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Health Insurance Resources

Guide to California Medicare Options
This site will give you the information you need to make your best Medicare choice right now and help you understand the historic changes coming soon to Medicare.

Health Insurance Guide
This consumer guide presented by the California Department of Insurance explores types of health insurance and how it works in the State of California. 


Selecting and Using Dental Benefits: A Consumer's Guide to Dental Insurance
The California Dental Association (CDA) presents this information in the public interest. The information provided should not be construed as either an endorsement or recommendation by CDA. While this brochure attempts to be comprehensive, there may be questions that it has not answered fully. Consult your insurance carrier, insurance broker or company benefits coordinator for complete information.


Guide to Choosing a Health Plan in California
This website is sponsored by the California Medical Association (CMA). CMA is unable to provide specific advice about which plan is best for you and your family. If you're still not sure which type of plan to choose, you may want to use their checklist of health plan features and services to compare your options or ask for more information from the health benefits manager at your workplace or a health plan representative. Your physician may also be in a good position to help you compare plans, since he or she is familiar with your health and medical history.


Choosing a Health Plan: A Guide to Managed Care for Families
The American Academy of Pediatrics addresses issues of importance to families including specialty and emergency care, your ability to change physicians and what to do if a plan rejects your claim for payment.

 

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What is Individual Health Insurance?
An individual health insurance policy is a policy that you purchase on your own, with only one person (yourself) as the covered policy holder. There are many different types of policies for individual health insurance, such as PPO, HMO and short-term health insurance.

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What is Family Health Insurance?
A family health insurance policy is very similar to an individual policy. However, instead of one covered policy holder, each member of your family that is listed on the policy will be covered.

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What does PPO Mean?
PPO stands for Preferred Provider Organization. This type of insurance will normally require you to visit doctors within a certain network in order to receive insurance coverage.
This type of plan normally will have a deductible and may include a co-payment for doctor visits.

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What does HMO Mean?
HMO stands for Health Maintenance Organization. While this type of insurance is generally much more affordable, there are more restrictions than a PPO plan. The network of available health care providers may be smaller and you will need to select a Primary Physician.  However, there are usually no deductibles and co-payments for HMO plans are normally lower than PPO co-payments.

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What is a POS Plan?
POS stands for Point of Service. This type of health insurance is a hybrid between a PPO and an HMO. You will still need to have a primary care physician, but you will have access to more health care options within your network.  As with an HMO, there are normally no deductibles and co-payments are lower.

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What in an Indemnity Plan?
An Indemnity plan will allow you much more freedom in health care choices. This freedom comes with some drawbacks and will normally require you to pay a deductible and may also require you to pay for health care visits and submit your claim for re-payment from the insurance company.

A UCR (usual, customary and reasonable) rate will be paid out on your claims. This rate will be predetermined by your health insurance company before you purchase your policy.

You will not need to have a primary care physician with this type of insurance plan.

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What is an HSA Plan?
HSA stands for Health Savings Account. This type of plan was introduced in January of 2004. Basically, you set up a “savings account” and this account is used in conjunction with an HSA insurance plan to pay for your medical costs.

Contributions to your HSA savings plan are made at pre-tax and you may invest these funds however you would like.

Unused funds in your account are tax free and may accrue interest year-to-year.

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What is a Co-Payment?
A co-payment is a charge that will be agreed upon between you and insurance company before you purchase your plan. This co-payment may range anywhere from $15 to $50, depending on the insurance company.

Your insurance company may require you to provide this co-payment for doctor’s visits or for prescription medications.

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What is a Deductible?
A health insurance deductible is a set dollar amount. Any expenses occurred before this deductible is met will need to come out of your pocket. Once you have met your deductible, the costs will then be covered by your health insurance provider.

For example, if your deductible is $250, and your first doctor’s visit is $245, you will be responsible for this amount. However, your next visit will be covered by your insurance company.

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What is Co-Insurance?
Co-Insurance is separate from your deductible and any co-payments you may be required to provide. This amount can range anywhere from 10% to 80%, depending on your health insurance provider.

For example, your doctor performs a procedure that costs $500. You are required to provide a 10% co-insurance payment. This means that you would need to provide $50 and the insurance company will provide the remaining $450.

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What Does the term In-Network Provider Mean?
This term refers to a doctor or health care practitioner that has contracted with your insurance company. Since they have contracted with your insurance company, visits to these providers will be covered by your health insurance company.

You will usually receive a list of all of the in-network provider in you area from your health insurance company.

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What Does the term Out-of-Network Provider Mean?
This term refers to a health care provider that has not contracted with your health insurance company. Visits to out-of-network providers will cost more, depending on your plan, and may not even be covered.

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How Do I Find the Best Health Insurance Plan for Me?
You will need to weigh carefully your financial, health and medical requirements before selecting an insurance company plan. If you can afford a more expensive

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