California Health Insurance

Affordable California health insurance for the California medical Insurance shopper

Vitality is proud to represent the finest array of California health insurance available to California health insurance consumers like you! As an Independent Authorized Agency, California health insurance companies we work with include:

Anthem Blue Cross - the largest member of the Blue Cross and Blue Shield Association, a federation of 39 separate health insurance companies and organizations in the United States serving over 100 million! Anthem offers a lineup of PPO, preferred provider organization plans, HMO, health maintenance organizations, POS, point-of-service plans, EPO, exclusive provider organization, traditional indemnity plans, and an amazing assortment of other plan offerings. Along with a range of affordable California health plans, the company offers a suite of specialty plans including dental and even California term life insurance products!

Probably one of the best known of Anthem’s specialty line is the California health insurance it offers through its popular online exclusive: Tonik; Tonik health insurance users are typically young(er) consumers with no health issues and – not unusual of folks at that stage in life – feel personally empowered about the state of their health and accept the higher deductibles that are part and parcel of a Tonik plan – plus: once deductibles are met Anthem covers 100% of costs.. Anthem’s Tonik health insurance program is a Web-based model. It’s an Anthem Internet-ready California health insurance concept for the breed of California health insurance client who is comfortable and reliant on the Internet’s abilities to provide service to the California health insurance consumer!  If you have a health insurance need, Anthem has got a California Health Insurance plan for you, your family, and your California small business!

Other companies besides Anthem Blue Cross in the California health insurance portfolio we offer at Vitality Health Insurance Services include: Assurant, Cigna, Aetna Health Insurance, Health Net, and PacifiCare - A UnitedHealthCare Company. You’ll find a suite of California health insurance managed care plans such as HMO, POS, and PPO plans to serve you with the affordable California health insurance plan that’s right for you! We’re also proud of Vitality’s representation of the Kaiser Permanente managed care organization! Kaiser health insurance is an integral part of the California healthcare scene and we’d be delighted to assist in your review of their California health insurance plan offerings as well as those of Blue Shield of California. In the world of California health insurance, Anthem Blue Cross and Blue Shield of California are two separate companies. Blue Shield of California, which offers HMO, PPO, and assorted specialty California health insurance plans such as dental coverage, high deductible plans matched with accompanying Health Savings Plans or HSAs – the “Shield Savings Plans” – is the final member of the Vitality California health insurance lineup!

As you can see from the above, we offer variety, versatility, and flexibility and we think that is a sure path to both a higher level of service quality and cost savings improvements from the California health insurance company that you choose for your California health plan strategy!

We also offer an outstanding range of options for clients seeking fast, free, and convenient California health insurance quotes: You can use our fast online quoting system – a few quick details about your present needs and you’ll get the health quotes you want! Or: Call us! A member of the Vitality Health Insurance team will be happy to assist you with the personalized service we specialize in! Finally – you can also use our convenient Contact Us Page: Let us know how we can assist you with our free California health insurance consulting services!

Thank you in advance for your review of the individual California health insurance information you see before you on this page of the Vitality Health Insurance website serving Californians throughout our great state! We’re pleased and honored that you have placed your trust in this site to provide you with California health insurance information as well as fast, easy, and FREE quotes for affordable California health insurance.

A Californian has some basic options when it comes to securing the affordable health care coverage that is right for them and their family. These include:

• Affordable California health insurance individual consumers can rely on.
• Affordable California health insurance via their own or their employer’s small business (Also known as Small Group: 2-50 employees))
• Affordable California health insurance via a larger business (Also known as Large Group: 50+ employees)

Assuming that you have chosen to seek out affordable individual California health insurance plan, you’re at the right section of the Vitality website! Let’s start the process by concentrating on…you!

We’ll start with you because the process of selecting a health insurance plan that fits your current and projected healthcare needs as well as that of your household budget starts with important questions you’ll need to be aware of. Our job as your partner in this process is to help you review and answer those questions so there isn’t any disappointment or surprises down the road once your California health insurance has been secured.

