California Individual Health Insurance

Health insurance is an essential safety net that will protect you in case of an accident or severe illness accompanied by costly medical expenses. Individual health insurance from a private insurer is expensive and has its own limitations compared to group coverage. Shopping for a health insurance policy can turn out to be quite a tedious task. However, for those considering private California individual health insurance, the possibilities are endless, as there are often literally hundreds of plans to choose from. There are laws and regulations in California surrounding these private policies that you should be aware of, in order to make a more informed decision.

Eligibility: How Am I Evaluated?

Applicants are usually evaluated based upon their age, health status, geographic location, gender and health history. There are no laws regarding how applications should be reviewed and each company has the flexibility to take their own policies and regulations into account when deciding whether or not to cover an individual. The only exception is for HIPPA eligible consumers. If you are unable to qualify for individual coverage and you exhaust Cobra, then there is typically HIPAA option available to you. According the California law, each insurance company must offer their two most popular individual plans on a Guaranteed Issue basis to HIPAA eligible individuals. The rates are higher than a regular health insurance policy but it does provide a back-up option in case you are unable to get your own individual coverage.

An applicant can be turned down for any reason, including health status. Insurers are not required to cover any person unless they are HIPPA eligible or a newborn dependent of a woman who is already covered under the insurers policy. The health insurers have the right to raise the premiums depending on the health status of the insured. For medically uninsurable residents, California offers Major Risk Medical Insurance Program (MRMIP)

California Guaranteed Benefits Pre-Existing Conditions

HIPPA eligible residents are guaranteed a health plan from private insurance companies, but there are limitations on what these companies are required to offer. For example, you can be limited to just two policy options from the insurer. This will usually be either the providers two most popular policies or a high and a low basic policy option.

Although there are no regulations on standardized policies, all plans must cover certain basic benefits, such as breast, prostate and cervical cancer screenings, vaccinations, diabetes-care services for residents, routine care for cancer clinical trials and continuity of medical care for pregnant women. Knowing more about these standard benefits will make it easier for you to choose between policies. Aside from HIPPA eligible consumers, all applicants can be affected by a pre-existing condition exclusionary period. The maximum exclusion period for these conditions can only last for up to 12 months and an insurer has a look back window of 12 months to determine what exclusions should apply.

The state law requires California health insurance companies to have the same coverage limits and benefits for mental health conditions also known as mental health parity. All insurance rate reductions or increases must be approved by the state's insurance commissioner before the change goes into effect.

California Individual Health Insurance Premiums

Premiums for California individual health insurance policies are determined based on many individual factors, including health status. The only rate restrictions are afforded to HIPPA eligible consumers, who have a limit on how high their premiums can run; everyone else can be charged any amount that the insurer sees fit and there is no limit to how much one can be charged for a policy. These rates can even be based on your health status, gender, age, geographical residence, health history and health care costs in the location you reside. So, if you have poor health, your rates will likely be much higher than the next person.

Lastly, in California you are guaranteed the opportunity to renew your health insurance policy at the end of your plans term, regardless of your health status. On the flip side, your insurer can also review your policy rates and charge you a higher premium if your health has declined since. This helps to protect both the consumer, from being without protection when in declining health, and the insurer, from paying costly medical expenses on their own dime.

For those individuals who cannot easily obtain health coverage, the California Major Risk Medical Insurance Program (MRMIP) health insurance to its residents who were denied private market coverage due to a medical condition.

The cut-throat competition in the health insurance market can make health coverage shopping confusing and inconvenient. Therefore, before opting for a health insurance policy, it becomes important to be aware of the coverage details and the costs associated with owing that health plan. With the assistance of a qualified broker/agent, you can purchase appropriate health coverage with benefits befitting your medical needs.