California Children's Health Insurance

People who have children need to find low-cost children's health insurance in California, and they need to have their own coverage as well. Luckily, there are many types of affordable children's health insurance in California for parents to choose from. And at the same time that they insure their children, they can insure themselves.

When recommending a children's health plan I always show plans that do not include maternity.  This immediately reduces the premium by 30-40%.  Another suggestion to lower premium would be to consider a plan with generic only prescriptions. One of the nicest features about many of the plans is that there is no enrollment fee for most parents to get California low-cost children's health insurance for their kids. The services that are usually covered at very low costs include outpatient, inpatient, emergency, prescription and other services. There is really no excuse for not having affordable children's health insurance in California.

Parents generally have three types of low-cost children's health insurance in California and throughout the United States to choose from, as well, including basis, standard and specialized plans. Most California low-cost children's health insurance is either a health maintenance organization (HMOs), preferred provider organization (PPOs) or pay-for-service plan. It's important for everyone to have insurance, but insuring their children is even more important.

Note sure which plan to choose?  Here are a few suggestions.

I personally chose the Blue Cross PPO Tonik plans for my (2) children.

The Blue Cross Tonik 1500 (branded as Calculated Risk Taker) has the lowest out of pocket exposure from any PPO plan from any and all carriers in California that includes unlimited doctor visits.  Most of the new "basic" plans today limited office visits to three or four per year.  For children, this may not be enough?  In summary, if you have any hospital, surgery or catastrophic event the most you could ever pay is $1500.  Once the deductible is met there is NO co-insurance.  The plans pay 100% for the rest of the calendar year.  There is a $40 co-pay (unlimited) for office visits and $10 generic prescriptions.   Plus, the plan includes basic dental and vision! The plan does not include maternity and brand prescription benefits.  Blue Cross Tonik is a great plan for about $125 per month.  Because Blue Cross Tonik has the best benefits from all plans offered in California the plan has the toughest underwriting guidelines to qualify.  If your child has had medical claims within 12 months or has pre-existing conditions please call me at 877-840-0554 so we can review and discuss if Tonik is right for him/her.

There are also "No Deductible" PPO plans to choose from?

These plans are good in that they provide unlimited office visits (co-pays range from $25-$50) and include first dollar benefit or "no deductible".  The carrier will pay (depending on which plan you choose) anywhere from 50% to 70% of any claim with no deductible to satisfy.  The risk to these plans is that the out of pocket maximum is typically $7,500.   For example, if you received a bill for $10,000 and were on a 60/40% plan the carrier would pay $6,000 and you would owe the difference of $4,000.  However, you are still exposed to more potential payments (out of pocket expense) until you reach $7,500.  At that point the carrier pays 100%.  These plans typically range in price from $70-$110 per month.   Thus, although the Blue Cross Tonik plan has a deductible and you are paying the first $1500 of bills you are covered 100% from that point forward.

Can my child be declined for health insurance or can they increase the price based on his/her pre-existing conditions?

Yes, like all California Individual Health Insurance you must pass through underwriting.  You can also receive a rate-up or "risk adjustment factor" called a RAF.  This means that the carrier has approved the policy and inserted higher price based on medical records and risk.  Most RAF range from 20%-50%-depending on each carrier's guidelines.

How long do I have to keep the plan and can I change plans over time?

California Health Insurance is month-month.  You can cancel at anytime.  You can upgrade your plan at any time as long as you are not upgrading for medical reasons.  The carrier will review your medical records.  You can downgrade at anytime-much easier.

For free help navigating Children's Health Insurance and to get a quote
to help you select which Children's Health Insurance plan is best for you [ click here ].

 

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