An increasing number of our young people are suffering from a multitude of ailments that result from the modern environmental pressures like lack of exercise, lifestyles or stress. The medical profession has also progressed some and is usually able to address most of these resultant disorders. However, for people in the low-income brackets, the steady rise in health insurance expenses means that they are now finding it difficult to get medical help on time.

For most people medical health insurance seems to be unaffordable. Health insurance is there to offer succor for the unexpected medical problem. There is a dearth of health insurance service providers in California resulting in a very competitive market.

The laws in California require that every person has access to some medical cover. The state provides health insurance programs for people in low-income brackets to afford insurance.

Low income individuals in California can use the services of the Medicaid program. The federal government set up this program to permit as many people as possible to be able to some form of insurance cover. The funding for this program comes from the federal and state funds.

Individuals get the application forms from an office in the Division of Family services. Some form of documentation is required of each applicant to be able to qualify for the program.

The individual and their family have their various health needs catered for. For the individuals whose employees to not cover the rest of the family, the Medicaid program provides a feasible option for them.

The MRMIB (California Managed Risk Medical Insurance Board takes pains to provide a quality health insurance that is also affordable. For low-income groups, through their HFP (Healthy Family Program), MRMIB cover for vision, dental and health, at fairly inexpensive rates for children.

Another MRMIB program, AIM (Access for Infants and Mothers) provides low cost insurance to pregnant women in low income groups. The infants also get cover under the program.

Before picking health insurance service provider, take some time to research the options available that suit your needs and your budget.

 



By: Jack Adams

Health insurance rates in Florida are some of the highest in the nation. Here’s how to find the cheapest Florida health insurance quotes from top-rated companies.

Florida Health Insurance Plans

There are two types of health insurance plans:

* Indemnity plan – This plan lets you choose your physicians and pays for for all or part of your medical expenses. This is the most expensive health insurance plan.

* Managed care plans (HMOs, PPOs, POSs) – These plans set you up with a network of health care providers and hospitals, and pay for medical expenses within that network. Depending on the plan, you pay all or part of your out-of-network expenses. These plans are the least expensive health insurance plans, with HMOs being the cheapest.

Health Insurance Coverage

Whatever plan you choose it should include the following coverages:

* Hospital coverage – Pays for your room, board, and medical services when you’re hospitalized.

* Surgical coverage – Pays for surgeons fees and other surgical expenses.

* Physicians coverage – Pays for your physician’s office visits and your physician’s hospital visits.

* Major Medical coverage – Pays for medical expenses from a catastrophic injury or illness like cancer.

In addition to the above coverages you may want your plan to include prescription drug coverage, dental care, vision care, mental health care, and maternity care.

Compare Rates

The best way to get the least expensive health insurance quote is to comparison shop. There are a number of online sites that let you compare quotes from different companies so you can choose the best quote and the best plan for your particular situation. If you have questions about health insurance plans some of these sites even have a chat feature that lets you talk with an insurance expert online. (See link below.)

Visit http://www.LowerRateQuotes.com/health-insurance.html or click on the following link to get Florida health insurance quotes from top-rated companies in your area and see how much you can save. You can get more health insurance tips by checking out their “Articles” section.



By: ryan@thesatellitetvguide.com

Some people opt for a small family, but some people love big size family. Having a lot of children around us is a very cheerful moment even in our worse time ever. It could be natural healing power to problems sometime. However it may also invite more risk to your family if it is not properly organize, especially for our beloved wife.

Pregnancy is a very happy moment for a woman. But have you ever thinking that being pregnant and gave birth is a hard thing to do? Especially when you have no insurance in maternity? When you gave birth, you put your life in the line, and you need to make sure that you guarantee your own save and your children to be. But how could you do that? You can apply for special health insurance coverage for the maternity woman. This article will tell you the details about maternity health insurance coverage.

The information about maternity insurance presented here will do one of two things: either it will reinforce what you know about insurance or it will teach you something new. Both are good outcomes.

