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Options For Non-Maternity Plans on the California Individual Health Insurance Market

Aug 21, 2008
What are some current plans that work well when maternity coverage is not needed? Maternity is one of the single biggest determinants on health plan cost when researching individual health insurance plans in the California market. It's easy to see why when a simple delivery can run $10,000 and an uncomplicated C-section can run $20,000. Maternity is probably the only health care service you can actually plan on to some extent. No one plans for a broken bone. Health care costs have spiraled up over the last years primarily because of facility based care (translated as hospital based care) and maternity is deeply dependent on such care. So if maternity is something you may need now or possibly in the future, it's probably best to stop reading. Be careful not to assume that you can get a non-maternity plan now to save money and switch in the future as you get closer to the need for maternity coverage. If your health changes or if you become pregnant, it might be impossible to switch to a plan that covers maternity.

Non-maternity health plans on the market

Let's look at some plans on the market for people who will definitely not need maternity coverage.

First, HMO (Health Maintenance Organization) type plans have become pretty expensive in comparison with mid-level PPO options. The HMO plans usually cover maternity anyway which is partially why they are so expensive so we'll concentrate more on PPO plans which is were the market has been heading.

PPO (Preferred Provider Organization) plans offer a full range of non-maternity health plans but on a practical sense, it comes down to really two ways of approaching health care needs. We will look at Anthem Blue Cross as an example since they are both a strong carrier and priced well. First, are we going for? Well, we want comprehensive coverage. This means we do not want to find big holes in our coverage later on relative to the other plans on the market. We also do not want the richest plans. When you're paying for your own health insurance, the annual premium difference between various plans is a major consideration if two plans differ by how they treat office copays and RX copays but the premium difference is $1000. $1000 pays for a lot of copays in a year's time. Based on this, start by looking at these two suite of plans.

Lumenos HSA plans (non-maternity option) or PPO $3500 HSA compatible plan

This is a simple plan as far as health insurance is considered. Essentially, you have a high deductible for which all covered benefits are subject to. The Lumenos plans carves out some preventative benefit coverage which is very useful for those that require this. Either way, the theory is a high deductible to keep the cost down. This is best suited for:

1. Older individuals (since age is the primary driving force of cost)
2. People who are most interested in catastrophic health insurance to cover big bills
3. Those individuals that wish to take advantage of the the tax benefits of an HSA.

The pricing tends to be some of the lowest on the market for comprehensive coverage. One note...the deductible for two or more people on one policy is double and cumulative for all family members on the policy. For example, if one person's deductible is $1500, a family's cumulative deductible would be $3000 and all family members are working towards the same deductible.

Smart Sense PPO plans with no maternity coverage

The other suite of plans to compare is the Smart Sense PPO plans with Comprehensive RX. You have an option of deductible amount to choose from which drives the cost of the monthly premium. The major difference between these plans and the HSA plans mentioned above is that office copays and RX coverage is not subject to the main deductible. Also, the main deductible is per person with the Smart Sense plans while the HSA plans are cumulative deductibles.

You can run your instant quote at www.calhealth.net to research both the HSA compatible plans and the Smart Sense plans for comprehensive, non-maternity health insurance. Make sure to read through the brochures and please let us know if we can help in any way.
About the Author
Dennis Jarvis is a licensed California broker with extensive knowledge of the Individual and Small Group health market in California. Individual California health insurance.
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