Anthem Blue Cross Health Insurance

Yes.  Insurance companies may look at smoking and drinking history when they decide whether to offer insurance. 

The following chart summarizes underwriting information that health insurance companies have filed with the Department of Insurance.

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Yes. Insurance companies usually look at your height and weight when they decide to offer insurance. They may offer you insurance at a higher premium rate or refuse to insure you if you are overweight or obese. Some insurance companies use a measurement called the Body Mass Index (BMI) to decide. If your BMI is above 39, most insurance companies will not offer you insurance. If your BMI is 30-39, an insurance company may offer you insurance at a higher premium. If you have health problems because of your weight, such as diabetes or heart disease, an insurance company may refuse to insure you, even if your BMI is under 30.

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Insurance companies may offer you insurance at a higher premium and/or limit the products or benefits you can purchase if you had a health problem in the past but you have recovered or you have been without symptoms for some time.  Insurance companies will also do this for minor health problems that you had in the past or may currently have.  Insurance companies argue that these conditions pose a risk that it will cost more for your health claims than if you were completely healthy.  Each application and insurance company is different.  An insurance company may charge a higher premium or limit the products offered for the health conditions below.  There may be other health conditions and time frames that are not on this list.

• Stroke, after 10 years with no reoccurring problems;

• Allergies, while testing is in process;

• Ear infections, controlled with medications;

• Lyme’s disease, without symptoms after one year;

• Breast Implants (non-silicone);

• Ringworm;

• Joint sprain or strain, recovered and no restrictions;

• Migraine headache, mild and infrequent with no emergency room visits;

• Mild depression.

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Downgrading is easy to do within the same kind of plan such as Share 500 to the Share 1500. Upgrading is possible if you are in good health as it is subject to underwriting.

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There are a few options for payment with either carrier.
Billing - Shield monthly, quarterly Blue Cross bi-monthly, quarterly
Credit Card Blue Cross allows monthly, bi-monthly, quarterly credit card deduction
Checking account auto-deduction monthly deduction.

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No. The policy can be canceled or renewed (by payment) month to month.

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Blue Cross has an online application which tends to process very quickly. Otherwise, you can fax your completed application and copy of check (or credit card section) to 800-569-1156 to start the process immediately. You would then mail the original if paying by check. The credit card option just requires the faxed copy.

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There is no fee to apply. Only the initial month's premium is submitted with the application.

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The first month's premium must be submitted with the application. This can be done with a check made out to the carrier or via credit card (for Blue Cross of California). If the application is not approved, this initial payment will be fully refunded.

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There are two different scenarios. If the applicant is in good health and there isn't much the carrier wants to check into, we usually hear back in one to two weeks. If the volume of applications is running high in underwriting, the time frame can be longer. If the carrier wants further information on something listed in the application, they will request records directly from the doctor and this can delay the processing time. It usually adds another 2-4 weeks depending on how quickly the doctor responds back to the request.

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Yes. With either carrier, you have a single child or multiple siblings on one plan if they are under the age of 18.

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The rates can change by class (the entire state of California or county) or when you move up to a new age band (typically at 5 year increments such as age 35-39). The stronger the carrier, the less severe and less often the rate increases. Once approved, they cannot change rates based on your medical health or claims.

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This basically lets you know how the plan will treat large bills...so called catastrophic or major medical coverage. Your max-out-of-pocket let's you how much you will pay up to for covered benefits, in-network in a calendar year. Usually, the max is per person up to two people maximum. The Blue Shield Preferred Savings plans have a family deductible for 2 or more people on one plan.

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A deductible is an amount that you will pay first before the plan kicks in. Keep in mind that you will still get the discounted rate (usually 30-60% off) on covered benefits, in-network even before you meet your deductible. After the deductible is met, you typically go into a % of the discounted rate. Some benefits such as maternity and brand name descriptions will have their own, separate deductible.

