Understanding Health Insurance
Getting the right health
insurance can be one of the most important things you can do.
Various plans and pricing is the most confusing aspect of the individual
health insurance market. Understanding Insurance and choosing an appropriate
policy for your specific needs can be complicated. There are many plans, various
coverage’s, options and restrictions. Deciding on a policy that best suits
your needs is not always easy. For instance, the premiums for similar products
from different insurers can vary by as much as 50 percent for the same person.
The deductible and coverage is a balancing act depending on each plan and
each company and price. Our
dedicated agency gives you the advantage of One-stop shopping. You get to shop
and compare health insurance rates and benefits with all the major plans in
California. This saves you time and money, with the benefit of always speaking
with an agent right away.
Plans vary from year to
year, so you should carefully consider each plan, using our website and our
What is the difference between HMO and
Maintenance Organization (HMO): An
organization that provides a wide range of comprehensive health care services
for a specified group at a fixed periodic payment; a prepaid health care plan
under which people may enroll by paying a set annual fee. Members then receive
all the medical services they need through a group of contracting doctors and
hospitals, often with no additional co-payments or fees. Members are generally
limited to using providers designated by the HMO.
Provider Organization (PPO): A
delivery system where providers are under contract to a carrier to provide care
at a discount or for a fixed fee, and the health plan provides incentives to
patients to use the contracting providers. The PPO does not assume insurance
risk, and it does not facilitate the sharing of risk by its covered persons.
factors to consider when choosing health insurance:
amounts: Most insurance policies require you to cover part of your health
expenses yourself (your part is called the "deductible"), before the
insurance company pays anything. Under some policies the deductible is annual,
and you pay only once each year if you use the insurance. Under others, you pay
the deductible each time you have an illness or injury. When choosing insurance,
you should think carefully about how much you could afford to pay out of your
own pocket each time you are sick or injured and weight the deductible against
the premium before you decide.
Usually, even after you have paid the deductible, an insurance policy
pays only a percentage of your medical expenses. The policy might pay 80
percent, for example; the remaining 20 percent, for which you are responsible,
is called the coinsurance or co-payment. So, if you were injured and incurred
$3,000 in medical expenses, a policy with a $400 deductible and 20 percent
co-payment would cover $2,080 (80 percent of $2,600).
Prescription Drug (generic drug): Safe, effective and equivalent to brand name medications that may
cost considerably less than the brand name medications. Generic drugs must meet
the same high standards of quality as brand name drugs and are formulated to
have the same effect in the body as the brand name version. Generic drugs often
become available when a brand name drug's patent expires
When leaving a
group health insurance plan, it is important to ask the administrator about all
of your options before you leave the plan.
Many insurance policies do not cover pre-existing conditions. If you
arrive with a condition that will need medical attention, verify the
pre-existing aspect of the policy that you are reviewing.
maximums: Many insurance policies limit the amount they will pay for any
single individual's medical bills or for any specific illness or injury.
When to get health
you don't have health insurance right now, you should seriously consider
purchasing it as soon as possible. No one can predict the future--you don't know
when you might suffer an accident or become seriously ill. Health insurance can
help to protect you against financial ruin. Call us today at 619-889-0889 for a
free comparison or quote.
offer California residents a full range of Health Insurance choices.
Please call us at 619-889-0889 for a competitive comparison.
Below are some of the products and services we offer:
Cross of California has been
serving the health care needs of Californians
since 1937. Blue Cross of California,
together with its branded affiliates,
provides health care services to more
than 6.8 million members. Offering a full
continuum of product and coverage options,
Blue Cross provides customers with unparalleled
choice and flexibility in meeting their
health plan needs. These options are continually
fine-tuned to enhance access to affordable,
quality health care. The Company, with
its strong track record for innovation,
focuses on progressive products and services
designed to improve the health status
of all Californians. Unique product offerings
available in the individual, small group,
large group, senior and Medi-Cal markets
include a full range of integrated medical
and specialty products.
Tonik Plans: Is a very popular and new plan from Blue Cross of CA. Tonik is affordable health insurance plans designed just for you with easy to understand deductible's and co-payments. The new plans from Tonik Health, offered by Blue Cross Life & Health may be just what you need. Tonik offers three simple plans to choose from with rates as low as $64 - $123 per month, depending on the plan you pick and where you live. Each plan includes health, dental, and vision benefits. The main difference between each plan is what you pay per month, number of doctor visits, and deductible. The downside to Tonik is no maternity and no brand name prescription drug coverage. Call an San Diego CA agent today at 619-889-0889.
Shield of California Life &
Health Insurance Company Life has grown by offering competitive insurance
products including Group Term Life, Accidental Death & Dismemberment, Blue
Shield of California Life & Health Insurance Company Life Vision Plan, Stop
Loss and Exec-U-Med medical reimbursement plans in tandem with Blue Shield of
California health plans or on a stand-alone basis . In the early 1980s,
introduced their Short-Term Health products. The Option One and Option Twelve
plans remain one of the leading products of their kind in California
New Essential Plan 3000 & Essential Plan 4500 - These new affordable individual subscriber-only health insurance plans from Blue Shield of California offer medical, dental and vision benefits in one convenient package. Either is an ideal choice for Californians looking for straightforward individual coverage with low monthly rates. The man difference between each plan is the annual deductible. Plan highlights:
- Medical, dental and vision benefits
- Predictable co-payments for doctor visits, dental and vision services
- First-dollar coverage for three office visits, preventative care, emergency room services and prescriptions
- Access to one of California's largest PPO provider networks
- After the deductible is met the following services are coverage at 100 percent: X-ray and lab services with network providers and In-network services
- Generic prescriptions are covered with a low copayment. This plan does not include brand prescription coverage.
- No maternity coverage, however, members who become pregnant can transfer without underwriting into the Shield Spectrum PPO Plan 5000.
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Please Note: The information contained in this Web site is provided solely as a source of general information and resource. It is a not a statement of contract and coverage may not apply in all areas or circumstances. For a complete description of coverages, always read the insurance policy, including all endorsements