California Child’s Health Insurance
People who have children need to find low-cost children’s health insurance in California, and they need to have their own coverage as well. Luckily, there are many types of affordable children’s health insurance in California for parents to choose from. And at the same time that they insure their children, they can insure themselves.
When recommending a children’s health plan I always show plans that do not include maternity. This immediately reduces the premium by 30-40%. Another suggestion to lower premium would be to consider a plan with generic only prescriptions. One of the nicest features about many of the plans is that there is no enrollment fee for most parents to get California low-cost children’s health insurance for their kids. The services that are usually covered at very low costs include outpatient, inpatient, emergency, prescription and other services. There is really no excuse for not having affordable children’s health insurance in California.
Parents generally have three types of low-cost children’s health insurance in Orange County California and throughout the United States to choose from, including basic, standard and specialized plans. Most California low-cost children’s health insurance is either a health maintenance organization (HMOs), preferred provider organization (PPOs) or pay-for-service plan. It’s important for everyone to have insurance, but insuring their children is even more important.
Due to the Health Care Reform Act, which went in to effect in 2010, effective January 2011 all children’s plans in California are guaranteed issued. What that means is that children cannot be declined. However, if there is a lapse in coverage within the past 90 days all carriers will add a 20% surcharge to the premium. Additionally, children can be “rated” up for pre-existing conditions up to 120% of the Tier 1 (preferred) rate. Lastly, all plans cover preventative care 100% without a co-pay.
There are (2) types of plan available for children. Plans with unlimited visits and plans with a fixed amount of visits. Additionally most plans in California are sold with a Generic Only benefit or Generic plus Brand. However, the brand Rx benefits always carriers a separate deductible for brand medications of $500.
The plans with the lower number of visits have lower deductibles and lower out of pocket maximums. These plans are great for kids that are healthy without pre-existing conditions are most parents are looking for plans with lower out of pocket limits in the event of an accident.
The plans with unlimited office visits have higher deductibles and out of pocket maximums are designed for kids that do see doctors on a semi-regular basis.
There are also “No Deductible” PPO plans to choose from?
These plans are good in that they provide unlimited office visits (co-pays range from $25-$50) and include first dollar benefit or “no deductible”. The carrier will pay (depending on which plan you choose) anywhere from 50% to 70% of any claim with no deductible to satisfy. The risk to these plans is that the out of pocket maximum is typically $7,500. For example, if you received a bill for $10,000 and were on a 60/40% plan the carrier would pay $6,000 and you would owe the difference of $4,000. However, you are still exposed to more potential payments (out of pocket expense) until you reach $7,500. At that point the carrier pays 100%. These plans typically range in price from $70-$110 per month. Thus, although the Blue Cross Tonik plan has a deductible and you are paying the first $1500 of bills you are covered 100% from that point forward.
Can my child be declined for health insurance or can they increase the price based on his/her pre-existing conditions?
No, due to the Health Care Reform law no children can be declined. However, they can be rated up for conditions that are pre-existing. This rate-up or “risk adjustment factor” is called a RAF. This means that the carrier has approved the policy and inserted higher price based on medical records and risk. The RAF range is from 20%-120%-depending on each carrier’s guidelines and the child’s health condition.
How long do I have to keep the plan and can I change plans over time?
California Health Insurance is month-month. You can cancel at anytime. You can upgrade your plan at any time as long as you are not upgrading for medical reasons. The carrier will review your medical records. You can downgrade at anytime-much easier.