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Most people already have a strong preference between these two models but in case you a need a quick summary, here it is.
With a PPO, you have more flexibility to choose your doctors; you are not locked into a region or a primary care doctor. You can self-refer yourself out to specialists. The trade off is that you will help share the costs when you get sick or hurt in the form of a deductible or co-insurance.
With an HMO, you choose a Primary Care Physician who has more control over referral and/or decisions regarding your care. You must remain within your medical group and within a geographic region. The trade off with this more structured approach is that there will be less out of pocket when sick or hurt. For example, for inpatient hospital, you may be looking at nothing out of pocket.
TIP HMO's have become more expensive so compare the annual premium difference with PPO options to make sure you are not paying too much.

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Blue Cross of California and Blue Shield of California are separate, competing companies that offer comprehensive plans at the Individual and Small Group level.

Provider Networks Both companies have extensive doctor and hospital lists with 48,000 doctors and 400 hospitals up and down the state. Typically the lists overlap with doctors/hospitals participating in both. Occasionally there will be a doctor who participates with one company but not the other so it's best to check on your doctor.
Financial Strength This really is the main reason to go with the "Blues". Smaller or less efficient carriers are having difficulties with some filing for Bankruptcy. If you are with a smaller carrier that is offering significantly reduced costs, they almost definitely raise rates, lower benefits, and/or leave the market entirely. If you have developed health conditions, the other carriers will not pick you up at that time. Blue Cross of California is owned by Wellpoint, named the most admired health care carrier in the nation three years in a row. Blue Shield is a close second.

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Currently there are a few health plans that stand out as being good values. Interestingly enough, they are also the most popular plans state-wide. All these plans combine solid carrier strength and comprehensive coverage with a high(er) deductible which helps to keep your monthly rates down. With current rate increases (last four years), this this is a smart way to insure. Check out the following plans:

SmartSense (no maturnity)
Lumenos HIA
Lumenos HSA (no maturnity)
RightPlan40 (no maternity)
PPO 3500 HSA Compatible Plan
BC Life & Health PPO 3500
PPO Share 2500
HMO Saver

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There are a lot of differences between a PPO and an HMO, but the biggest differences are in how you access care, and what providers you can access.

“PPO” means Preferred Provider Organization. A PPO is a healthcare network system where the providers are contracted with a carrier to provide healthcare at a discount or for a fixed fee.

Members can access care from PPO network contracted providers, or from non-contracted out-ofnetwork providers.

“HMO” means Health Maintenance Organization. An HMO is a prepaid healthcare plan that offers members a variety of comprehensive healthcare services available from a specific group of contracted hospitals and medical professionals.

If you elect PPO coverage, you can see any licensed physician or provider in the PPO-network or out-of-network. Of course, if you see a Blue Cross PPO-network provider, the plan’s reimbursement will be greater than if you see an out-of-network provider.

If you elect HMO coverage, your non-emergency care is managed by a Primary Care Physician (PCP); Specialty care requires a referral from your PCP. You are generally limited to seeing only providers contracted with the HMO. Most Blue Cross HMO services have no or very limited out-of-pocket cost to the member.

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Depending on what your condition is and when it was diagnosed and treated, you can probably buy California health insurance. However, the insurer may do one of three things:

* provide full protection but with a higher premium, as might be the case with a chronic disease, such as diabetes;
* modify the benefits to increase the deductible;
* exclude the specific medical problem from coverage, if it is a clearly defined condition, as long as the insurer abides by state and federal laws on exclusions.

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If you work for a company with 20 or more employees, your employer must offer you (through age 69) the same California health insurance coverage offered to younger employees. After you reach age 65, you may choose between Medicare and your company’s plan as your primary insurer. If you elect to remain in the company plan, it will pay first—for all benefits covered under the plan—before Medicare is billed. In most instances, it is to your advantage to accept continued employer coverage.
But be sure to enroll in Medicare Part A, which covers hospitalization and can supplement your group coverage at no additional cost to you. You can save on Medicare premiums by not enrolling in Medicare Part B until you finally retire. Bear in mind, though, that delayed enrollment is more expensive and entails a waiting period for coverage.

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No. Although you can select a California health plan such as a Blue Cross of California plan or buy a policy that should cover most medical, hospital, surgical, and pharmaceutical bills, no single policy covers everything. Moreover, you may want to consider additional single-purpose policies like long-term care or disability income insurance. If you are over 65, you may want a Medicare supplement policy to fill in the gaps in Medicare coverage.

