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California health insurance  -  Understand California Health  -  Hot Topics for California Coverage

California Health Hot Topics

This is the page to find what's really on Californian's minds when it comes to health insurance in the State.  It's a combination of the big changes that are coming (Health Reform) and the nuts and bolts of how to pick a plan.  We'll be updating this page often as the California health insurance market is literally changing all the time.  Hold on tight!

Health Reform
Plan Basics
Consumer Protection

Summary of Health Reform:

Health Reform changes appeared on the California health market 3/23/2010 and have continued piece meal since then.  The big changes will take place Jan 1st 2014 and we'll be updating along the way as new information comes out.

Key Points for Health Reform 

3/23/2010.  Demarcation point between Grandfathered and newer plans which are subject to new mandates.

3/23/2010.  First wave of new mandates.  Preventative benefits to be covered at 100%.  Children policies are guaranteed issue regardless of health.  Life time maxes go away.  Dependent children can remain on parent's plan till age 26.  MLR requirements dictate a percentage of gross premium goes to benefits.  Establishment of PCIP plan for people unable to qualify for individual/family.

 7/1/2012  Maternity is covered on all plans for both grandfathered and non-grandfathered plans in California. 

 8/2012.  Rebates go out to Californians based on MLR requirements. 

 10/1/2012  New requirements for benefits notification to employees with standardized benefit explanation. 

 Effective Jan 1st 2014, there will be four plans (platinum, gold, silver, and bronze) plus a  lower priced option for young adults on both the individual and family market.  Kaiser $30 Copay no-deductible plan is used as benchmark for metallics.

 Fall of 2013, we should have benefit details and pricing since people can begin to enroll for coverage then for a Jan 1st, effective date.

 Coverage will be guaranteed issue (regardless of health) for most Californians.

 Between 130% (expanded Medi-Cal basis) of poverty and 400%, most Californians will receive an immediate subsidy when they purchase health insurance through the Exchange (online shopping market which we'll have access to from  Tiers (higher rates based on health) will go away on both individual and group markets. 

 We expect band compression since oldest age band can not be more expensive than 3 times the youngest age band.  Age 40 and below will likely rise as a result.

 Individuals that do not have adequate insurance will be levied a penalty (most likely through taxes)

Jan 1st, 2013, 3% tax on passive source of income for individuals making over $200K or couples making over $250K including real estate gains, dividends, etc.

Small Group will now be 1-100 employees but fines/mandates primarily affect groups over 50 employee (equivalent hours).   (delayed till 2015)

Most current plans will end on Jan 1st 2014 except for grandfathered plans (which will be few and far between especially on the group market).

Our take on Health Reform.  There are many aspects we like.  Our major concern is that of cost since the bill primarily addresses universal coverage but not efforts to keep cost down. 

As we get more information, we'll continue to add it to our Understand California Health Reform page dedicated to all things ACA.  That's the place to go for up to date information.

Additional Reading for California Health Reform:

400% of Federal Poverty Level and Subsidy in California
Early Group Renewal for 2014 (Pump fake)
Bronze California health plan
Shrinking Doctor Networks and the Exchange
HSA plan options after Jan 1st, 2014
Benefit Subsidies on the California market
Health Reform Pump Fake
The Haves (Subsidy) and Have Nots of California health insurance
California release Health Exchange plan benefits
PCIP health plan for uninsurable
Predicting Future of California health insurance
Jan 1st 2014 Transition
Non-Exchange versus Exchange health plans
Expected California health Rate Shock
Introduction to the health Exchange
Health reform penalties for not buying insurance
Subsidies available for California health insurance
Enrollment Window
Hold on to old plans effective prior to 3/23/2010 
September 2012 Health Reform Update
Maternity on all Plans
Health Reform Rebates
Guaranteed Issue for Children
Grandfathering Coverage
Women's Preventative Coverage


Summary of Plan Basics:

We have written extensively regarding the basic components of most health plans on the market.  Most of these articles have undergone significant revisions to reflect changes mandated by Health Reform.  Below  are key points to consider and then additional reading with much more detail.

Key Points for Plan Basics: 

The California market breaks down into Individual/Family, Group Health, and Medicare (age 65 and over or disabled under age 65)

Within these segments, you have major types of plans primarily dictated by the network of doctors you can use, how you access care, and different tax incentives.  They are PPO, HMO, HSA, and HRA.

PPO plans allow more flexibility of doctor access but requires more cost sharing by you.  HMO's are structured in terms of accessing care but can have richer benefits (very expensive on individual market now).  HSA"s combine high deductible health plan with tax favored checking account for out of pocket expenses.  HRA's combine pre-funded accounts with high deductible plans.

The main components found in most California health plans are Copays, Deductibles, Co-insurance, and Out of Pocket Max.  You can find articles with great detail on each. 

Maternity is covered on most plans now by State law effective July 1st, 2012.  Preventative benefits are also covered on most plans with no cost-sharing effective 10/23/2012. 

The deductible plus max out of pocket is what protects you from big bills and is increasing the most important part of health insurance.  Some carriers show the max as separate from the deductible while others show it including the deductible.

There are no annual or life time maximum benefits on most California health plans.

You can access the brochure for any plan in the California quote by clicking on the plan name.

Find all benefit related articles here:  California health insurance Article Database

Additional Reading for Plan Basics:

Max out of Pocket
Brand RX versus Generic RX
How to really compare the plans

Summary of Consumer Protection:

Consumer Protection is primarily a responsibility of the California Department of Insurance (DOI) and for HMO's, the Department of Managed Care (DMC).  There are many important protections in place for the California health insurance consumer and we'll tough on many of them here.

Key Points for Consumer Protection:

Most applicants have a 10 day free look period from the time they are notified of an offer by a California health carrier to cancel the policy never effective for a full refund.  This can be for any reason.

There cannot be an application fee to apply for coverage and only the first month's premium is required to submit the application.

Most plans (except for Cobra) have a 30 day grace period for payment and a 2 month re-instatement period if back premiums are paid.

California has a 2 year clause from the effective date of a new plan after which a carrier cannot rescind coverage. 

Individual Family coverage is currently medically underwitten (except for children) which means that they can decline coverage based on health or apply higher rates (tiers).  This will change Jan 1st, 2014 as part of health reform.

Contracts are month to month and can be cancelled for any reason prior to the 1st of the month you wish the plan to end.

Cobra is a set of laws establishing continuation of coverage for employees that leave group health insurance.  Cal-Cobra extends this option down to 2 employees.  You also have a Cal-Cobra extension which gives you another 18 months on top of Cobra's original 18 months of coverage.

HIPAA is a law that basically states that all California health carriers must offer their two most popular plan to a person who exhausts or involuntarily loses their Cobra or Group health (among other requirements)

The PCIP plans provides coverage for people who are declined coverage and have not had coverage in the last 6 months.

Additional Reading for Consumer Protection:

10 day free look window
How rate guarantees work in California
Department of Insurance and other agencies
Filing a complaint regarding California health insurance
Recent California health insurance legislation
Options if you are uninsurable
Important resources and agencies

You can run your California health exchange plan quote to view rates and plans side by side from the major carriers...Free.

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