A Quick Introduction To California Health Insurance And Pre-existing Conditions, Waiting Periods, And Exclusions

This is just an overview in layman 's terms. It 's important to look at a carrier 's policies and restrictions regarding pre-existing conditions, waiting periods and exclusions as they can differ from company to company.

The official definition reads as follows: First...what is a pre-existing condition.

Pre-existing Condition

Any illness or health condition for which you have received medical advice or treatment during the six months prior to obtaining health insurance. Group healthcare policies cover pre-existing conditions after you have been insured for six months, and individual policies cover pre-existing conditions after you have been insured for one year. Reference CIC Section 10198.7. Creditable coverage must be counted towards any pre-existing condition exclusion in either an individual or group policy.

Essentially, it is a medical condition, illness, or injury for which you just had treatment, are undergoing treatment, or have had treatment in the past. The context in which an insurance company will look at pre-existing conditions strongly depends on the type of insurance.

Individual and Family California health insurance.

This type of coverage is medically underwritten which means that you need to qualify based on health. Pre-existing conditions have the most impact here and it affects coverage in two ways.

First, you must qualify for coverage based on health so a carrier can increase your rates or decline/defer coverage altogether based on your pre-existing conditions. They typically have underwriting guidelines specifying how they may look at particular issues. Ultimately, the underwriter (person who decides to approve or decline health coverage) makes the final decision based on information found in the health application or medical records (if requested).

For some issues, the health insurance carrier may want a certain amount of time away from a give situation before offering coverage. A general rule of thumb is 6 months to one year for a more simple situation (simple broken bone, infection, etc). Some issues are deemed uninsurable for which they will not offer coverage ever.

If you are unable to qualify for individual - family health insurance in California, you can find options for the uninsured through the State such as MRMIP.

The second way pre-existing conditions can affect coverage for Individual Family California health insurance is after approval. If approved for coverage, there can be a waiting period for treatment (payment of) pre-existing conditions of up to 6 months if you did not have prior coverage or lapsed coverage for more than 62 days. Essentially, they will take into account time on a prior qualified plan (may be individual, small group, short term) towards a six month waiting period for pre-existing conditions.

Tier increase with Individual and Family coverage.

If a carrier does not decline coverage based on pre-existing conditions, they can increase rates. Tier 1 is the best rate and you can find this rate when you quote individual California health insurance. Tier 2 is typically 25% higher than this standard rate. Tier 3 is typically 50% higher and Tier 4 is typically 100% higher. Some carriers apply different increases. For example, Blue Shield of California has a Tier 5 which is much higher. This tier increase is not locked in stone and you may be able to have it removed or lowered in the future once time has passed from a given situation (assuming you are in otherwise, good health). We recommend submitting the required change of coverage form every 3-4 months until this tier increase can be increased.

California Small group health insurance and Pre-existing conditions.

Pre-existing conditions are treated differently for Small Group in some important ways. HMO 's are typically not subject to waiting periods for pre-existing conditions. Maternity in California is typically not subject to waiting periods for either HMO or PPO plans. Otherwise, the six month waiting period is the same as individual plans. Always submit all claims through the carrier regardless and let them make the decision on waiting periods.

Small Groups do not have tiers but by law, a carrier can go up or down 10% from the standard (Request Small Group California quote at www.calhealth.net) rate based on the health of the group. This is called the RAF (Risk Adjustment Factor). A 1.0 RAF is the standard rate. 1.1 would be 10% higher and .90 would be 10% lower. The larger your group, the more likely you will have a lower RAF. Some carriers automatically give small groups the extra 10% increase as there are fewer people to spread the risk among.

Exclusions of certain conditions

A plan 's summary and explanation of benefits will list their standard exclusions. maternity, brand name drugs) by design. Some plans will exclude certain coverages (i.e.

Keep in mind that this exclusion is only dealing with a specific person 's pre-existing condition. The downside is that a person might be unable to qualify for coverage altogether which defeats the purpose of banning exclusions to begin with...The law of unintended consequences. On one hand, a new enrollee does not need to worry about a condition re-occuring and having coverage declined during a period of time. This is a mixed blessing. California law prevents carriers from excluding conditions a specific applicant may have (if a covered benefit) upon approval as other states allow.

It 's important to look at a carrier 's policies and restrictions regarding pre-existing conditions, waiting periods and exclusions as they can differ from company to company.

The Basics Of Term Life Insurance

Or, would it be more likely that you or your spouse?s loss would financially devastate your family? If you stop and think about all the time, effort and energy you have put into creating your family?s assets and your family itself, can you say that you have accumulated enough financial resources that your family would be secure upon your death or the death of your spouse?

Generally, term life insurance policy could also enable your spouse to pay off any of your existing credit card or other miscellaneous debts as all of those are passed down to your survivors.

Additionally, if you have children or if your spouse does not work, term life insurance can protect your family 's finances by providing money for college and living expenses if you die before your children are fully-grown. Your survivors can maintain their lifestyle, as they currently know it. To be sure, buying term life insurance gives your family peace of mind knowing they would be financially protected should the unthinkable occur.