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Your aim should be to insure yourself and your family against the most serious and financially disastrous losses that can result from an illness or accident. If you are offered health benefits at work, carefully review the plans’ literature to make sure the one you select fits your needs. If you purchase California individual coverage like Blue Cross of California, buy a policy that will cover major expenses and pay them to the highest maximum level. Save money on premiums, if necessary, by taking large deductibles and paying smaller costs out-of-pocket.

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No. If you choose to use a credit card, your card will only be charged if you qualify for short-term coverage. Please note that credit card billing of premiums is optional and you can obtain coverage without using that method of payment.

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In most cases, as soon as you complete your application, we will be able to let you know if you do not qualify for short-term coverage.

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Coverage for many short-term health insurance plans can start as soon as 24 hours after the application is submitted. In order for coverage to start promptly, you can make your first premium payment by supplying a valid credit card number with your application. Please note that credit card billing of premiums is optional and you can obtain coverage without using that method of payment.

If you would prefer to have your coverage start later, you can select a date up to 30 days in the future.

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Most short-term health insurance plans have a minimum coverage period of 30 days. Even if you only need coverage for less than 30 days, you can either:

• Make a single payment upfront for 30 days of coverage, or
• Select the monthly payment option, and then cancel your coverage when you no longer need it. Please note that you will not be refunded for partial months of coverage.

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At the end of your coverage term, most health insurance companies will allow you to re-apply for another short-term plan. These plans do not typically constitute an automatic continuation of your first plan. Many short-term health insurance plans only allow you to re-apply once.

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If you're between jobs, waiting for coverage from another health insurance plan to start, laid off, on strike, a recent college graduate or seasonal employee and know that you only need coverage for a specific period of time, short-term health insurance may be a great option for you.

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Short-term health insurance plans provide you with coverage for a limited period of time, and may be an ideal solution for those between jobs or those waiting for other health insurance to start. Typically, short-term plans offer coverage up to six months, although some plans may offer coverage up to 12 months. If you think you'll need coverage for a longer period of time, you may want to look at a standard, longer-term health insurance option like our individual and family health insurance plans.

The application process for short-term health insurance is usually simpler than standard, longer-term health insurance. Short-term health insurance plans are designed to protect against unforeseen accidents or illnesses, rather than to provide comprehensive coverage, and, as such, typically do not include coverage for preventive care, physicals, immunizations, dental or vision care.

Purchasing a short-term medical insurance plan will make you ineligible for any guaranteed issue individual health plans commonly referred to as HIPAA Plans. HIPAA plans are usually very expensive and are generally intended for people with pre-existing medical conditions who would have trouble getting health insurance otherwise. If you wish to maintain your eligibility for HIPAA plans, you should not purchase a short-term plan. Please consult your benefits advisory to discuss your rights under the Health Insurance Portability and Accountability Act (HIPAA) and other rights under state law.

Short-term health insurance plans typically do not cover pre-existing medical conditions. The definition of a pre-existing condition varies by state, but, in general, short-term health insurance policies exclude coverage for conditions that have been diagnosed or treated within the previous 3 to 5 years. If you have an existing medical condition, you may want to research whether you can extend your current insurance. Employer-sponsored insurance can be extended under a government-regulated option commonly referred to as COBRA, which you should seriously consider if you have an existing medical condition.

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At HealthCoverageQuotes.com we know it can be confusing and frustrating trying to find the right group health insurance plan for your business. Many people may not understand exactly how health insurance works and may not be familiar with health insurance terminology.
 
The best way to help yourself decide which plan is best for your business is to understand the health care needs and financial constraints that you and your employees face. To get started, you and your employees should answer these questions:

• How often do you utilize medical services?
• Will you need coverage for benefits such as prescription drugs, chiropractic care or maternity?
• Is coverage for preventive care checkups important to you or are you more concerned about coverage in case of a major injury or illness?
• What kind of monthly premium can you afford?
• What kind of deductible, if any, are you willing to pay on an annual basis before your coverage begins?
• Is it important to you to be able to see any doctor you want to, or are you willing to work within a provider network or through a primary care physician?

