Group Health Insurance in California
Group health insurance plans in California offer a wealth of choices for comparison, but you could easily find the complexities a bit overwhelming. Group plan choices include indemnity or traditional insurance and managed-care plans.
Comparison shoppers can investigate multiple companies through online comparisons. Whether you are an individual or a small business owner, you can find a group health care plan to meet your needs. Employers must pay 50% of your premiums, and the yearly benefit is not taxable. California residents can also find group plans available from trade associations, professional organizations, chambers of commerce, or credit card lenders.
Evaluating Group Health Plans
Health plans vary tremendously, but the basic comparison factors are relatively simple – you should analyze benefits, price, and providers of any plan.
You should research the benefits of various plans to find what each covers. Assessing the following benefits will provide practical help evaluating policies:
- You should find out what co-payments are required for outpatient care and inpatient treatment.
- Find out what kind of co-payments are required for generic or name brand prescriptions.
- You should understand what your deductible options are and how they will affect the insurance premium.
Compare plans with similar benefits to determine which plan offers the best value for your money. Your employer might offer several options from which you could choose:
- Some companies offer a choice between two insurance plans.
- California employers can also provide a basic insurance plan, but they allow employees to purchase more comprehensive insurance as a personal option.
- Some larger companies offer multiple insurance plans.
This is an important area you should investigate. Traditional insurance plans allow you to choose your own doctor, but managed care plans include preferred provider organizations (PPOs), health maintenance organizations (HMOs), and point of service (POS) plans. These plans often restrict your choices of medical services providers to an approved list. The list could prove crucial in deciding whether to enroll in a given plan.
California Group Health Regulations
California regulations require small group health plans to enroll a minimum of 75% of eligible employees. Employers must pay a minimum of 50% of the basic coverage plan. State regulations also include the following restrictions:
- Guaranteed issue: Every eligible person must be accepted, regardless of any pre-existing conditions.
- Guaranteed renewal: Insurance companies cannot cancel policies because policyholders make medical claims.
- Ratings Protection: Insurance companies face limits on the rates they can charge, so they cannot make group insurance premiums too high for groups with greater levels of medical risk.
- Portability: You must have the option of continuing your coverage if you change jobs.
Top California Group Medical Insurance Providers
Some of the top California group health providers include Kaiser Permanente, Anthem Blue Cross, United Health, Aetna, Health Net, Blue Shield of California, and Pacificare. These providers offer a variety of indemnity and managed care plans, including HMOs, PPOs, POSs, EPOs, and HSAs.
- HMO: Health maintenance organizations provide a list of doctors. You must choose a primary care physician from the list who makes all decisions about the need for further treatment and specialist consultations.
- EPO: Exclusive provider organizations include physicians and specialists. You do not needed to choose a primary care physician, but you must use the network to receive benefits.
- PPO: Preferred provider organizations operate similarly to HMOs, but you do not choose a primary care physician. You have the option to go outside the network, but you will receive a limited benefit.
- POS: Point of service plans combine the features of HMOs and PPOs. You must choose a primary care doctor, but you have the choice to follow his or her recommendations. If you elect to get treatment outside the approved network, your benefit will be greatly reduced, and you will have to fill out all the paperwork to make a claim.
- HAS: California health savings accounts offer many benefits for consumers. You can choose to buy a high deductible insurance policy with a low premium, and you pay for routine medical expenses out of the account without any tax penalties. Benefits of HSAs include the following:
- Contributions from your employer are not taxed, and account interest also enjoys freedom from taxation.
- The combination of high deductible insurance plans and HSAs often provide more affordable insurance solutions.
- The money continues to build in your account if you do not use it. The funds can be rolled over into IRAs.