Information for the Uninsured among us.

While most health insurance is only available to employees through their employer’s group plans, there are a few insurance companies in California who offer coverage to individuals and their families. Though the plans vary somewhat, they have some common themes.

You can enroll in an HMO (which is the least expensive plan), or you can pay a larger premium and have more choice of medical providers (with the exception of Kaiser, which is HMO coverage only). There is also a wide selection of co-payments and deductibles available.

How much does it cost?
The cost for the plan depends on several factors. First, the cost depends on which plan you choose. If you choose a plan with a low deductible and low co-payments, your monthly insurance premium will cost more. If you choose a plan that has a higher deductible and large co-payments, it will cost significantly less.

Geographic Rating
In California, the cost of providing care is significantly different from county to county. As a result, insurance companies (other than Kaiser) have designed the cost of their plans based on which county or zip code you are requesting to be covered in. Generally, they are broken out by region with several zip codes incorporated into one region.

Kaiser rates it health care plans by North and South. Generally, Fresno and any city north are in Kaiser North, and any city below Fresno is in Kaiser South. If you don’t know which service area you are in, you can call Kaiser toll-free at 1-800-464-4000.

Pre-existing conditions
All of the plans available to the individual market have pre-existing condition clauses. If you have been diagnosed with certain medical conditions, an insurance company can decline to offer you insurance for that particular condition. Or, the insurance company may not pay for the condition for a certain period of time. When you inquire about a health plan, be sure you ask what pre-existing conditions apply before you purchase a plan.

What insurance companies offer plans?
The insurance companies who are currently offering plans to individuals are listed below. Because the health care market is changing so rapidly, a company may choose to no longer offer coverage at any time, or other companies may begin to offer coverage. Always check your local telephone directory to be sure you have exhausted all the options available before you purchase.

Kaiser (800) 464-4000

Health Net (800) 909-3447

Blue Shield (800) 431-2809, opt. 4

Blue Cross (800) 777-6000, opt. 2

A few of the insurers have additional plans available for people with special circumstances. For example, Kaiser has the “Steps-Program” available. This is a plan designed for low-income families. In addition, Blue Shield has a short-term policy available for 12 months for people who are job hunting, changing careers, finishing college, etc. Again, when you call a company to get a quote, ask if there are any other plans available that you might qualify for.

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