Once you have an understanding of your health care needs and your financial constraints, you'll be more prepared to examine the benefits and costs of the plans offered in your area. For example, you may want to avoid a health insurance plan that offers benefits that you and your employees never use since these unnecessary benefits may translate into higher premiums. If you're looking at a health insurance plan that requires you to use the insurance company's network of doctors and hospitals, you may want to make sure that your current doctor --if you have one-- is on the list and that network facilities are located near your home or office.
 
If you're looking for an answer to a specific question, or if you just want some advice to help you narrow down your options, please contact our Customer Care Center. We have licensed professionals available to help you with just this kind of issue. You can reach a Customer Care representative Mon - Fri, 6AM-5PM PT at 707-578-333. If you prefer, you can also send us an email.

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Group health insurance plans are categorized as either indemnity plans (also known as "traditional indemnity," "fee-for-service," or "FFS" plans) or managed care plans. Indemnity and managed care plans differ in their basic approach. Put broadly, the major differences concern choice of providers, out-of-pocket costs for covered services, and how bills are paid. You will typically have a broader choice of doctors (including specialists, such as cardiologists and surgeons), hospitals, and other health care providers with an indemnity plan while you will typically have less out-of-pocket costs and paperwork with a managed care plan.

Indemnity plans once dominated the American health insurance market, but are no longer as popular as they used to be. They are most common on the east coast. Managed care plans now take up a much larger share of the general health insurance market and are especially dominant in the western parts of the country. There are three basic types of managed care plans: PPOs, HMOs, and POS plans.

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Your company will probably be eligible for a small business plan if it meets the following criteria:

1. Your company consists of at least two full-time owners, officers, partners and/or employees, as verified by officially-filed state quarterly wage and tax statements (e.g., NYS-45 in New York and DE-6 in California) or annual federal tax return documents;
2. Your company is a legitimate business entity (i.e., your company was formed for a purpose other than to obtain insurance), as verified by one of the following documents:
• A business license or fictitious name filing (proprietorships and partnerships);
• Articles of incorporation (corporations); or
• Articles of organization (limited liability company).
3. Your company meets the minimum employer contribution percentage set by the insurance company.

Please note that eligibility criteria may vary among insurance companies and by state. If you have any questions about your company's eligibility for a particular small business plan, please call one of our licensed representatives Mon - Fri, 6AM-5PM PT at 707-578-3333.

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Significant tax advantages may be available to employers who offer group health insurance coverage to their employees. Employers can generally deduct 100% of the health insurance premiums they pay on qualifying group health plans. Providing health insurance coverage to employees as part of a total compensation package may also result in reduced payroll taxes for employers. Additionally, when the employer offers group health coverage, it's possible for an employee's share of the premium to be paid with pre-tax dollars, resulting in tax savings for the employee. Check with your accountant or tax advisor for specific tax benefits for your business and employees.

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Typically, an employer is required to cover 50% of the employee's monthly premium. In these cases, the employee covers the remainder of his or her own premium and then covers the full premium for any of his or her dependants. Minimum employer contribution levels may differ from state to state and from one insurance company to the next. Also, some employers opt to cover a higher percentage of the employee's monthly premium and sometimes a portion of the premium costs for an employee's dependants.

During the application process, you'll be able to indicate how much of your employees' (and their dependents') monthly premiums you would like to cover.

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It's no secret that employees value health insurance benefits. Surveys have shown that workers value health insurance coverage second only to monetary compensation. By offering group health insurance benefits to your employees, you may find it easier to hire and retain the best workers for your company.

As a business owner, you may not have health insurance coverage yourself. Perhaps you've considered shopping for an individual health insurance plan for yourself and your family, but did you know that by obtaining insurance through a company, you may get better rates than through the individual market?

Additionally, there are various tax incentives available to you and your employees when you participate in a group health insurance plan. For example, businesses can generally deduct 100% of the premiums they pay on qualifying group health plans and, by offering group health insurance as part of a total compensation package, you may be able to reduce payroll taxes. Plus, your employees can pay their portion of the monthly insurance premium with pre-tax dollars. Make sure that you take these incentives into consideration when determining the affordability of a health insurance plan for you and your employees.

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