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California health insurance  -  Individual California health insurance  -  Splitting individual policies

What are Rate Tiers in California Individual and Family health insurance?

ACA UPDATE:  The individual rating tiers no longer apply to the California market as of Jan 1st 2014.

Information below pertains to old market rules which no longer apply are available for old grandfathered plans only.

To quote the new plans standardized ACA rates and tax credits, click on Individual health quote including Covered Ca

California family health insuranceWhen does it make sense to split individual health insurance policies?

Is there a time when it makes sense to split an individual California health insurance plan? The answer is yes and we'll go through when it's to your advantage and how to analyze it. The tools are all available right through our quoting engine but we're happy to do this analysis for you.

First, let's look at how policies are "packaged" together.

We're essentially dealing with subscriber/spouse, family, or subscriber and child(ren) policies where more than one person is on a policy and plan. It used to be that almost all the plans on the market were priced based on the age of the younger spouse and that would drive the total family rate. This has changed quite a bit with many carrier individually pricing each person and then packaging the family rates with these individual rates. With this in mind, it makes less sense to focus on combining family members on one plan since they're individually priced anyway. The old benefit was that the rate would be based on age of the younger spouse which in today's world, can be a big spread which results in a bid price savings. Again, that's less of an issue these days.

The other issue dealt with different health insurance needs between family members. For example, a family might want richer benefits for children since they're more likely to use them but take advantage of the premium savings for having catastrophic coverage for adults where downgrading benefits can really swing the rates. A family may want the two adults to be on a high deductible plan while choosing a lower deductible for children. The guaranteed issue coverage for children which took effect 10/23/2012 has somewhat skewed this calculation now as children's coverage has gone up considerably and depending on their health, a higher tier can be applied.

One important note on the deductible and max out of pocket. If the family is combined on one policy and plan, there is usually a two member max which means that if two people meet their deductible, the other family members don't need to. For a larger family, this can be a risk to consider. Some carriers allows you to be on different plans but keep it under policy number and bill.

When split policies make sense with Family health plans in California

The two situations above (same plan and same tier) do not always apply. First, let's look as same tier.

Different tiers for family members

When a family goes through underwriting, the carrier will come back with a tier if approved. Tier reflect the rate that was offered. The rates you see in your Individual family health insurance quote are the best rates or Tier 1. There is also a tier 2 (25% higher), Tier 3 (50-75% higher), and so on. Occasionally, we'll have some family members get the best tier and perhaps another family member get "rated up" to a higher tier. In this case, that person is really on a separate plan. Since carriers like Anthem Blue Cross have gone towards separate plans bundled together anyway, this is not as big a deal. If your offered a higher tier, we generally recommend to take the combined coverage and then we can try to reduce the tier in the future since the carriers have pretty similar underwriting criteria. Tiers will go away with Health Reform effective Jan 1st, 2014. Make sure not to check the "all or none" for family members on the application so that the carrier can continue underwriting all family members if someone is declined.

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