Health insurance plans are either Indemnity (fee-for-service) or Managed Care. Indemnity and Managed Care plans differ in the flexibility they offer in terms of provider choice, ranging from the most choice to the least choice respectively. The major differences concern choices of providers, out-of-pocket costs for covered services, and how bills are paid. Usually, Indemnity plans offer more choice of doctors (including specialists, such as cardiologists and surgeons), hospitals, and other health care providers than managed care plans. Indemnity plans pay their share of the costs of a service only after they receive a claim form and bill from the insured. Managed Care plans have agreements with certain doctors, hospitals, and health care providers to give a range of services to plan members at reduced cost. In general, you will have no claim forms with an HMO and lower out-of-pocket costs. Besides Indemnity plans, there are three basic types of managed care plans: PPOs, HMOs, and POS plans.
With all of the various managed care plans available today, choosing between health plans is not as easy as it used to be. But even though the many choices available may be a bit confusing, there is certain to be an optimal choice to meet your particular needs. Plans differ in how much you have to pay and how easy it is to get the services you need. With any health plan you will pay a monthly premium to pay for the insurance, and in addition, there are other payments you must make. These payments vary by plan, but essentially consist of deductibles and copayments.
The application process takes on average 4-6 weeks depending on underwriting time. Please do not cancel any insurance until your new plan has been approved.
Individual health plans can rate up or decline you for pre-existing health conditions. Group employer plans cannot. Please call us for underwriting guidelines.
If you are moving out of state you will need to change your coverage. Some carriers like Blue Cross and Blue Shield offer conversion plans. Please contact carriers in the state to which you are moving.
If you are pregnant neither you nor the father of the baby are eligible to purchase an individual health plan. We recommend contacting state agencies such as AIM or Medi-Cal if you are not eligible for a group employer plan.