Maternity card is a card that designed to providing the best help for maternity woman. This provides you much less cost from the regular one with a wide covers of maternity medical needs. To find out where you can apply for this maternity card, you can do some search on google about the policies and do some research for each companies that you choose. Each company will offer you different health insurance coverage or the maternity woman. They even offer the different price for this health insurance coverage.

It’s really a good idea to probe a little deeper into the subject of Maternity coverage. What you learn may give you the confidence you need to venture into new lifestyle.

There are so many health insurance companies that provide the maternity coverage for their customer. You may need to wait for three months to one year before your clause become effective and ready to use. What happens when you get pregnant when you still waiting for the clause being active? One alternative that you can choose is checking your COBRA if you have one. COBRA is an extended coverage from your previous employer. While you’re checking whether the maternity covered in that COBRA or not, you should know that it will be costly for you.

Do you know that thirteen percent of American pregnant women don’t have any health insurance coverage for maternity? Will you be one of them? Having the health insurance coverage for maternity at least could minimize the financial burden of having a child. You don’t have to face the risk for paying the high cost for your maternity care because the health insurance coverage for maternity already covers it for you. Before you accepting any health insurance coverage plan for maternity, it’s better for you to study it with your financial planner.

There’s a lot to understand about insurance. We were able to provide you with some of the facts above, but there is still plenty more to write about in subsequent articles.



By: Yazed Jamal

The medical world has for decades seen the importance of good nutrition during the various stages of pregnancy that a woman goes through. It has found that pregnancy places huge demands on the body as the unborn baby goes through huge spurts of growth in the first nine months of its development in the womb.

Studies have shown that the pregnant mother needs more than adequate amounts of nutrients during this stage and even if the amounts of vitamins and trace elements were missing in lesser dosages it would seriously impact on the baby’s development. Studies have shown that small deficiencies of one nutrient such as omega 3, iron or vitamin B6 may affect the baby’s brain development seriously.

Pregnancy and vitamin supplements:

The major growth burst start in the second and sixth week of conception where we see huge development of the baby’s new organ system and the heart starts to beat at around the 4th week.

For this to take place we see a huge growth in the cellular system of the new baby’s body and there is a massive demand for the proper nutrients in the form of vitamins, minerals and trace elements to be at hand to help with the building blocks needed for proper development.

For the cellular growth to take place the baby’ s cells need adequate amounts of nutrition in the form of vitamins and minerals in the right ratios and balances for optimum growth to take place. During pregnancy and the lactating months following the pregnancy the young mother has huge demands placed on her body by the baby she is caring and her body is depleted of vital nutrients by this so called loving “parasite that has invaded her body.”

It is prudent that the young mother to be looks after her nutrition as she is not only responsible for her health but that of the child she is carrying. Most prenatal vitamins for pregnant mothers seem to be inadequate with the amounts of vitamins, minerals and essential fatty acids they seem to have.

Young mothers to be must consult their physicians about what vitamins are safe for them. Unfortunately most physicians do not have a good in-depth knowledge of what is adequate and safe to take on the market.

This is not their fault as nutrition does not play a huge part in the medical world. And this is unfortunate as studies are coming out that proves that nutrition is vital for cellular growth of the human body and we just cannot get the right amounts needed from our foods.

The importance of pre-pregnancy vitamins:

Women who are considering getting pregnant should start taking omega 3 fatty acids way before pregnancy to help the future development of the child they will carry to have proper brain development during pregnancy.

This is important as the nervous system starts to develop immediately after conception and way before the woman even knows if she is pregnant.

Important vitamins such as omega 3 and folic acid has a positive effect on your health and that of the baby during pregnancy. By taking proper nutrition way before pregnancy you can almost guarantee that your pregnancy will have the proper nutrition for your baby’s growth. It is like you are taking an insurance policy out for your future family.

Keep in mind that the brain development takes place well past birth and so you should be taking omega 3 fatty acids during the lactating months to ensure your baby is properly nutrient.

Supplementing with folic acid during pregnancy helps to reduce neural tube defects by 50%. In order to protect the baby from such defects you should consider daily supplementation with folic acid way before the pregnancy.