Let’s start with affordability and the dollars and sense of the plans you are considering:

• Monthly premiums: How much do they run and what would their impact be on your monthly household budget?
• Deductibles: Are they ‘per family unit’ or are they per family member? Can you afford to go with a higher annual deductible and fund an HSA that can be matched up with that high deductible policy? Remember: High deductible equals lower premiums.
• Will there be copayments or coinsurance? What will be the flat fee dollar amount of the copayment or a percentage of the coinsurance? Bottom line: What kind of out-of-pocket expenses are you, the policyholder, looking at before your plan begins to reimburse you and begin sharing the load?
• Speaking of reimbursement, how would your plan’s reimbursement process work? An indemnity plan – while offering greater freedom of choice in the providers you work with – will also likely come with claim form requirements and reimbursement that goes to you rather than the healthcare provider. This makes you an active participant in the management of the financial side of your healthcare. If you’re okay with that, great! If not, that’s where managed healthcare options like PPOs and HMOs shine.
• Asking yourself whether you need or even care about what your out of network options are in your California health insurance is important too. Decide going in whether out of network availability or the cost burden of that kind of coverage is a concern or even needs to be “on the radar”. Some policyholders are perfectly okay with the providers in their network and it’s never an issue. Other policyholders have providers that they swear by who are out of network and the network limitations that can come with a PPO, HMO, or EPO can make those plans a non-starter in the minds of Californians seeking affordable health insurance.
• If you decide to go with a managed health care plan option like a PPO from a carrier such as Anthem Blue Cross for your California health insurance you’ll be dealing with a network of providers who have contracted with your insurance company to provide healthcare services at more favorable rates. That’s good for you and the insurance company. In this case, you’ll want to make certain to ask if the plan will cover services you may use. We stress “may” because again – if you have a particular physician that you are devoted to and that doctor is out of network or if you live in a remote part of the state whose hospital, laboratory, or other healthcare provider are few and far in between you’ll want to make sure they are in-network for the affordable California health insurance you want to select. The cost of going out of network could necessitate a closer look at available indemnity plans for your area.

Okay. We’ve asked the important questions any consumer should ask when beginning the shopping process for affordable California health insurance. Now let’s start looking at the various types of plans along with a deep dive into the areas we discussed above:

