HIPAA Guaranteed Issue Health Insurance for California
HIPAA is guaranteed issue health insurance for California residents who are terminating COBRA or Cal-COBRA benefits. Or if you are loosing group heath insurance coverage without the availability or COBRA continuation being offered. HIPAA regulations allow you to purchase guaranteed issue health coverage under the following rules.
See Monthly Rates below
- You have had continuous group health coverage for the past 18 months.
- COBRA or Cal-COBRA benefits are exhausted or not offered, in other words COBRA benefits are no longer offered.
- You are not eligible for other group health coverage, Medicare, Medicaid, MediCal, or have any other health insurance coverage.
- You must apply for HIPAA coverage within 63 days of loosing COBRA or Cal-COBRA benefits.
- California HIPAA companies do not have waiting lists or waiting periods. Although California HIPAA is a guaranteed-issue policy, the processing time may take two or three weeks.
- California HIPAA rules allow members to enroll into one plan only. Once you have a HIPAA plan you are not allowed to change plans or companies.
HIPAA Effective Dates:
- HMO HIPAA plans only have first of the month effective dates. So if your COBRA coverage ends in the middle of the month, you may be uninsured until the first of the month when the HMO HIPAA plan starts.
- PPO HIPAA plans will coordinate with the last day of your COBRA coverage, any day of the month.
- Also, HIPPA applications can take several weeks to process, although will be effective retroactive the desired effective date.
Please call with your HIPAA questions … 800-700-1246
|
HIPAA Basics |
Blue Shield 5000 PPO |
Anthem Blue Cross 5000 PPO |
Health Net Simple Value 50 PPO |
Aetna 2500 PPO |
|
Deductible |
5000 |
5000 |
$0 |
2500 |
|
Office Copay |
$35 |
$40 |
$50 |
$30 |
|
Prescriptions |
$10:Generic $35:Brand ($500 brand Deductible) |
$10:Generic $35:Brand ($750 brand Deductible) |
$10:Generic $35:Brand |
$15:Generic $35:Brand |
|
Outpatient |
30% |
30% |
50% |
30% |
|
Hospital |
30% |
30% |
$400/ Day + 50% |
30% |
|
Emergency |
30% |
30% |
$50 + 50% |
$100 |
|
Out-of-Pocket Maximum |
$7,000 |
$7,500 |
$7,500 |
$7,000 |
|
Lifetime Max |
6 Million |
5 Million |
6 Million |
5 Million |
If you qualify for a HIPAA plan and are not eligible for an Individual and Family underwritten plan (which usually has a lower premium) you can choose one of the plan options below.
Blue Shield of California - Three PPO plans offered (PPO 5000 & 5400, HSA 4000)
- Blue Shield of California HIPAA - Rates
- Blue Shield HIPAA - PPO 5000
- Blue Sheild HIPAA - PPO 5400
- Blue Shield HIPAA - HSA 4000
- Blue Shield of California HIPAA - Application
Anthem Blue Cross of California - Two PPO plans and Two HMO plans
- Anthem HIPAA - Rates
- Anthem HIPAA - Benefit Brochure
- Anthem HIPAA - PPO Application
- Anthem HIPAA - HMO Application
HealthNet of California - Four plans offered (HMO - 14 & HMO 40) (PPO Simple Choice HSA & PPO SmartValue 50)
Aetna - Two PPO plans Open Access 2500 & Open Access 5000
- Aetna - HIPAA Rates
- Aetna - HIPAA Application
- Aetna - HIPAA Open Access 2500 Benefits
- Aetna - HIPAA Open Access 5000 Benefits
Feel free to contact me anytime with your HIPAA questions.
John Conner
john@johnconner.com
800-700-1246 - office
800-995-9913 - fax
916-240-6422 - cell
Questions:
