California has earned high marks for its low prevalence of smoking. The state also enjoys low rates of occupational fatalities, cancer deaths and infant mortality.
But the fact still remains that a lot of consumers are not able to get the desired type of health plan needed to make sure they receive optimal healthcare coverage.
Like any other health plan,
the main motive of all California health plans is to provide coverage for expenses incurred for diagnosis and treatment of covered medical conditions. California has many different types of Health Insurance plans available, but not every plan could meet the requirements of every individual, family or group. It is important to choose and find the most suitable health plan according to the needs and falling within the range of stipulated budget.
Types of health plans in California
The companies that provide health insurance in California include Aetna, Anthem Blue Cross, Assurant, Blue Shield, Celtic, Cigna, Healthnet, IAC, Kaiser Permanente, PacifiCare, and Solera Dental. There are basically three types of health plans offered in California by various providers:
1. Indemnity Policies—Traditional Fee-for-Service Insurance 2. Preferred Provider Organizations (PPOs) 3. Health Maintenance Organizations (HMOs or Managed Care)• Indemnity Policies-California Heal
More often than that, the indemnity policies let the consumer select any doctor and hospital that for health care services. The salient feature of any indemnity plan is the freedom of choice. A consumer is given medical coverage regardless of the doctors or hospitals he/she chooses. However, indemnity plans often have deductibles.The California Department of Insurance (CDI) regulates indemnity policies. As a resident of California, a consumer can contact the California Department of Insurance in case of any need provided the health plan is bought from an insurance company that has been authorised by the department. A lot of consumers may get confuse because jurisdiction is divided between state and federal agencies—so, it becomes sensible to approach the CDI for any questions.
Important Points to Remember About Indemnity Policies:
• A consumer has the freedom to choose your doctor, specialist, or hospital with few limitations.• A consumer may be responsible for paying a deductible before covered medical benefits are provided by the company.• Sometimes, indemnity plans also include a co-payment for covered medical services.
• Preferred Provider Organizations (PPOs)A Preferred Provider Organization (PPO) provides a list of preferred providers from which a consumer can choose to get medical care services. A consumer receives the highest monetary benefit when the health care services are available from listed providers only.
In case the consumer wants to avail medical services from outside-the-network-provider, the reimbursement would be on lower side. It makes sense to check the list of preferred providers. A PPO plan in California may be regulated by either the CDI or the Department of Managed Health Care (DMHC) depending on whether the contract or policy was issued by a licensed insurance company or a managed care company. S
Important Points to Remember About PPO
• PPOs provide maximum benefits when the consumer avails health care services from providers within the network.• It makes a wiser move to check to make sure if any doctor or any specialist referred to the consumer is part of the PPO network before utilizing covered services.• PPOs can be regulated by either the CDI or the DMHC depending on if the company that issued the contract is a licensed insurance company, or a managed care plan. PPOs can also be self-funded.
Health Maintenance Organizations (HMOs or Managed Care)
HMO of managed care, as clear from the name, does not allow the members to avail medical care services from providers outside the network. Unlike PPOs, no reimbursement will be provided if the consumer goes for an out-of-network provider.
California HMOs are required to cover medically necessary emergency services even when outside of their coverage area. The main intent of managed care products is to create less costly delivery of health care services while maintaining quality health care. All HMOs in California are regulated by the Department of Managed Health Care (DMHC).
Important Points to Remember About Health Maintenance Organizations:
• As a consumer, healthcare services would be provided except in certain emergency situations.• The options of primary care provider are limited by the geographic restrictions of the HMO network.• A small co-payment is charged each time an HMO covered service is availed.Health Care Advocacy Groups in California
Some groups are working for the betterment of health insurance industry so that it could reach out and provide maximum benefits to the residents of California. Here are some of them:• Health Access California• California Association of Health Plans• California HealthCare Foundation • Health Care for All–California • Vote Health Coalition
Tips for browsing through California health plans
Some points that a consumer needs to check before buying any type of health plan in California:
• What is the level of medical coverage provided?• How much is the premium monthly, quarterly, and annually?• How much is your deductible?• Does the health plan provide coverage for prescription drugs?• Does the health plan allow coverage for pre-existing condition?