• Fee for service, “traditional”, “indemnity” California health insurance plan: The plan with the greatest freedom of choice for the policyholder. You see the healthcare provider of your choosing. No networks here, folks! The physician is typically paid based on a UCR schedule (Usual, customary, and reasonable) for the same service provided by other physicians in that area. Claims can be filed by either the provider or the policyholder. Freedom of choice but also more hands on with some of the financial aspects of the healthcare experience.  
• The managed care California health insurance plan: Here’s where you find your PPO (Preferred Provider Organization), POS (Point of Service), and the HMO (Health Maintenance Organization) offerings. This is where more than half of all Americans have these plans and they work well for patient and insurer alike in that they provide comprehensive health care to the member with lower out of pocket costs to these members with the understanding that they will stay in network for their health services and utilize providers who have contracted with that insurer to be in that insurer’s network while charging less for their services. It’s a win-win for patient and insurer alike. Stray outside the network? Be prepared to pay more for the healthcare choices you make from that point forward.
• PPO (Preferred Provider Organization): Provides a network of healthcare providers who will charge less for the services. If the patient stays within network they pay a lower portion for their healthcare. Go outside of network, they pay a higher portion of the cost(s). Typically doesn’t require referrals to specialists but check if pre-authorizations or pre-certifications are necessary.
• HMO (Health Maintenance Organization): An HMO is the ultimate in managed care California health insurance plan. It allows the member to receive care through a network of participating doctors and hospitals. The member selects a primary care physician (PCP) from whom that member will receive treatment and who will also act as a gatekeeper, coordinating the member’s care and authorizing a specialist referral when necessary. Out-of-network is generally not an option unless the member is traveling and finds themselves in an urgent care situation or the existing network cannot offer a particular form of treatment that is available out of network and that requires pre-authorization.  The emphasis in an HMO is on preventative medicine and wellness that helps avoid the risks of serious medical issues down the road.
• POS (Point of Service) California health insurance plan: Brace yourself. This one can get a wee bit convoluted but it’s worth understanding as it can offer some interesting features. Okay, let’s start by saying the POS combines features of Indemnity, PPO, and HMO California health insurance plans. Whew! Okay, how so? The CA health insurance POS combines the features and benefits of both PPO and HMO managed care plans but with a dash of the freedom found in an indemnity plan. Thus POS has the distinction of being the least restrictive type of managed care. The POS is like an HMO in the sense that you work with a network of healthcare providers and you also choose a Primary Care Physician (PCP). As with PPOs, stay within network with your provider choices and lower fees ensue. However, your primary care physician can refer you to a specialist from outside the network. Further, claim forms and paperwork in general are handled by the in-network providers you use. Going outside the network will require the policyholder to be more “hands on” with the inevitable paperwork and payment process that follows a doctor’s visit. So – like indemnity – freedom of choice but at the cost of paperwork, payment handling, and accurate accounting of medical receipts.
•  HSA (Health Savings Account): Let’s look at one more option: This California health insurance option is called consumer directed, consumer-driven, or consumer choice. This option refers to the mating of a High deductible California health insurance plan with a tax advantaged health saving account (HSA) that allows the policyholder to pay current health care costs or even save for future anticipated healthcare expenses. Contributions are tax deductible and earn interest tax free and can also carry over from one year to the next. Funds accumulated can be used to pay for qualified medical expenses without tax penalty for early withdrawal.

We asked some questions earlier. Let’s answer some now:

What is a California health insurance premium? That’s the regularly scheduled fee you pay a company like California Blue Cross health insurance plan. Paying the premium keeps the policy in force and working on your behalf. Having trouble paying the premium? Contact your Vitality Health Insurance professional immediately. We’re here to help you understand what your available options are in times of financial hardship.

How does a health insurance deductible work? This is the amount the policyholder agrees to pay for covered services in a given time period (benefit year) per their California health insurance plan before the insurance company will be required to start contributing to the cost of the policyholder’s medical expenses. Example: The policyholder must pay $1500 annually for the cost of covered services. After $1500 the insurance company will pay 80% and the policyholder will pay 20% for covered services.

What is a co-payment? This fee is the policyholder’s share of the fee for healthcare services rendered under the terms of their California health insurance. Generally a flat fee. For example, in an HMO, a visit to the doctor would generate a co-pay of $20. A co-pay might also be utilized by a PPO. A co-payment is sometimes used interchangeably with the term coinsurance. Actually, coinsurance would be a more appropriate term for the higher cost sharing mentioned above where the policyholder’s obligation was 20% of the cost of covered services.

What are out-of-pocket costs? Simply put any money you as the California health insurance policyholder need to spend to secure medical services. Deductible, coinsurance: Each an example of your out-of-pocket costs.

Okay: We’re almost there. You’ve reviewed the types of affordable California health insurance plan types that are right for you based on medical and financial concerns, and now there’s just one more thing we should look at before we move on to the next step in the process of buying affordable California health insurance: Determining what the insurance company’s rights are related to their ability to cancel or renew your health insurance policy at some future date.

You’ll want to know if your choice for affordable California health insurance is noncancellable, guaranteed renewable, or perhaps conditionally renewable:

Noncancellable: The best for obvious reasons. It’s noncancellable by the insurer. They aren’t happy with how much you’re using your plan? They aren’t happy with the costs incurred by your use of the plan they sold you? Tough luck on them. Your policy will continue to be in force for the period of time specified in the contract.

Guaranteed renewable:  While you won’t be subject to cancellation the insurer is within its rights to raise the premium for the California health insurance plan you have. However, don’t take it personally: The insurer can raise rates but only for an entire “class” of policyholders such as those in a given geographical area.

