Individual, or family, health insurance is also commonly known as personal health insurance or private health insurance. Most insurance companies offering this product will refer to it as individual health insurance. Family health insurance, where you, your spouse and your children are all on the same plan, is still referred to as an individual health plan. This is the type of policy you would purchase for yourself and your family if your employer does not provide insurance benefits to its employees. You may also consider family medical insurance if you are self-employed, unemployed or a student. Individual and family health insurance plans are available for newborns on up to the seniors at age 65.
Individual and Family health insurance is different from Group (Company) insurance in that they can decline and or change rates based on your health at the time of application. Below we have some common reasons for difficulties in getting approved but first a few quick tips regarding qualifying for coverage.
No. Each insurance company has its own underwriting guidelines, which are usually not made public. However, insurance companies marketing and selling individual health insurance policies in California must file information with the Department of Insurance pertaining to their policies, procedures and underwriting guidelines for offering such insurance (Insurance Code Section 10113.95 which was added by Assembly Bill 356 in 2005). We have summarized the information that companies hav
There are many medical conditions that may cause an insurance company to automatically deny or not approve your application. These may include the following:
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 insura
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 d
Prior authorization is required for:
Yes, you may go to a non-network provider, but your out-of-pocket costs will be substantially less if you go to a Participating Provider. Please consult your Evidence of Coverage. You can find a network provider here.
You may be able to nominate him or her. Call our Customer Service number on your ID Card. If you utilize the services of a non-Participating Provider, your out-of-pocket expenses will be considerably higher than when you use a Participating Provider. You will be responsible for all charges in excess of what Anthem Blue Cross allows for that provider.
Receiving services from Anthem Blue Cross PPO Providers can substantially reduce your out-of-pocket costs. These lower costs are due to negotiated rates that Anthem Blue Cross PPO providers agree to accept instead of their typical fees, and generally, benefits paid for non-participating providers are more limited. You do not need to make payment for services, unless your plan has an office visit copay, when you receive care from Anthem Blue Cross PPO providers.
- Go to our Provider Finder and follow the prompts to retrieve your health plan's network providers. If you want directions to a specific provider, simply click on the provider's name and you are linked to an area map that shows various routes to the provider's location.
- Look in the printed Anthem Blue Cross PPO Directory. You can get a provider directory mailed to you by calling Customer Service at the toll-free number on your ID card.