Too much vitamin A acetate may lead to birth defects. Take a multivitamins that is free from vitamin A but rather has beat-carotene which the body can break down to vitamin A as and when it needs it. It is the safer alternative.

Optimal nutrition helps to give you and your baby years of good health and happiness



By: Claude Fullinfaw

Anthem Blue Cross of California and Anthem Blue Cross and Blue Shield Colorado, Connecticut Tonik, Georgia, Nevada and New Hampshire all offer coverage for active Americans who need health insurance but hate paperwork and jargon. The Tonik health plans feature:

1) Easily understood benefits – including medical, dental, and vision

2) 10-minute Online applications

3) Affordable pricing 

Take one look at Anthem Tonik or call 1-877-MY-TONIK and you’ll see that it’s an awesome health insurance plan.

  TonikHealthInsurance.com offers a choice of three Individual PPO plans. The health  insurance application is online and only takes about 15 minutes. In most cases, applicants  receive an immediate decision. For 19-29 year olds, rates can be around $100 a month,

That includes Medical, Dental, and Vision.

Blue Cross Tonik Health Insurance plans provide coverage for the everyday, preventive like checkups and the more serious encounters – broken bones, head injuries, cancer, etc. Almost everything except Blue Cross Tonik Health Insurance plans do not provide maternity coverage.

Other Covered benefits

Doctor visits — Blue Cross Tonik Health Insurance members pay $20, $30 or $40 to see a doctor, depending on the plan

Generic prescription drugs — only a $10 copay

Emergency room care – hospitalization, surgery, physical therapy, etc.

Dentist appointments – Two cleanings, x-rays, exams, every year!

Eye exams, glasses or contacts

Tonik Health insurance has three easy deductibles and zero in network co-insurance. The deductibles for Tonik are 5000, 3000, and 1500. Annual Deductible is the amount you would have to pay before Tonik starts paying. The deductible is waived in certain cases, such as doctors visits. 

Tonik offers PPO Coverage. This means you get to choose any doctor in your area that takes Anthem Blue Cross Blue Shield.

Visit Tonik Health Insurance for more information on Tonik Health Insurance.



By: Bill James

Families do not have to worry if a disaster hits if all of the family insurance needs have been met. If some insurance is in place, a family might worry only about the portion of the insurance triangle that is still in the research phase because that particular area is exposed to losses that a family might not have imagined was possible. Family insurance needs will often include health care insurance but some renters might fail to consider renter’s insurance.

An insurance agent will be able to discuss all possible insurance needs that a family will need over a lifetime. Some families are able to obtain healthcare insurance from the place where they work, but there are other healthcare policies that can be purchased to ensure that leftover expenses not covered by one policy can be absorbed by another. Large families usually need this type of insurance when there are several children at home, and some modifications to those policies might be needed along the way.

Families that have teenage children at home that are female, would hate to think that teenage pregnancy could occur. Families that elect to include maternity insurance coverage for all family members will be glad they did if this situation occurs. The maternity clauses that are placed in the insurance policies designed for families could end up saving the family money that was reserved for the child to attend college. Insurance policies are for protecting families in all sorts of situations.

Family insurance policies will always include a homeowner’s policy so that families can comply with home mortgage loan lending requirements. Should losses occur to the home at any time, homeowners will have a financial resource to turn to so that repairs can be made after the incident to any portion of the home. Since monies received in the settlement of insurance claims can be used for any need, some homeowners might choose to use the money to do some home remodeling projects.

The insurance policies for the home will also protect homeowners from any liability for accidents that occur on the property and for damage that occurred from items that damaged a neighbor’s property. This type of insurance coverage insures that people can live in peace knowing that every item in a difficult situation was handled in a professional manner. Insurance agents can review homeowner’s needs and adjust policies as time goes by because family needs can change often over a period and some homeowner’s can save money by making little changes to insurance policies.