Conditionally renewable: Again – not to be taken personally: The insurance company can cancel your policy but needs to cancel an entire class of policyholders along with your individual California health insurance policy. While that might not be a piece of business the company wants to walk away from , you still have greater exposure than had you been in a guaranteed renewable or noncancellable policy. 

When the insurance company cancels your policy they are exercising their rescission rights.. You have those too: Otherwise known as your free look period, you can pay your first premium, receive your policy and carefully review it. If – within 10 days – you are not satisfied with what you’re seeing in the policy, you can return the policy and get your premium back and walk away.

We want to be crystal clear about this: When you are applying for a California health insurance individual policy, you will be asked questions pertaining to your medical history. Conditions, treatments, physical, mental, a full spectrum of questions that are geared to helping the insurance company understand what type of risk you represent to them as a client. Insurance underwriting is all about risk: Understanding the magnitude of that potential client’s risk to the company who will be contracting with them to insure them. That’s right; we said contract and the answers you give on your application are called representations. In insurance and a court of law, these representations are expected to be true and accurate to the best of your knowledge and belief. 

Submitting an application for California health insurance which contains falsehoods or misinformation opens an applicant up to having that policy cancelled by the insurer at a later date. That is called rescission and an insurance company can do that if they uncover inaccuracies in your application (Typically within two years of the policy activation date.).

Please – please! – help us help you avoid any future financial and emotional misery by being up front and honest in your representations to us and the insurance company you choose for your California health insurance. While a higher premium might result, your peace of mind knowing that a policy rescission isn’t lurking in your future – when  you could least afford it financially or health-wise is – to us – priceless.

California Prescription Drug Plan

Part of the process of selecting an affordable California health insurance plan that’s right for you and your family is the careful review of the options available in the area of the prescription drug plan that will be part and parcel of your new California health insurance plan. Just like with the other elements of your health care plan strategy there’s variety to be found here too: Can you work with a plan that offers just a generic prescription drug option? Do you want the flexibility that comes with the availability of both generic prescription drugs and brand prescription drugs? Do you have no other choice but to seek out the most affordable brand prescription drug plan as part of your overall California health insurance plan strategy? 

Let’s say you are currently taking Lipitor to combat high cholesterol. This prescription drug is working great for you; your cholesterol counts are significantly lower; you and your doctor are happy! Lipitor is a brand name prescription drug and it’ll be years before this particular drug will be available as a generic. Your first choice is – obviously – to stay on the Lipitor and maintain your vigilance regarding your high cholesterol which we now know can lead to serious medical complications down the road. Moving forward, that is going to require that you stay with a prescription drug offering brand name drugs as part of your overall California health insurance planning. You can rely on your Vitality professional to help you work through a strategy that takes issues like this into consideration as you work together to craft a viable solution that matches medical necessity with practical household budget reality.  And we do this planning with you for a cost your budget will love: Free! Our careful, considerate consultation with you and your family is free of charge – all the time. The insurance carrier pays for our services to you. That’s how it works at Vitality Health Insurance Services!

This part of your healthcare strategy could require a review of the insurance company’s formulary. A drug formulary is a list of drugs that the insurance company will pay for. If your drug isn’t on the formulary list you might have to pay a higher co-pay or you might have to foot the entire bill for that drug. The formulary contains a range of both brand name prescription drugs and generic drugs that your physician can choose from when prescribing medicine that will treat both a short term illness (An ailment of a viral nature.) and as part of a long term drug treatment strategy designed to help you deal with health issues that affect quality of life at some later point in time (Think Lipitor for high cholesterol.).

Invariably a California prescription drug plan involves some type of copayment or coinsurance element: Pick up a generic drug, pay $5. Pick up a brand name, pay $25. Your plan also might feature some element of the PPO aspect wherein the supplier agrees to be part of the insurer’s network and you might pay a reduced fee for the drug but then have a coinsurance obligation that says you’ll pay 20 percent of that reduced fee. Today, more plans even feature deductibles which need to be met before coverage for your prescription drug purchases will begin.

