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HIPAA Guaranteed Issue Health Insurance for California

HIPAA health insurance plans are 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 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 - 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 only, following receipt of payment and application. (If application and payment have been received and application is approved within the first 15 day of the month, Blue Cross will go back to the first of the month effective date (Retro).
  • Blue Shield of California - 1st or 15 after application approval.
  • Health Net - 1st or 15th after application approval.
  • 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

3500 POS

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)

Anthem Blue Cross of California - Two PPO plans and Two HMO plans

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 (these HIPAA plans are not similar to the IFP Open Access plans).  Thsese are POS plans which are similar to a cross between a PPO and HMO.  Please call regarding the Provider restrictions.

Enrollment paperwork:

  1. HIPAA application
  2. Group Health plan cirtificate
  3. COBRA cancellation date 

Please feel free to call anytime with your questions, or for more information.

Kind Regards;

John Conner
Health & Medicare
www.JohnConner.com
john@johnconner.com
800-700-1246 - office
800-995-9913 - fax
916-240-6422 - cell

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