Everyone that lives under one roof will be protected under a families insurance policies and some family make certain of this by selecting balloon coverage for the insurance needs they have. Homeowners will select this type of coverage to ensure adequate monies are allotted in case lawsuits are filed for any reason, and to protect all of the family insurance needs that other policies cover. Many people will select life insurance coverage to complete a part of the insurance needs triangle, and others will only ask an agent for an insurance policies that covers automobiles driven by various family members.



By: Jim Brown

As a starting point one thing should be made very clear: You cannot be discriminated against for being pregnant! You cannot be fired. You cannot be refused employment. You cannot be demoted. You cannot be docked pay.

Unfortunately, it seems to be a fairly common occurrence that once a woman becomes pregnant her formerly nice and reasonable employer treats her differently. Treating a woman differently – unless it’s to say how awesome it is that she’s pregnant – is likely to be illegal.

In 1978, Congress enacted the Pregnancy Discrimination Act (PDA) as an amendment to Title VII of the Civil Rights Act of 1964. In doing so Congress made clear that women were not to be punished for becoming mothers.

The PDA prohibits discrimination in areas and ways, including*:

*    Hiring/Firing: An employer cannot refuse to hire a woman because of her pregnancy or a related condition and cannot fire a woman for those things either.

*    Pregnancy & Maternity Leave: An employer: cannot single out pregnant women for special procedures to determine

her ability to work; must hold open the job while she is on pregnancy leave; must treat

her the same as any temporarily disabled worker if she is unable to perform her duties

for a short time; must allow her to work if she is able. 

*    Health Insurance: Employer provided health insurance must cover pregnancy and pregnancy-related

conditions on the same basis as other medical issues. 

*    Fringe Benefits: Benefits cannot be given only to married couples. Benefits cannot be provided differently to pregnant and non-pregnant employees. Seniority, vacation, pay,

temporary disability benefits, must all be the same as all other employees.

*This list is not all inclusive. See an attorney if you feel as if you have, or are, suffering some sort of mistreatment.

Additionally, the law prevents retaliation for complaining about discrimination either to your employer or to the EEOC. States and local governments may also have laws that are similar to the PDA. For example, in Illinois the city of Chicago, Cook County, and the state of Illinois all have laws intended to prevent or remedy pregnancy discrimination. There are also administrative forums at each of these levels devoted to hearing claims of discrimination and providing remedies, including monetary damages.

Women who suffer, or believe that they may have suffered, discrimination need to file a charge of discrimination with the EEOC within 180 days of the date of the last act of discrimination. The various local and state agencies may have different filing times but many mirror the 180 day filing requirement set by the federal government as well as the types of discrimination considered illegal. Missing the filing date may eliminate the women’s right to sue so careful attention must be paid to the date, or dates, the act of discrimination took place.

As always, it’s best to consult a local attorney about a claim of discrimination but these forums will allow a woman to file her claim without a lawyer and some will investigate the claims using trained personnel.



By: Justin G. Randolph, Esq.

Are you a woman? If you are, have you been thinking about motherhood? If you have, you may be wondering whether or not you are ready to be a parent. While parenthood is occasionally unexpected, a large number of women and their partners plan and prepare for it. If that is the approach that you would like to take, there are a number of important factors or issues that you should first take into consideration.

Perhaps, the most important factor to take into consideration is healthcare. When pregnant, you will need to schedule regular prenatal exams. Towards the end of your pregnancy, these exams may be as common as once or twice a week. For that reason, healthcare should be taken into consideration. Do you have health insurance? If you do, does your health insurance cover pregnancy and prenatal care? If it does not or if you are uninsured, you may end up paying for the cost of your pregnancy alone.

In keeping the cost of having a child, it is also important to examine the costs after your baby is born. It is no secret that raising children is expensive. How are you currently managing, financially, now? If you are having difficultly making ends meet, you may be unable to afford the cost of a child. Of course, there are financial programs out there to assist, but you shouldn’t rely too heavily on them. If you would like to have a child, it is advised that you take steps to financially prepare for doing so. These steps may involve increasing your work hours or eliminating unnecessary purchases.

