California Individual Health Insurance

Health insurance is an essential safety net that will be there for you in the case of an accident or severe illness accompanied by costly medical expenses. 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 health status and age for older applicants. 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.

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 insurer?s policy.

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 provider?s 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 cancer screenings. 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 good news is that this period can only last for up to 12 months for plans covering up to 2 people or just 6 months for plans covering 3 or more people. An insurer has a look back window of 12 months for plans covering up to 2 people or 6 month for plans covering 3 or more people, to determine what exclusions should apply.

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. 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 plan?s term, regardless of your heath 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.