Figuring out the Length of Term You Should Purchase

When determining what kind of term life policy you should buy, ask yourself the following questions:

1. What is your income? The rule of thumb is to buy 10 times your annual salary.

2. What are your short-term debts? Credit cards, car payments?

3. What are your long-term debts or financial obligations? For example, do you need money for future college educations?

4. What is the remainder of your mortgage?

The answers to these questions will help you determine how long a term to buy. Whether you buy a 10, 20, or 30-year policy is determined by your total debts, financial needs, and the needs of your dependents. If your children are almost financially independent, then you can purchase a shorter term -- unless, of course, your spouse might need more financial support or if there are other relatives who depend on you for money. You can also buy term life insurance that covers you until you reach a certain age, usually 65 or 70. Just keep in mind that term life insurance policies expire at a set time and premiums usually increase upon renewal.

Review Annually

It is important to review your policies annually. Many aspects of our lives change thus affecting what kind of insurance we may need. Life changing events occur that would definitely change what kind of term life coverage we may need. Perhaps a birth of a new child may prompt you to increase your term coverage from 20 to 30 years. Perhaps a divorce will prompt you to scale back on your coverage.

Do you want to leave money to charity or any heirs? Did you start a new business in the past year that would need to be protected financially upon your death? Aside from life changing events, you may also review your policy for any other financial protection you may need.

You want to maintain proper coverage without wasting money on too much policy for your family?s needs. All of these things should be considered each year, as our lives are never consistent.

Investment Strategies

How you invest now may be the difference between a comfortable retirement, and working for the rest of their life, and we have put together a list of do?s and don?ts to secure a comfortable retirement. Investment strategies for the long term are a vital to our future.

Tip #1 Educate yourself

There are people out there who play the stock market like they play the lottery. This is very dangerous, gambling on the stock market is the equivalent of going to Las Vegas and putting your life savings on the line. With any investment that is going to provide a decent return, there is risk. How much risk you take on with any investment directly affects the return. The general rule of thumb is, the higher the risk, the higher the return on your investment, and likewise, the lower the risk, the lower your return. The risk of investing into just a savings account has been explained. While investing in stock is riskier, educating yourself can reduce the amount of risk you take on. This includes finding out what common terms are and what they mean. Understanding the financial statements of the company you want to invest in, and understanding the market that you are investing in.

Tip #2 Devise a plan

This step is just as important as the first, having the education is useless without having some kind of direction. Decide where you want to be by the time you retire, where you want to be when you hit fifty. Evaluate where you are now and what you want to accomplish in the next year, you can never plan too much. You will also need to decide what kind of retirement you want to have. Do you want to maintain the quality of life you have now? Do you want to retire rich? Filthy rich? Or do you want enough to just get you by every month? Realize what you want to do and devise a plan.

Tip # 3 Investing is vital to your retirement

This cannot be stressed enough. It used to be that you worked for a company for 30 years until you retire, you get your office party and the faux gold watch, but you had a pension and social security waiting for you afterwards. Nowadays you have companies cooking the accounting books, and executives being the only ones with guaranteed pensions, and CEO?s abandoning their companies leaving their employees with nothing while they take their guaranteed multi-million dollar pensions home. What does this mean? It means that the person with your best interest is you. Nothing is guaranteed any more, not even social security. Corporations are replacing pensions with 401k plans, in essence they are shifting the responsibility for your retirement from them to you. It is up to you to decide whether you want to invest in your future. Realize that if you decide not to invest at all, you are throwing you future away.

Tip # 4 Research Research Research

There are so many reasons that you need to research whatever investment vehicle you choose. Whether its real estate, stock, whatever, you should never invest off of an assumption. Most investors refer to this as due diligence. First and foremost, never invest off of a ?tip.? There is always someone out there that knows what the next big investment is. They?ll tell you to buy some shares of so and so stock because they are guaranteed to give you phenomenal returns. While the advice may have some truth, it is best to do a little research first before putting any money into it. When doing research, it helps to understand financial statements. In general, if a company has more costs than it does revenue, this means the company is not turning a profit. In 2000, Amazon.com (NASDAQ: AMZN) was selling its shares at $113.00 per share, all while never having turned a real profit since the company started. Today Amazon?s stock can be bought for $45 a share. Imagine if someone invested their entire life savings into Amazon?s stock at this time, they would have less than half of what they saved left. This is the reason for the most recent stock market crash, investors were buying shares from companies that could not show a profit. Companies were having lavish office parties every week because their stock was flying through the roof, all while their product sales could not fund these expenses. Another reason for the recent stock market crash is because a lot of investors invest with emotion rather than knowledge. Over the holidays investors feared another terrorist attack, so they sold shares fearing another attack would drive the stock market back down. The emotion was fear. And that fear is detrimental to the stock market. If enough investors get scared and begin to sell their shares, the market will surely drop. If more investors are buying than selling, the stock market will rise.

Tip # 5 Inflation

If it would take $2 million to retire today, find out what $2 million will be by the time you retire, otherwise you will be selling yourself short. A good example of inflation, is how a million dollars today, isn?t what it was 20 years ago, and it wont be what it is 20 years for now. In other words, as time goes on, prices rise. The Webster?s dictionary defines inflation as: an increase in the volume of money and credit relative to available goods and services resulting in a continuing rise in the general price level.

It is important to know that as it pertains to your future, inflation is not good. The final tip is also a part of research, understanding inflation.