Another factor that needs to be examined is your current living situation. Do you own your own home or do you rent an apartment? Regardless of whether you are a homeowner or a renter, do you have enough space for a child? If you do not, it may be a good idea to rethink your current living situation. Although many mothers like to keep their newborns in the same room with them at night, there will come a point in time where your child will need their own room. If you would like to buy a larger home or rent a larger apartment, you may want to think about doing so before you decide to become pregnant, as it may save you a considerable amount of stress.

Another issue that needs to be discussed is your partner or spouse’s feelings on having a new child. Although it is more than possible for you to be a single mother, by way of a sperm donor, many women make the decision to have a child with a man that they love. Despite being more than possible to raise a child as a single parent, it is important that you seek assistance from the father. That is why the decision to have a child is one that you and your partner should make together. If you are married or if you have been with your partner for a long period of time, there is a good chance that they will be just as excited with having a baby as you are. If, at this point in time, you realize that you both have difficult goals and aspirations in life, the issue needs to be dealt with as soon as possible.

When deciding if you are ready to become a mother, the above mentioned issues are all ones that should be taken into consideration. As a reminder, many women have children unexpectedly, but many take the time to plan and prepare for pregnancy and childbirth. If you would like to thoroughly examine your decision before getting pregnant, it is advised that you do so. You can research pregnancy and raising a newborn baby by speaking with your healthcare professional and other parents or by buying a collecting of birthing and parenting books, as well as by using the internet to your advantage.



By: Jasmine Stone

Shopping for individual health insurance can be confusing. Having a basic understanding of what types of individual insurance coverage are available is important.

Group discounts that are applied to insurance policies available to employees aren’t applied to individual health insurance policies. If you are looking for an individual policy you are going to pay more for your plan than you would if you were insured as part of a group through your employer or even going COBRA. It is almost always a better idea to go with group coverage if it is available to you. Even COBRA rates are lower than those for individual policies.

Just like group policies, individual insurance coverage has the option of health maintenance organizations (HMO), preferred provider organizations (PPO), and indemnity (fee-for-service) plans. When choosing coverage you need to decide what you want from your policy. If you are looking for more freedom of choice then traditional policies are probably better. If you want to save money and you don’t mind being restricted to certain service providers then managed care types such as HMO and PPO may be a better choice for you.

Managed care is a type of insurance plan that allows you to use providers from a select group. This type of health insurance plan is usually less expensive and more restrictive than indemnity plans. If you are looking for an individual health insurance plan that allows you to use a specialist you probably aren’t looking for managed care. Check to see if your doctor is on the list, if not it is possible you may have to change doctors. Sometimes talking to your doctor can also get him/her to join the group so you are able to still see the same providers you have been seeing all along with a better priced plan than an indemnity plan.

Indemnity plans are usually a little more expensive but allow you to make more choices about your healthcare. When it comes to what services are covered and what is not covered indemnity plans are usually better. If you want more control over your healthcare then this type of plan may be what you are looking for.

If you are looking into purchasing individual health insurance you should write down exactly what you will be using your health insurance for. Keep track of what you want covered and what coverage isn’t important to you. Services such as vision, maternity care, and dental may be something you are willing to go without to keep your rates down.

The cost of an individual health insurance plan is usually roughly what it would cost you if you had to pay for your routine care out of pocket. Insurance companies set premiums for individual policies close to what they expect health care to cost for the individual. If you have gone without health for an extended period of time you may be given restrictions for the first year of your policy. If given these restrictions your insurance won’t cover pre-existing health conditions.



By: John C Alzza

Five Critical Criteria used to compare California carriers.

1. Health Plan pricing in the market. Ultimately, benefits need to be priced well relative to other similar plans on the market. Also, the plans have to make sense financially in today’s world of ever-increasing cost. Some large multi-line carriers like Principle offer extremely rich benefits that have completely priced themselves out of the market. There’s a “sweet spot” where plan design meets the consumer’s budget and that has to be a given when choosing a plan. Interestingly enough, this pricing value is driven by a carriers ability to do well in the following other areas so let’s take a look at them. More information on the major carriers in the California market.

