Paul Zane Pilzer

  

  




State-by-State Guide to       

Individual/Family Health Insurance

 
California Department of Insurance
Consumer Communications Bureau
(213) 897-8921
 www.insurance.ca.gov/
Guaranteed Issue   
Community Rated   

CA



 

Average Cost for an Individual Policy Sold in 2004: $140/month*
(single, average age 32, healthy)
*From 82,000 policies sold nationally online in 2004, see first page of Appendix A.

Typical Healthy Individual/Family Coverage
 

Traditional Co-Pay
Policy*

HSA/High-Deductible
Policy*
  Single Family Single Family
Monthly Premium $204 $617 $97 $294
Annual Deductible $1,500 $3,000 $2,400 $4,800
Annual Out-of-Pocket Max $4,500 $9,000 $3,200 $5,800
Doctor Visit Co-Pay $40 $40 -- --
Prescription Co-Pay $7-60 + $250 brandname ded $7-60 + $250 brandname ded -- --
Lifetime Maximum $6 million $6 million $6 million $6 million
*Blue Shield of CA Shield Spectrum PPO Plan 1500; single applicant (M/35); family applicant (M/35), spouse (F/35), children (F/8, M/5) from Sacramento, CA 95814; quoted 4.25.05.
Blue Shield of CA Shield Spectrum PPO Savings Plan 2400 (single) 4800 (family); single applicant (M/35); family applicant (M/35), spouse (F/35), children (F/8, M/5); quoted 4.29.05.

State-Guaranteed Coverage for
People with Preexisting Conditions

California Major Risk Medical Insurance Program (MRMIP)*
Monthly Premium Annual Deductible Annual OOP Max Doctor Visit Co-Pay Prescription Co-Pay Lifetime Maximum
$356 $0 $2,500 $25 20% $1.5 million

*The Blue Cross Plan for MRMIP; applicant (M/35) from Sacramento, California, based on quote from Leslie at Major Risk Enrollment Unit at 800.289.6574.

Eligibility: (1) California resident, (2) ineligible for COBRA/CalCOBRA, and (3) denied coverage within the past 12 months with rejection letter from insurance carrier, involuntarily terminated from coverage for reasons other than fraud, or offered coverage with premium higher than MRMIP, or (4) federally eligible.

HIPAA-eligible individuals: State requires mandatory acceptance by all individual insurance carriers without exclusions for preexisting conditions. Each company independently determines the monthly premium.

Excerpted from The New Health Insurance Solution

 
 
  ADDITIONAL RESOURCES FOR THE NEW HEALTH INSURANCE SOLUTION
   



New Health Insurance Solutions for individuals, families, self-employeds, and businesses.

  



View the basic chapter table, expanded topical table, and pdf table of contents.

  



View the html or download a pdf version of the October 2005 press release.

    



Read excerpts on each topic discussed in The New Health Insurance Solution.



Read full reviews of The New Health Insurance Solution by Newsweek, The Wall Street Journal, Forbes, etc.



Read selected portion of reviews by Newsweek, CNN, The Wall Street Journal, Forbes, etc.
   



Read endorsements of The New Health Insurance Solution.

  



View other books written by New York Times best-selling author Paul Zane Pilzer.

  



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