The Ultimate List of the Best Medical Insurance California
Californians spent $230 billion on healthcare in 2009 — one of the lowest per-capita amounts in the United States. This amount represents about 4.5 percent of California’s economy. The largest providers of medical insurance California has include Aetna, Anthem Blue Cross Blue Shield, Health Net and Kaiser Permanente. The state laws that relate to medical insurance include California Small Group Law AB1672, Cal-Cobra, HIPAA and California Mental Health Parity Law AB 88.
Aetna
Aetna provides managed health care with a variety of insurance products, with revenue of $27.6 billion in 2007 and $31 billion in 2008. It provided medical insurance California to 17.5 million members in 2008 and had a network of 4,919 hospitals. The California Health Care Quality Report Card for 2011 rated Aetna two stars in Meeting National Standards of Care and one star in Members Rate Their HMO. One star is “Poor,” two stars is “Fair,” three stars is “Good” and four stars is “Excellent.”
Anthem Blue Cross Blue Shield
Anthem was originally an insurance company that was spun off from American General Insurance in the 1980s. It became a publicly traded firm in 2001 and merged with Blue Cross Blue Shield organizations over the next three years. Anthem’s final merger was with WellPoint in 2004, and the combined company took the WellPoint name. WellPoint currently uses the Anthem Blue Cross Blue Shield brand name in 11 states, including California. The California Healthcare Quality Report Card gave Anthem two stars in Meeting National Standards of Care for 2011.
Health Net
Health Net is one of the largest publicly traded health care companies in the United States. It provided health insurance to about 6.6 million people in 2011, including 845,000 Californians. Health Net is headquartered in the Woodland Hills district of Los Angeles, California. The 2011 edition of California’s Health Care Quality Report Card gave Health Net two stars out of four for Meeting National Standards of Care.
Kaiser Permanente
The Oakland-based Kaiser Permanente consortium provides managed health care. It is composed of three groups, including Kaiser Foundation Health Plan, Kaiser Foundation Hospitals and Permanente Medical Groups. Kaiser Permanente is the largest organization in the United States that provides managed health care with 8.9 million members in 2009. California has four legal entities of the Kaiser system, more than any other state. The California Healthcare Quality Report Card gave Kaiser Permanente four out of four stars in Meeting National Standards of Care in 2011. Kaiser also received three out of four stars in Members Rate Their HMO.
California Small Group Law AB1672
California Small Group Law AB1672 defines small businesses as those that have more than one and less than 51 employees, with the majority of those employees residing in California. AB1672 requires insurance carriers to provide medical coverage to small businesses. It regulates the renewal and rates of these policies, and it specifies the conditions under which coverage can be denied based on preexisting conditions. AB1672 also specifies the information that carriers must provide about their products.
Small businesses in California have the right to buy any health plan available to other small businesses in the same area. AB1672 also requires carriers to set premiums that are no more than 10 percent above or below the standard rate. This law prohibits carriers from denying coverage based on preexisting conditions, although it does allow carriers to impose a waiting period of up to one year. Carriers must also provide employers with complete and accurate information about their products, so that employers can perform comparison shopping easily.
Cal-COBRA
The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) is a federal law that regulates continuing health coverage when an employee changes employers. Cal-COBRA is a similar state law in California, although with some significant differences. For example, COBRA applies to business with more than 20 employees while Cal-COBRA applies to businesses with more than one employee. Both laws allow an employee 60 days to obtain a health care plan under COBRA.
Employees in California with COBRA coverage lasting 18 months may obtain an additional 18 months of coverage under Cal-COBRA. In no event can Cal-COBRA extend COBRA coverage beyond 36 months. COBRA allows insurance carriers to charge a premium of up to two percent for most types of continuation coverage, while Cal-COBRA allows a standard continuation premium as high as 110 percent. The continuation premium for both laws may be up to 50 percent for employees with a disability extension.
HIPAA
The Health Insurance Portability and Accountability Act (HIPAA) is a state and federal law. The federal version applies to businesses with at least two employees, while the California HIPAA applies to all businesses. HIPAA allows qualifying employees to get new health insurance when they lose their current health plan, regardless of preexisting conditions. An insurer generally must provide a former participant in a health care plan with a HIPAA certificate that describes the length of time that the employee was covered under their previous health care plan. Changes to HIPAA in 2014 will prevent insurers from denying coverage based on claims history, health status or preexisting conditions.
California Mental Health Parity Law AB 88
The California Mental Health Parity Law AB 88 is a state law that applies to all insurance carriers offering private medical insurance. It prevents health plans from limiting the coverage or excluding members with severe mental health problems. These conditions include, but are not limited to, major depressive disorders, bipolar disorder, schizophrenia and children with a serious emotional disturbance. Health care plans can’t require higher deductibles or co-payments from participants with qualifying conditions, nor can they place a lower cap on the maximum benefits for these conditions. Plans that cover prescription drugs must also cover the drugs for covered mental illnesses.
AB 88 allows participants to receive a second opinion on the diagnosis and treatment of severe mental disorders. They can also file a grievance with the Department of Managed Health Care when they feel they have been denied medical care that is medically necessary.