California Health Insurance Coverage Protection Guidelines...
If you are searching for health insurance in the state of California, we offer you some information to help with your decision and also a convenienent form for having a wide range of national insurers compete for your health care dollars.
Numerous state and federal laws make it easier for people with pre-existing conditions to get or keep health insurance, or to change from one health plan to another. A federal law, known as the Health Insurance Portability and Accountability Act (HIPAA) sets national standards for all health plans. In addition, states can pass different reforms for the health plans they regulate (fully insured
group health plans and individual health plans), so your protections may vary if you leave
California. Neither federal nor state laws protect your access to health insurance in all circumstances.
- Health Insurance Coverage in California under your group health plan (if your employer offers one) cannot be
denied or limited, nor can you be required to pay more, because of your health
status. This is called nondiscrimination.
- All health plans in California must limit exclusion of pre-existing conditions. There
are rules about what counts as a pre-existing condition and how long you must wait
before a new health plan will begin to pay for care for that condition.
What this simply means is that if you
join a new health plan, your old coverage will be credited toward the pre-existing
condition exclusion period, provided you did not have a long break in coverage.
- Your health insurance cannot be canceled because you get sick.
Most health care coverage is guaranteed renewable, however, you must understand this on a per policy basis, as not all insurers guarantee this.
- If you leave your job, you may be able to remain in your old group health plan for a
certain length of time.
This is called COBRA or Cal-COBRA coverage. For
example, it can help when you are between jobs, or when you retire early and are not yet
eligible for Medicare. There are limits on what you can be charged for this coverage. CORBA stands for
Consolidated Omnibus Budget Reconciliation Act, and was put in place at the federal level to protect the rights of individuals against loss of health insurance coverage.
- If you lose your group health insurance and meet other qualifications, you will be
federally eligible.
If so, you are guaranteed the right to buy an individual health plan from any insurance company that sells individual coverage. You will not face a new pre-existing condition exclusion period if you are federally eligible. There are limits on what you can be charged for such a policy.
- If you have had difficulty obtaining affordable individual health insurance coverage in California because of your health condition, you may be eligible for Major Risk Medical Insurance
Program (MRMIP) coverage.
You may face a new pre-existing condition exclusion period when you join. If you qualify for MRMIP, there may be a waiting list for enrollment
that will delay the start of your membership.
- All fully insured health plans
for small employers must be sold on a guaranteed issue basis.
If you are a small employer buying a fully insured small group health plan, you
cannot be turned down because of the health status, age, or any factor that might
predict the use of health services of those in your group.
- Modified Community Rating.
If you are a small employer buying a fully insured group health plan, the health
status of your employees cannot be taken into account when your premiums are set.
Other factors such as the age of your employees can be taken into account.
- If you have low or modest household income, you may be eligible for free or
subsidized health coverage for yourself or members of your family.
The California Medi-Cal program (also called Medicaid) offers free health coverage for pregnant
women, families with children, elderly and disabled individuals with very low incomes. In
addition, California’s Healthy Families program offers subsidized health coverage for
certain uninsured children.
- What are the limitations on my Protections?
Every state is different regarding your health care insurance protections. California's Health Insurance Coverage approach is no different and you will want to make sure that your health insurance agent or health care provider informs you clearly on these points.
If you are looking for some more information regarding policy rates and your rights under your state or federal health care laws, then you can continue your research by visiting the following convenient link.
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