Since 9/23/2010, we have new options available for people who are declined coverage in California.
We'll walk through the original options available as well as some of the new ones which we have now.
We'll also take a took at Jan 1st 2014, which will likely do away with most of these options as individual family health insurance becomes Guaranteed Issue through the Exchanges.
First, what do we have now since 9/23/2010.
As as date, children are guaranteed issue which means that they cannot be declined due to pre-existing conditions.
This is a big change from before where they could be declined coverage altogether.
The carriers can increase the tier or rate charged which can be really high but at least we no longer have to worry about getting coverage altogether.
So children are covered...what about the big
There are a couple of tracks to consider depending on your prior coverage. Yes, your prior coverage dictates options now until Jan 1st, 2014.
There are two different paths for the California uninsured that basically break down into coming from Group health insurance or no prior health insurance.
There are guaranteed issue options already available (for some time now) if you are coming off of group health insurance in California.
Many people have heard of Cobra which allows for an employee leaving a group to continue their group health insurance coverage (including dependents) for up to 18 months (and sometimes 36 months with a Cal-Cobra extension).
The cost is usually the same as what the employer paid or 10% higher depending on the size of the group. Many people do not realize that there can be a Cal-Cobra extension of an additional 18 months. You want to check with your carrier or administrator when you're exhausting regular Cobra to see if you have this option. Keep in mind that the underlying group plan must stay in effect for Cobra exist.
If the company closes or shuts down the group plan, Cobra goes away.
If a person exhausts Cobra, they may be eligible for HIPAA coverage. By law, each California carrier must offer their two most popular individual family health plans on a guaranteed issue basis.
The rates can be high but at least it's an option.
HIPAA can continue well until Jan 1st, 2014 which we'll discuss later. So those are the main avenues for coverage if you cannot qualify on the individual family market due to health. What if you have no coverage (the other big category)?
It depends on how long it's been since you've had coverage and income levels. If you have had no coverage in the past 6 months, you may qualify for the PCIP plan (Pre-existing Condition Insurance Plan) which you can quote through our engine.
You'll likely also need a declination from a carrier.
The rates and benefits are pretty solid on this plan and it was designed a interim fix until Jan 1st 2014 (there's that date again). If you have had coverage in the past 6 months and you are unable to qualify for coverage, you can check out MRMIP through the State here.
You will also find information on AIM, which is an income-based program for expecting mothers.
The MRMIP plan can have a waiting period so
don't delay if this is your best option. The
benefits are okay (some caps that we don't like)
but the rates are high. This is, after all, the
high risk pool.
If you qualify based on income, you may also want to check into Healthy Families and Medi-Cal .
The only issue here is the network of
providers that participate (and of course, the
enrollment process) but if cost is the main
issue, it's better than no coverage of course.
So most of these plans will become obsolete (aside from Medi-Cal) Jan 1st 2014 when the Exchanges come online.
Coverage will be guaranteed issue for most Californians and the rates will be high but there will only be one tier and you may qualify for subsidies depending on income.
To some extent, we're just waiting to get to that point in a holding pattern for now. In the meantime, these different options can help you if you are uninsured and unable to qualify for individual family California health insurance.
Of course, we're happy to walk through your specific situation here to over these various options. Group health insurance is guaranteed issue so if you get that option, make sure not to lose it.
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