FAQ's About Health Insurance
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Choosing a health plan
Enrolling in a health plan
Membership issues
General Information


Choosing a health plan

What is individual health insurance?
Individual health insurance is coverage that a person buys independently. It can be sold to a single individual, to a parent and dependent children, or to a family. The majority of Americans get their health insurance coverage through an employer or through a government program, but five percent of the population purchases private health coverage on an individual basis. Each state separately regulates how individual policies may be marketed and sold.

What's important when comparing carriers?
There are three main issues that arise when selecting a carrier.  First is rate stability.  How secure are we that they will be stable (relatively speaking since all carriers are going up) over the long haul.  Secondly, how easy are they to deal with...all the way from the application process to paying claims once you're on board.  Finally, do they offer a range of plans and options to better fit your exact needs. 

Can health affect my rates?
Yes.  California carriers can offer higher tiers based on health status and history.  The underwriter ultimately makes this decision but we can provide some guidance as to what you might expect.

What impact will smoking have on qualification and rates?
It will increase your rates on the individual/family market.  It's best to assume that your rates will be 20% higher solely based on tobacco use.

What if I'm in poor health?
If you are unable to qualify based on health, there may be options available.  This can be Cobra (continuation of group coverage), MRMIP through the State, and AIM for pregnant months (also through the State), HIPAA if Cobra has been exhausted.  There are options and this may all change in the next few years if they pass guaranteed issue coverage.

Should I replace my existing health insurance plan?
There are many variables to evaluate with this question.  Obviously cost is a crucial issue as the carriers roll out new, usually less-expensive plans but this is really where a licensed health insurance agent like us becomes crucial.  Let us know what you currently have (carrier, plan, rate, ages, zip code) and we'll see if there are better options on the market to compare.  That's our job!

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Enrolling in a health plan

Once I submit my application, then what happens?
We'll go through the paperwork to make sure there's nothing that will slow it down.  The online applications process more quickly but if you submit a hard copy, we'll quickly get it into underwriting.  A physical is usually not needed.  We are now in the underwriting process which we help with during the entire process.  The carrier will then either make an offer for coverage or defer/decline coverage.  We can help with your options at this point as well.

Do I submit money with my health application?
Most people opt for the credit card or auto-deduction option.  In this case, the carrier usually takes the first draw while in underwriting, after approval, or at the start of the next month.  You have a 10 free look period to request a full refund within 10 days of receiving the policy.  With a written request, we can easily do this for you.

Is there a discount for certain payment options?
No.  Health insurance is different from other types of coverage such as life in that there is no difference in paying monthly, bi-monthly, or quarterly.  These are the standard options.  There may be a fee (for example $2 with Anthem) for receiving a traditional billing.  The other carriers will likely follow in this.  On the group side, it's usually a monthly billing option.

How long does the application process take?
The initial underwriting periodusually takes 5-10 days after the application is submitted and sometimes faster depending on the carrier (Anthem Blue Cross being the fastest).  If the carrier wants to look further into information listed on the application, they may request medical records from your doctor.  They handle this and you rarely need to do anything during this process.  All together, it's best to assume 2-4 weeks to fully process.  This is why it's important to apply sooner rather than later.  Group underwriting typically lasts 5-7 business days from when they receive complete information.

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Membership Issues

Can my health insurance policy be cancelled due to health issues?
Health insurance plans quoted on the site are Guaranteed Renewable.  This means it can only cancel due to non-payment of premium.  There is a 2 year Contestability Clause which comes into play the first two years of the policy if there was fraud of misrepresentation during the application/enrollment process.  This is key reason to honestly and thoroughly provide your information during the application process

What are the different payment options?
Most carriers offer standard billings, auto-deductions from a checking account, and of payment by credit cards.  You can usually choose a bi-monthly, quarterly, or monthly payment.  Auto-deduction is the most common only because it has the lowest lapse ratio compared to a standard mailed billing.  Addresses change and Auto-deduction avoids the issue of lapsed coverage do to non-payment.

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General Information

How can I buy individual health insurance coverage?
In almost every state, individual health insurance coverage can be purchased through licensed health insurance salespeople known as agents or brokers. Independent agents and brokers sell insurance plans from many companies, and we can help you find the coverage that best suits your individual needs.

Agents of CaliforniaHealthChoice.com also provide service on the policies they have sold, and can help you process claims or with anything else you need regarding your policy. The insurance companies for which agents and brokers sell coverage pay them a commission for their work, so you will not be charged a direct fee if you want to use the services of an agent or broker. You can find agents and brokers who sell individual coverage via the Internet, or you may prefer to consult with one in person.

