Q: I am coming off of a group plan from my prior job and I understand from
recent legislation that I will be guaranteed a health plan. Is this true?
A: Recent legislation enacted by both the United States Congress and the California
State Legislature have made it possible for anyone coming from a group plan to an
individual plan to have guaranteed access to an individual health plan. Under the law,
before you can be eligible for the guarantee under this plan you must complete your 18
months of COBRA eligibility. But this is really only necessary if you know you are
uninsurable. These guaranteed plans have high deductibles and are expensive. If you have
no major health problems you have a good chance of being accepted onto a regular plan at
normal premiums. Chances are that an individual plan will be much less expensive then your
group COBRA plan. Contact us with our information request form or call us at (619)
575-2846 or toll free at (888) 571-4150 for details.
Q: Is it difficult to be approved for an individual or a family health
insurance plan?
A: In most cases, no. In California these types of insurance plans are individually
underwritten. The insurance company looks at the health history of each person applying
(except in the situation described above.) Then, depending on the medical history of the
person (or persons) applying, the insurance company makes a decision on whether or not to
approve the application. From our years of experience in this field, I would say that
about 90% of applications are approved as applied for.
Q: Is it possible to get immediate coverage?
A:
Yes, with our Short Term Medical Plan through CPIC. You can request an effective date of
as soon as the day after you mail (or fax) in the application. In fact we can even fax you
the application to make the process even faster. Just call us at (619) 575-2846 or toll
free at (888) 571-4150 or contact us through our information request form. Of course,
there is a small amount of medical underwriting to go through. These plans are available
for between one and twelve months. If you are looking for a permanent policy such as a
Blue Cross or Blue Shield plan, then you can start with one of these short term plans and
have it roll into a permanent plan. The permanent plans take from two to six weeks to go
through the underwriting process.
Q: I'm leaving my job soon and I'm going to have to obtain my own insurance. Does
this take a long time?
A:
The application process for an individual policy can take from two to six weeks. It is
very important to never give up your current policy until you are approved for your new
one. You may be eligible to continue your group plan after you leave your employment. Ask
your employer whether or not you qualify for COBRA. This is a federal law for companies
with 20 or more employees (two employees or more in California) that allows you to
continue your group benefits for up to 18 months. Then you could keep the coverage until
you are approved for your individual plan. If you are not eligible for COBRA then you can
apply for an individual policy right away and ask for a start date of the first of the
following month.
For example: Let's say you are leaving your employment the first of
next month. As long as you apply before that date, you can request a start date for the
first of the month.
Q: What are the benefits of an individual insurance policy in California?
A:
In most cases you will run into two types of policies; Preferred Provider Organizations
(PPOs) and Health Maintenance Organizations (HMOs).
PPOs are the most popular. With this type of plan you have a huge list of physicians and
hospitals that you can use. For instance, the Blue Cross of California plan has 40,000
physicians and 330 hospitals. The best of these plans have no deductible and just a small
co-payment when you go to the doctor. With most of these plans you are covered anywhere in
the world.
HMOs work differently. With this type of plan you have to choose a Primary Care Physician
(PCP) out of a list from the HMO. You go to this PCP whenever you need medical services.
If you need to see a specialist then your PCP will refer you to someone in his or her
medical group. Also, with an HMO you have no deductibles and many services are paid at
100%. So the advantage of an HMO is that the benefits are higher than the PPO, but the
disadvantage is that you are much more restricted as to the doctors you can use.
Q: I have heard that individual health insurance is much more expensive than group
health insurance. Is this True?
A:
In most cases individual insurance is less expensive than group. This is because
individual insurance is "age rated"; the older you are the higher your premium.
Group insurance is "community rated"; everyone pays the same premium no matter
what your age. So, in most cases, if you are under 50 years old, an individual insurance
plan is probably going to be less expensive than a group plan through work - unless, of
course, your employer is paying the premium.
Q: I have insurance through work, but I'm paying a high premium for my children. Can
I get individual insurance for my kids?
A:
Yes. Most insurers who offer individual health insurance have special low premium rates
for children. These rates are often much less than what you pay through work.
Q: I am moving to California from out of state. Can I apply immediately for health
insurance?
A:
Yes. As long as you have a California residence address you can apply for health insurance
anytime.
Q: I am changing jobs and will be without health coverage for several months. Is
there an individual plan that will cover me?
A:
Yes. We provide some very good temporary insurance plans that will give you coverage from
one to twelve months.
Q: What if I am turned down by an insurance company because of preexisting
conditions?
A:
In California, if you are declined for coverage because of preexisting conditions, you
will be eligible for the Major Risk Medical Insurance Program (MRMIP). This is a state run
program for people in this situation. If you are coming off the end of your COBRA
eligibility please see the first FAQ.
Q: Does C&M Caccamise Insurance Services, Inc. sell these individual plans you've
described?
A:
Yes. We have been independent insurance agents for over 21 years specializing in
individual and group insurance products in California. Give us a call at (619) 575-2846 or
toll free at (888) 571-4150 or contact us through our information request form and we'll
talk about what plan will be best for you.