2. Extensive provider network for HMO and PPO. A carrier needs to have as many doctors and hospital in all major areas participate in their HMO and PPO networks. The more the better. This is especially true for PPO plans which is the direction the market is ultimately heading as costs escalate. This is primarily a function of how many subscribers the carrier can bring to the bargaining table with medical and hospital groups. If a carrier covers a significant number of people in a given area, the doctors and hospitals of that area need to contract with the carrier. Also, the carrier can negotiate rates better which is essentially the foundation for PPO plans. PPO’s are big group discounts essentially. Here, bigger is better. You can find more information on how the California health networks work.

3. Flexibility and Scope of plan design. The carrier must also offer a full range of plan options: both rich and value HMO options; a full range of PPO plans from rich copay plans to hybrid lower priced plans; Health Savings Account or HSA compatible plans and strictly catastrophic lower-priced plans. No one’s needs are the same. The carrier should be able to provide for both sides of the spectrum. A key direction in the market today is towards the segmentation of maternity and non-maternity benefit plans on the Individual/Family market. This is a critical consideration or any enrollee who may need maternity coverage in the future. Health Net currently only has one plan with maternity benefits in their PPO portfolio. On the group side, it has been more a move towards higher deductibles and in some instances, generic drug coverage only. The Generic only benefit is more and more prevalent on the Individual/Family side. We feel strongly at http://CalHealth.netthat Brand name prescription is important as more exotic medical conditions can require new drugs that run 10’s of thousands of dollars.

4. Ease of Use. One more time… EASE OF USE. The carrier has to be easy to deal with. This is critical for the day-to-day management of your policy (which we help with) and more importantly, the claims-processing side. Technology is increasingly figuring here. Which carriers have made the investment in the Information systems to facilitate both the membership and claims side. We deal with all the carriers day-in and day-out… common sense and practicality are essential in the carrier you choose.

5. Pricing Stability. Over the past decade, California health insurance costs have increased significantly. Barring major changes, it will likely continue as Americans use more and more health care. The ability to mitigate this increase is primarily a function of a carrier’s management of the above four items. Are they designing and pricing correctly for the market to encourage future rate stability? Can they negotiate well with the medical groups and large hospital chains in the California health market? Do they offer options for carriers to reduce benefits (and cost) and still feel well protected? Have they invested in making their business effective from and IT perspective? These are all important questions that directly your future rates and results as a function of the health carrier’s management.

California health insurance Carrier by Carrier listing in descending order based on our experience

Blue Cross of California

Blue Cross is owned by Wellpoint, which is probably the dominant carrier nationwide in terms of stability and progressive plan design. They are known as Anthem Blue Cross Blue Shield or Unicare in most other States. They have been the ones to beat in the California health market.

1. Plan Pricing – they are consistently priced in the top 1-2 for comparable plans.

2. Network – For PPO plans, they probably the most extensive network with providers in all counties. Over 70K providers and 400 hospitals State-wide plus access to the Blue Card network for family members or employees in other States.

3. Flexibility – On the Small Group side, they started the Employee Elect program which is still the most flexible and easiest to use. They even apply choice to the dental plans as well. They have 4 HMO plans, 5 HSA plans, and 12 PPO plans plus a suite called BeneFit for low cost plans. On the individual side, they consistently bring out new plans from the Right Plan 40 no-deductible PPO plan to the new Tonik health plan suite that the other carriers invariably try to copy 6-12 months later.

4. Ease of Use – They are easiest carrier to do business with. They tend to be the most flexible when dealing with issues and the issues tend to be less frequent than with other carriers. They are ahead of the curve (and have been) with technology both in terms of their internal processes and interaction with groups. New online control panels allow employee additions, terminations, changes and more on the Group side. They can be strict in underwriting (company requirements) and benefit management is definitely there but both of these attributes work ultimately to keep cost down which is the biggest issue (hence #1) in the market now. They the first to unveil an online application and online account management and visibility. Tonik enrollment is completely handled online.

5. Pricing Stability – Their increases as a percentage tend to be in the lower quadrant of the market…primarily due to their work on the above four items.

