Individual & Family
Group health
Medicare Supplement


Free Assistance 800-320-6269

California health insurance  -  Group health insurance in California  -  Important insurance terms 

California Health Insurance Terms

Most of the "Terms" webpages out there partially require that you're already well versed in California health insurance and they also have a lot of terms that you'll probably never need. We want to keep it straight forward and provide the big-ticket terms that will help you really understand your options on the market. Of course, we many articles which will allow you to dig as deep as you wish on any given topic. So let's begin with the top of the hierarchy in a plain and simple language.

Plan Types:

PPO. Preferred Provider Organization.

A type of health insurance plan that allows you more flexibility to access doctors/hospitals at a negotiated rate but requires more cost sharing. Currently dominates Individual Family market and increasing on Small Group side.

HMO. Health Maintenance Organization.

A type of health insurance plan which allows for richer benefits but is more restrictive in terms of accessing health care and providers. HMO's have been priced out of the Individual Family market but remain viable on the group side.

HSA. Health Savings Account.

Combines high deductible PPO (mostly) health plan with a tax-favored checking account. The theory is that you receive a tax benefit to encourage savings for smaller bills while using high deductible plan for more catastrophic needs.

Market Segment:

Individual and Family.

Refers to pre-65 private health insurance market in California for people without Medicare, Group health, or other options. Currently medically underwritten (subject to health) but will be guaranteed issue effective Jan 1st 2014.

Group Health Insurance

Refers to health insurance provided by employer. Subject to AB1672 which made group health guaranteed issue (regardless of health) down to 2 lives after meeting certain eligibility requirements.
Medicare Supplements.

Private health insurance plans which supplements traditional Medicare for individuals 65 and older or permanently disabled.
Catastrophic. Refers to lower cost health plans designed to cover very large health insurance bills.

Plan Benefits:


Fixed dollar amount you pay for certain services (usually office visits and RX) as part of health insurance benefits usually before deductible is met.


Fixed amount you must pay first before the plan starts to help with medical expenses. Calendar year Jan-Dec.
Coinsurance. Shared percentage that you pay (usually after deductible) until you hit the max out of pocket.
Max out of Pocket. Annual cap on your exposure according to health plan benefits. Assumes in-network and eligible expenses.
Use of Plan:
EOB. Explanation of benefit comes from the carrier after each medical service with detail on how the plan has paid.
Negotiated Rate. Discounted PPO rate for using in-network providers. Usually 30-60% lower than initial charge.
Preventative Benefits. Now covered at 100% on newer plans for services such as annual routine physicals, annual pap/mammogram, and well-child check ups.

Coverage of pregnancy and delivery is now covered on all California health insurance plans effective July 1st, 2012.

Health Reform:

A series of Federal laws governing changes to the health insurance market. The first round of changes went into effect 3/23/2010 (guaranteed issue for children, preventative benefits, dependents stay on plan till age 26). The next big change will bring guaranteed issue to all Californian's effective Jan 1st, 2014 through Exchanges with subsidies based on income.


You can run your California Health Plan Quote here to view rates and plans side by side from the major carriers...Free.

Again, there is absolutely no cost to you for our services.  Call 800-320-6269 Today!


In just 15 minutes:

  • - Get the most tax credit available
  • - Find the best plan for your needs
  • - Enroll right over the phone!

Call 800-320-6269

Our Services are FREE to You!

Need Help
With Existing Account

We can help you:

  • -Get required docs to covered Ca.
  • -Make changes to income and other info
  • -Choose and finalize plan enrollment
  • -Make sure you get right tax credit
  • -Payment/membership issues with carriers

Call to Enroll over the Phone in 15 Minutes

If Your Income
Is In This Range

Current Years Estimate; All those that file together on one 1040:

Single Person: $16k - $47k
2 People $22k - $64k
3 People $27k - $80k
4 People $33k - $97k

Call 800-320-6269
Anthem Blue Cross California
Blue Shield of California under Covered California
Kaiser of California
Health Net of California
and more
Thousands of Californians
Hundreds of California Companies
Thousands of Californians
Hundreds of California Companies

from SC

"My sincere thanks for making a miracle happen- 2014 health insurance !! Many thanks for your expertise and advice yesterday !!"

from SD

"Thanks again for your help - I had absolutely no idea how to get this done when I got up this morning. You've made it remarkably easier than I expected. I hope you're not stuck at the office all night..."

from KV

"Anyway, I hope you got some time off this past week! Thank you again for your help and efforts on my behalf! I was very lucky to find you."

from EK

"I thank you very much for the time that you have invested in handling everything

from SR

"I truly appreciate the quick response and will think of you in the future if I need to make any changes to my insurance plans."

from VH

"You are awesome... takes a huge worry off my back, thank you for your kind. thanks for your time and kindness. !!"

from SA

"Wow, I can't thank you guys enough for your help...I couldn't imagine trying to tackle this on my own!"

from LM

"You are my new best friend. A HUGE thank you again.

Find out what customers are saying about our services

20 years of experience in the California health insurance market has taught us one thing...Competent and experienced guidance is Invaluable

We can quickly (very important) size up your health insurance needs and clearly explain the options available to you. Our focus is finding the most coverage at the best cost to you.

We are licensed Covered Ca agents with in-depth knowledge of their plans, process, and tax credits.

Call will be Pleasantly Surprised.  800-320-6269

Request a 10 Minute Health Plan Check-up

We'll quickly see if you have the best priced plan available and if you qualify for a tax credit

calhealth website

Our Services are FREE to You is a Goodacre Insurance Services Website

This website is owned and operated by Goodacre Insurance Services, which is solely responsible for its content. This site is not maintained by or associated with Covered California, and Covered California bears no responsibility for its content. The email address and phone numbers that appear throughout the site belong to Goodacre Insurance Services, and cannot be used to contact Covered California.