medical history and other factors. The look-back period for pre-existing conditions is 12 months. California is one of the few states in the nation that is a "non-rider" health insurance state. Due to California medical insurance regulations, an insurance company offering health insurance in California is not permitted to place an "exclusionary rider" on a new health insurance policy. Therefore, the acceptance guidelines of the insurance companies in this state tend to be stricter than in other states, with a higher percentage of declined applications. Rates for individuals in California are based only on geographical location, age, medical history and other such rating factors. The insurance companies can impose an exclusionary period of 12 months on the applicants for the treatment of pre-existing conditions. However, the state mandates coverage for certain medical services such as breast cancer screening, vaccinations, post-delivery hospital stays, etc.

California also offers a high-risk pool (MRMIP) for residents with pre-existing conditions who are unable to find health insurance through a private insurance company, California provides a high risk insurance pool named Major Risk Medical Insurance Program (MRMIP).

California (CA)

Small Group Health Insurance Regulations

The State of California defines a "Small Group" as any company with between 2 and 50 employees. Any employee working for a qualified small group operating within the state is guaranteed approval on an application for health insurance. The insurance company can adjust their published rates by no greater than 10%. Rates are based on age, zip code of residence and the composition of the family. Any qualified group that renews their existing health insurance policy will follow the same criteria and rating guidelines. To qualify as a small group, a company must have at least 2 employees that work at least 6 months of the year and at least 20 hours per week. The owner(s) of the company can count as an employee if he draws wages from the company. For preexisting condition requirements, the insurance company may review in the 6 month medical history of the applicant and has the right to impose a 6 month exclusionary period for those medical conditions that did not have prior medical coverage. The health insurer may not cancel the group's health coverage just because one or more members gets very sick and generates high health care costs.

Cal-COBRA and Continuation Coverage

COBRA is available for up to 36 months under certain qualifying events and is a continuation of the same coverage you had under your group health plan. The qualifying event can be termination of job, reduction in hours, divorce, death, the employee enrolls in Medicare or he is no longer a dependant of the employee. The one exception to this is if the former employer was fired for gross misconduct. Upon the expiration of COBRA, you may enroll in a HIPAA individual health plan offered through private health insurance companies offering individual health plans in California; or in MRMIP, the high risk pool of California, provided you have pre-existing medical conditions. Premiums are typically very high, but acceptance is guaranteed if you enroll within 60 days of the termination of your COBRA coverage.

Cal-COBRA applies to employers with 2-19 employees and provides these employees up to 36 months of coverage after the occurrence of a qualifying event. If your Federal COBRA lasted 18 months, you may be able to keep your health insurance under Cal-COBRA for 18 more months, for a total of 36 months. If your Federal COBRA lasted 36 months, you cannot get more Cal-COBRA. For the first 18 months, you are responsible for paying 110% of the total health insurance premium your employer may have been paying.

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