Blue Shield of California

Blue Shield of California a strong carrier in California and also participates in the Blue Card network for out-of-State employees and family members. It is one of the few non-profits. Cross and Shield are two separate, completely independent carriers at the Small Group (2-50 employees) and Individual/Family level. If PPO is your preferred option, they are a good comparison for Cross and Health Net.

1. Plan Pricing – they are consistently priced in the top 1-3 for comparable plans.

2. Network – For PPO plans, they probably rival Blue Cross with providers in all counties. They probably do not negotiate as well as Blue Cross but may have a better reception from doctors/hospitals because of it. This also affects their pricing going forward. They do allow access to the Blue Card network for employees or dependents in other States. Their HMO is comparable to Cross but neither is thought to be the strongest carrier for HMO plans.

3. Flexibility – They allow selections from the different classes of plans (HMO, PPO, and HSA). They have a full range of plans with one of the last no-deductible PPO Small Group plans on the market. They have 7 HMO plans, 4 HSA plans, and 13 PPO plans on the Small Group side and an equivalent suite of plans on the individual side.

4. Ease of Use – Their Group underwriting is slightly more flexible than Cross but their claims and membership side is not as advanced…especially in terms of technology. Our sources say that they are undertaking a pretty significant IT project to integrate their systems and have been working to bring Small Group resources to the web (behind Cross). On the individual side, they have an online application and online tracking but their underwiting tends to be more involved.

5. Pricing Stability – Their increases as a percentage tend to be in the lower to mid quadrant of the market depending on the class of plan (HSA versus PPO for example). They will need to continue modernizing in order to keep this trend going forward.

Health Net of California

Health Net of California was originally Blue Cross’ HMO many years ago. Traditionally, they were a strong HMO carrier but they have aggressively moved into the PPO market as the future of HMO’s and its cost structure dimmed. They tend to copy Cross’ moves in the market so at least they are smart enough to the follow the leader. If a company’s main focus is HMO and they do not have employees out of State, Health Net is definitely to be considered. On the individual/family side, they are a solid carrier but need more of a PPO track record.

1. Plan Pricing – Health Net tends to copy Cross’ offerings and then under-price the market. In the short-term, this is fine for your company. Long term, the rates always increase and/or change. The only issue is if the increase occurs mid-year and employees have already met deductibles/max-out-of-pockets…making a carrier change difficult. This is true on the Individual/Family side and Small Group.

2. Network – Health Net has a strong HMO network as that has been their bread and butter long before the PPO came along for them. The PPO network should be well represented throughout the State although it’s range probably does not match Cross or Shields, whose experience in the PPO market goes back decades.

3. Flexibility – Health Net copied Cross beneficially in that they copied the nature of Employee Elect where you can offer multiple plans to their employees. They have a full range of plans with 16 HMO’s, 4 HSA’s, and 8 PPO’s. You can see their HMO background from the plan options. On the individual side, they only have one maternity PPO plan but offer a wider range of HMO plans. Their HSA’s are comparable but probably under-priced.

4. Ease of Use – Health Net tends to be pretty reasonable both in terms of enrollment (underwriting) and membership. They are behind Cross and Shield in terms of online capabilities and systems. On the individual side, they tend to be more strict with underwriting and if an applicant’s health is not clean, they have declined a high percentage of apps. Cross and Shield appear to be more pragmatic in terms of actually looking at a person’s health history and making a decision.

5. Pricing Stability – Pricing stability has been a weaker area for Health Net especially on the PPO front. For HMO, they have a good grasp of the market and the model. PPO has been a bit more elusive with more requent and significant changes with their plans. This is to be expected as PPO requires a good 5-7 years of claims experience to truly wrap your head around the model actuarially speaking.

We have listed Blue Cross of California, Blue Shield of California, and Health Net of California separately as they really are the strongest California health insurance carriers that offer both PPO and HMO options. Kaiser is a major carrier but primarily acts as an HMO. There are many other options on the market, but from our experience, they usually are not advisable against one of the above mentioned four.



By: Dennis Jarvis