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  Catastrophic coverage for California Health Insurance

California health insurance General Health Insurance Guides Catastrophic Coverage
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UNDERSTAND
CATASTROPHIC CALIFORNIA HEALTH INSURANCE
 
INDIVIDUAL FAMILY

Specific information for individual family coverage

 
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SMALL BUSINESS

Specific information Small Group coverage for 2-50 employees
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SENIOR

Specific information for Seniors eligible for Medicare Supplement
KEY POINTS FOR CATASTROPHIC CALIFORNIA HEALTH INSURANCE

Catastrophic health insurance options.  There are three main types of catastrophic California medical insurance plans:


1.  Hospital only 
The least expensive plans tend to be hospital only plans.  They typically do not cover issues outside of a hospital or outpatient prescription benefits

2.  High Deductible All Inclusive  The next level of plans are high deductible plans for which most services (usually everything but preventative) are subject to the main deductible.  The Health Savings Account - HSA qualified plans are an example of this type.  The Health Savings Account offers additional tax benefits in addition to the premium savings of the high deductible insurance plan.  You can find more information on the Health Savings Account.

3.  High Deductible with Office Visits/Prescription  The next level of plans typically have a high deductible but offer some sort of immediate benefits for office visits and prescription.
 

Trends towards Catastrophic Coverage  The monthly premium for California health insurance plans has increase significantly lately.  As this trend continues,  catastrophic coverage will make more and more sense...especially the Health Savings Account option.    

Who does catastrophic coverage work for?  As rates increase more quickly each year for full benefit HMO and PPO plans, the catastrophic, high deductible insurance plans will make become even more beneficial.  It works very well for anyone in the 40's, 50's or 60's as premium increases with age.  It also tends to work well with families.  Again, the annualized premium savings vs potential out of pocket is the key comparison to make (read below).   

High Deductible plans  Since the insured person is both paying the premium and receiving the benefits, it usually makes sense to look at a low cost, high deductible PPO plan that is comprehensive.  Compare the annual savings in premium versus the Maximum out of Pocket possibility.  If your savings in premium accounts for a sizable amount the potential out of Pocket maximum, then it might be a good decision.  In a bad year (health wise), it's a wash.  In a good to average year, you stand to save the annual premium difference.  We would be happy to help with this health insurance comparison.   We would be happy to help with this California health insurance comparison

You can get your Catastrophic health insurance quote for either option here:

Individual - Family Health Insurance          Small Business Health Insurance
 

vided by http://www.dmhc.ca.gov/  Link here

Emergency and Urgent Care and California health insurance

California Heath plans must cover emergency care, even if you do not go to a hospital in your plan's network. Any emergency room must treat you until you are well enough to be moved to a hospital in your health plan's network. Your plan must also cover emergency care when you travel outside of your plan's service area.

What Is an Emergency?

The law says that it is an emergency if you reasonably believe that it is an emergency. It is an emergency if waiting to get care could be dangerous to your life or a part of your body. A bad injury or a sudden serious illness can be an emergency. Severe pain and active labor are also emergencies. Your California health plan must cover emergency care no matter where you are and what hospital you go to. However, you may be moved to a hospital in your health plan's network when you are stable enough to be moved.

What Is Urgent Care?

Urgent care is care you need within 24 to 48 hours. Your health plan must cover urgent care when you travel outside your plan's service area. If you are within your plan's service area, you must use doctors in the network for urgent care.

Be Prepared Ahead of Time

  • Ask your primary care doctor what to do if you or your child needs urgent care.
  • Ask your primary care doctor or call your health plan to find out where you can go for urgent care or other after-hours care. You can also find out about urgent care in your Evidence of Coverage.

Tips

  • If you can, call your doctor or an advice nurse before you go to the hospital. Ask what you should do.
  • Keep your Membership Card with you at all times.
  • If your plan will not pay for the emergency or urgent care you received, you can file a complaint with your plan.
 

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