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HEALTH INSURANCE CALIFORNIA |
Illness for non-work related injuries can be financial
devastating. Insurance can help protect against disastrous health care
expenses and lost wages. If you have a job, your employer may make medical
and disability income benefits available to you. You can also purchase
these coverage's privately or through an insurance agent who is licensed
by the State to sell health insurance products.
Types of Health Plans and How They Operate
Medical Expenses Plans pay expenses incurred for diagnosis
and treatment of medical conditions.
Reimbursement and Fixed Allowance Insurance
Plans
(Department of Insurance Jurisdiction)
Full freedom-of-choice plans allow
you to choose any doctor and hospital. You can also choose the amount
of the "deductible" you must pay before the plan pays anything.
After the deductible is met, a percentage of all your expenses is usually
covered. The difference between the percentage the plan pays and the
amount charged is the "co-amount" that you must pay. The policy
or employer benefit booklet will spell out the terms and conditions
of what is covered and what in not covered. Read this contract BEFORE
you need to use the plan and ask your agent or employer to explain anything
which is unclear to you.
Preferred Provider Organization (PPO)
Plans allow you to choose a doctor or hospital from a list of "preferred"
providers in order to receive full benefits. If you go to a doctor or
hospital who is not on the list, the plan may cover a smaller percentage
or none of your costs. Check with the insurance carrier BEFORE you use
the plan to make certain your physician or hospital is a contracting
provider. Make certain your doctor refers you to other providers who
are on the list, or who the carrier agrees to pay at the "preferred"
rate.
Individual Health Insurance Plans are a good alternative
if you are not able to get coverage through your employer. A pre-existing
condition, such as a past illness, must be covered after one year. However,
the insurance company will decide on the basis of your health history
if they will issue the coverage.
Multiple Employer welfare Arrangements (MEWA)
may be insured or partially -insured plans. They are typically marketed
to self-employed individuals or small employers through membership in
a trade or other association. The California Health Insurance Code now requires
MEWA's to obtain a "Certificate of Compliance" and to set
aside financial reserves to operate. They must comply with the health
care reforms effective after July 1993. These plans can only be sold
through a licensed life insurance agent.
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