HIPAA Guaranteed Issue Health Insurance for California
Anthem Blue Cross – Blue Shield – Health Net – Aetna
To qualify for a HIPAA Guaranteed health insurance plan you must first must have exhausted all COBRA and or Cal COBRA available coverage. Or, if your employer is cancelling their group health plan. Please see details below.
HIPAA health insurance plans (2011) …
Guaranteed issue plans 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 in force you are not allowed to change plans or companies without underwriting approval.
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 – Start dates vary by each health insurance carrier:
Start Dates: Please call for clarification – All HMO plan are 1st of month only. PPO plans are 1st only or 1st & 15th, depending on the carrier.
- Anthem Blue Cross- 1st of the month effective dates only: Individuals whose applications and payment are sent (or postmarked) between the 1st and 15th of any given month will be assigned an effective date of the 1st of the following month. For example, if someone sends in an application and payment on October 12, the effective date will be November 1. Individuals whose applications and payment are sent (or postmarked) after the 15th of the month will be assigned an effective date of the 1st of the second following month. For example, if someone’s application and payment is postmarked on October 25, the effective date will be December 1.
- Blue Shield of California – 1st of the month effective dates only: Individuals whose applications and payment are sent (or postmarked) between the 1st and 15th of any given month will be assigned an effective date of the 1st of the following month. For example, if someone sends in an application and payment on October 12, the effective date will be November 1. Individuals whose applications and payment are sent (or postmarked) after the 15th of the month will be assigned an effective date of the 1st of the second following month. For example, if someone’s application and payment is postmarked on October 25, the effective date will be December 1.
- Health Net – 1st or 15th after application is submitted.
- Aetna – 1st or 15th after application approval.
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 Advantage 3500 |
|
Deductible |
5000 |
5000 |
$0 |
3500 |
|
Office Copay |
$35 |
$40 |
$50 |
$50 |
|
Prescriptions |
$10:Generic $35:Brand ($500 brand deductible) |
$10:Generic $35:Brand ($750 brand deductible) |
$10:Generic $35:Brand ($750 brand deductible) |
$15:Generic $35:Brand ($750 brand deductible) |
|
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 |
$10,500 |
|
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: (PPO 5000 & 5500, HSA 4000)
- Blue Shield HIPAA – Rates 7/2011
- Blue Shield HIPAA – Application 7/2011
- Blue Shield HIPAA – PPO 5000 & 5500
- Blue Shield HIPAA – HSA 4000
- HIPAA HMO Plans
Anthem Blue Cross of California – Two PPO plans and Two HMO plans
- Anthem Blue Cross HIPAA – Rates & Benefit Brochure 7/2011
- Anthem Blue Cross HIPAA – Application 10/2010
- Checking Account deduction form
- Credit Card form
HealthNet of California – Four plans offered (HMO – 15 & HMO 40) (PPO Simple Choice HSA & PPO SmartValue 50)
Aetna – Two PPO plans Open Access 2500 & Open Access 3500 Please call regarding the Provider networks.
- Aetna – HIPAA Rates – 7/1/2011
- Aetna – HIPAA Application
- Aetna – HIPAA Value MCOA 2500 Benefits
- Aetna – HIPAA Advantage MCOA 3500 Benefits
Applying is Easy …
- HIPAA application
- Group Health plan certificate (proof you have had continuous coverage for at least 18 months)
- COBRA cancellation notice showing cancel date
I know all of this may be confusing, so please feel free to call anytime with your questions. I’m here to help.
Need help or have questions?
John Conner
Health & Medicare
www.JohnConner.com
john@johnconner.com
phone: 800-700-1246
fax: 800-995-9913
HIPAA Health Plans, Medicare Supplement, Individual Health Insurance, Dental, Freedom Blue PPO
Hello,
I would like some clarification on the info noted above.
Must I pay for all 18 months of my COBRA in order to qualify for HIPAA? e.g. If I don’t pay the last month, am I ineligible for HIPAA?
Is my current insurance company obligated to carry my under HIPAA if I meet the above qualifications listed? I currently have Aetna PPO employer plan and applied to them for individual plan coverage a month ago and was denied due to my preexisting conditions. Will HIPAA require them to carry me under one of the plans noted above?
Thank you!
Diane
Hi Diane, yes all 18 month of COBRA must be paid in full before a HIPAA plan will go in force. The new HIPAA company will wait until the last payment is made. Also, regarding pre-existing conditions, the new HIPAA company cannot exclude any conditions.
I hope that helps. Please call anytime.
Thanks … John
Hello—
What happens if I exhaust the lifetime benefits on my current employer’s insurance policy & my employer does consider that to be a trigger for COBRA coverage. Can I apply for HIPAA coverage?
Thank You,
Bill
Hi Bill, with the current health care reform, there are no longer ‘lifetime maximums’ on Individual or Group health plans.
Hope that helps. Feel free to contact me if you have questions.
Thanks .. John Conner
John—-
Actually the lifetime maximum is on a retiree health insurance policy. Given that & the inability to obtain COBRA, would that allow for the purchase of a HIPAA policy?
Bill
Who is the carrier and what is the plan? All traditional group health plans now longer have lifetime max benefits.
John
John—
The carrier is Aetna & the plan is the Praxair pre-65 Retiree Plan.
Bill
Hello-
Are HIPPA HMO plans less expensive than Cal CObra Anthem Blue Cross plans? We were on Fed. Cobra, received subsidized ARRA Cobra rates that subsequently jumped to regular rates after ARRA ran out. Our family HMO Anthem plan is now around $1300.00 (now that Fed. Cobra has run out and they have switched us to Cal Cobra). My husbands former employer changed plans and that is all they offer.
Question: Since we had been on Fed. Cobra for 18 mos with all premiums paid on time do we have to continue Cal Cobra before switching to HIPPA? I’m just trying to find the most advantages and economical way to go because our health ins. premiums are ruining us fiancially.
Any help would be appreciated.
Thank you!
Kathy
Hi Kathy, yes unfortunately you have to exhaust all COBRA which is available to you. Then you are able to look into HIPAA guaranteed issue plans from the different carriers. How many more months do you have on Cal COBRA?
Thanks .. John
Hi…
I am 3 weeks away from exhausting federal COBRA benefits and have trying for 2 months to find if I qualify for HIPAA and how to apply. The policy administrator has finally notified my insurance co of an end-date so I may receive my certificate of continuous coverage (36 months due to divorce.)
How do I find which companies in CA offer HIPAA policies? I’d like another ppo, if possible and feasible.
Thanks very much.
Also, is Cal-COBRA the same as HIPAA; I’ve heard both.
Thx.
Hi Elizabeth, if you are exhausting all available COBRA benefits and do not let you health coverage lapse for more than 63 days you are eligible for HIPAA coverage. The cert you will receive will show your 36 months of continuous coverage along with stating your coverage will end on a certain date. Call me for more information or click here to view the plans and rates: http://www.johnconner.com/health/hipaa-guaranteed-issue-health-insurance-for-california/
Thanks
John Conner
john@johnconner.com
800-700-1246
No, California COBRA is simply an continuation of your previous employer health insurance plan. HIPAA plans are considered “Individual & Family” plans and will most likely be different from your group health coverage.
Thanks … John
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