In your review of California health insurance plans and the prescription drug component of those plans, you will likely run across these terms which we are of course here to help you sort through as you find the California medical insurance plan that is right for you:

• Brand name drug: A drug that is offered while still under its original patent protection from the company that developed it and/or markets it.
• Generic drugs: These are drugs which have the same active ingredients and provide the same clinical benefits of their brand name counterparts and can be made and marketed to the public after the patent protection for the brand name version has expired.
• Generic substitution: A practice (fairly commonplace now) of filling a drug prescription with the generic version where it is available, permitted by law to do so, and where the attending physician has not mandated in the prescription that it be filled “as written”.
• Drug tiers: A methodology used by insurance companies to more accurately define coinsurance or copayment rates for the drugs it will pay for in their plans: For instance: Tier 1 (Generic drugs); Tier 2 (Preferred brand drugs); Tier 3 (Non-preferred brand drugs); Tier 4 (Specialty drugs):
  • Tier 1 – FDA approved generic drugs. Features lowest copayment
  • Tier 2 – Brand name drugs that will meet the health needs of most patients for which they are prescribed. Next to lowest copayment
  • Tier 3 – These are brand name drugs which do not have generic alternatives but do have therapeutic alternatives within the Tier 2 group. Would not typically be used as a first line drug regimen. Higher copayment.
  • Tier 4 – Speciality, high cost medications typically prescribed and/or administered by a specialist and closely monitored for potential side effects. The highest copayment applies here.

We all know the drill when it comes to prescription drugs: They are expensive. It’s that simple. Prescription drugs in this country are expensive and getting more expensive with each passing day. This is not an area where you should “consider the odds” and see if you can sneak by without. One episode of illness – minor though it may be - can generate enough prescription drug fees to offset any possible savings you were enjoying by not having a viable prescription drug plan through your California medical insurance provider. Please allow the professionals at Vitality Health Insurance to help you review your options for this very important element of your healthcare strategy. If this is a situation of “pay now or pay later” the client who pays later always wishes they had paid less, sooner for their California prescription drug plan.

California Dental Insurance

California Dental Insurance – Dental coverage as part of your California health insurance strategy features some of the same elements you’ve seen in the California medical plans we’ve been discussing: The use of managed care via PPO and/or HMO networks. California dental insurance plans offered through insurance companies will typically rely on the creation of networks that offer discounted services by dental service providers who have contracted with that network to provide services at discounted rates. Features of California dental insurance plans include an annual deductible (typically small), coinsurance, and while annual benefits in plans such as these aren’t  typically very high (Say $1000-$2000) they are very helpful in providing good coverage that can be readily used for preventative care such as exams, cleanings, X-rays, and the like. Keeping out in front of dental problems before they occur can be a great cost saver to you in the years ahead so these plans do serve an important function as part of a dental “wellness” strategy for you and your family.

Dental insurance in California can also introduce another element of the medical plans we’ve discussed earlier: The use of the usual, customary and reasonable fees (UCR) in indemnity plans. The UCR feature basically says that if the dentist puts in a filling, the insurance company will pay that dentist based on what is usual, customary, and reasonable for dentists who are performing that same procedure in that general area. In other words: That dentist is not going to get $120 for that filling when all the other dentists charge $80 in that zip code.  If you use that dentist you will be responsible for picking up the difference between the UCR and the dentist’s fee. Two last comments: Some California dental insurance plans do offer partial coverage (50%) for such major dental services as root canal, crowns, extractions, and so forth…but these policies also can come with waiting periods upwards of 6 months on up to 12 months. That’s a long time to wait should you need a major dental service like a root canal or a wisdom tooth extraction. We suggest: Get the California dental insurance plan before you need it. And please: Use the coverage you have to take good care of your teeth with regularly scheduled checkups and cleanings! Vitality wants you to keep your healthy smile!

Vitality is your trusted resource for California health and dental insurance!