How is individual insurance different from group insurance?
Individual health insurance is very different than group health insurance, which is the type of insurance that is offered through an employer. Since laws mandating what types of services must be included in individual policies are often different than those dictating what must be included in group policies, benefits are generally less extensive than what most people would receive through coverage they have through work. Individual consumers may be surprised to learn that some benefits that may be considered "standard' in a group policy, like maternity coverage or substance-abuse treatment, may not be included in an individual plan.

Sometimes individual health insurance consumers have the option to pay extra for coverage of additional services like maternity coverage. This extra coverage is referred to as an optional rider. Cost is often the primary factor for individual health insurance consumers, which is another reason why the benefits included in individual policies are often simpler. In addition, deductibles (the amount you have to pay before insurance benefits begin) and cost-sharing (the fees you pay directly to medical providers at the time of service) are also generally higher.

Individual health insurance companies are much more limited than group insurance companies in their ability to spread risk, so the laws concerning individual health insurance are different in most states. This means that applicants for individual insurance will need to complete a brief medical questionnaire when applying for benefits and, unlike a group insurance policy, in most states a company can decide not to cover people with very serious medical conditions (e.g., HIV or cancer), deeming them "uninsurable.”

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How are premium rates determined?
In the vast majority of states, when you apply for individual health insurance coverage, you are asked to provide health information about yourself and any family members to be covered. When determining rates, insurance companies use the medical information on these applications. Sometimes they will request additional information from an applicant's physician or ask the applicants for clarification.

If the insurance company is unable to obtain information necessary to accurately determine the risk of a particular applicant, it will underwrite more conservatively, meaning that the assumption relative to the missing information will be negative rather than positive.
Example: A person has a history of high blood pressure, but it is controlled with medication and he is not overweight. If the company is unable to determine if that individual smokes or if he has normal cholesterol, the company will assume that the missing information is negative and rate accordingly.
Once the company has determined your health status, you will be assigned a rate class by the company and put into a pool of other insured individuals with similar health status. Your premium will be the rate charged to that entire class of customers. Subsequent annual renewal premium rates will be determined not by your individual claims, but instead by the claims experience of the entire rating class pool.

Are any pre-existing medical conditions covered?
Even though in almost every state an individual insurance company can choose not to offer coverage to people with serious medical conditions, most Americans don't have perfect medical histories and most still qualify for individual coverage. However, there are some individuals who do not decide to purchase health insurance coverage until they know that they have a medical problem that will require the use of benefits. This is known as "adverse selection,” and it can be a serious problem for individual market insurance companies since their ability to spread risk is so limited. To help prevent adverse selection, insurance companies are allowed to look back at your medical history for pre-existing conditions and may choose not to cover certain conditions for a specified period of time. This is known as an exclusionary, or pre-existing condition, waiting period. The amount of time an insurance company can look back at your medical history, and the length of time an exclusionary period can last, vary on a state-by-state basis. NAHU's Health Care Coverage Options Database will tell you what the requirements are in your state.
In some states, you can receive credit against a pre-existing condition waiting period if you have had prior health insurance coverage within a specified number of days. The amount of the credit against the waiting period is generally proportional to the length of the prior coverage.
Also, many states allow health insurance companies to issue elimination riders to people who have pre-existing medical conditions. Elimination riders allow for insurance companies to offer an individual with preexisting condition coverage but exclude coverage of that condition.
Example: An individual has severe seasonal allergies but can control them with medication. A company may offer the applicant two policy options: a policy at a more expensive rate with full allergy coverage and a pre-existing condition waiting period, or a cheaper policy with no waiting period that excludes allergy coverage. The individual may find that it is more affordable to buy the cheaper policy and pay for his allergy medication out-of-pocket.

Can I still buy individual insurance if I have a very serious pre-existing medical condition?
In most states you can be turned down for individual coverage if you have a very serious medical condition (e.g., HIV or cancer). Fortunately, even though they are not required to do so, most states have developed some way to provide uninsurable people with access to individual health insurance coverage. Thirty-three states provide coverage to medically uninsurable people through high-risk pools. Twelve states use other means of providing uninsurable people with access to individual coverage (e.g., requiring that all individual health insurance companies issue individual policies regardless of health status, coverage through a designated health insurance company of last resort, etc.). There are five states that still have no means of providing individual health insurance access to people with catastrophic medical conditions.

Since each state sets its own requirements for individual health insurance policies, how can I find out what the requirements are in my state?
To find out about each state's specific requirements regarding individual health insurance policies, please see NAHU's Health Care Coverage Options Database. The database also contains contact information for the state regulators of individual health insurance policies to use if you have questions or concerns.

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