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An
alternative that avoids the risk of going
uninsured and may cost significantly less
than COBRA.
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|
Individual
Insurance |
- Is purchased by
the individuals.
- Requires that the
applicant complete an application,
which includes health history questions,
and be approved for coverage.
- Offers various plan
designs and cost structures enabling
consumers to balance the "fixed" cost
of premiums and the risk of "variable"
costs known as deductibles, co-insurance,
and co-pays. The more variable cost
risk consumers are willing to assume,
the lower their fixed costs; the less
variable cost risk they are willing
to accept, the higher their fixed
cost will be. Only you and your insurance
agent can identify the balance best
for your unique situation and needs.
|
| Note: If you choose
not to elect continuation of group coverage
under COBRA you will loose valuable rights
under HIPAA. Read bellow |
| |
| A health care service plan or insurance company that offers
Hospital, medical or surgical benefits under an individual health care service
plan contract or insurance policy may not decline to offer coverage to, or deny
enrollment of, a federally eligible defined individual or impose any Preexisting
Condition with respect to the coverage. But if you don't take available COBRA
or Cal-COBRA coverage, you lose your rights to this guaranteed coverage.
|
| |
| A federally eligible individual is an individual who, as of
the date on which the individual seeks coverage under this provision, meets all
of the following conditions: |
| |
- Has had eighteen (18) or more months of creditable coverage, and whose most
recent creditable coverage was under a group health plan, a federal government
plan maintained for federal employees, or a governmental plan or church plan as
defined in the federal Employee Retirement Income Security Act of 1974 (29
U.S.C. Sec. 1002), and
- Is not eligible for coverage under a group health plan, Medicare, or
Medi-Cal, and does not have any other health coverage, and
- Was not terminated from his or her most recent creditable coverage due to
nonpayment of premiums or fraud, and
- If offered continuation coverage under COBRA or Cal-COBRA, has elected
and exhausted that coverage.
|
| Creditable coverage means: |
| |
- Any individual or group policy, contract, or program that is written or
administered by a disability insurer, health care service plan, fraternal
benefits society, self-insured employer plan, or any other entity, in this state
or elsewhere, and that arranges or provides medical, Hospital, and surgical
coverage not designed to supplement other plans. The term includes continuation
or conversion coverage but does not include accident only, credit, disability
income, Medicare supplement, long-term care, dental, vision, coverage issued as
a supplement to liability insurance, insurance arising out of a workers'
compensation or similar law, automobile medical payment insurance, or insurance
under which benefits are payable with or without regard to fault and that is
statutorily required to be contained in any liability insurance policy or
equivalent self-insurance.
- The federal Medicare program pursuant to Title XVIII of the Social Security
Act.
- The Medicaid program pursuant to Title XIX of the Social Security Act.
- Any other publicly sponsored program, provided in this state or elsewhere,
of medical, Hospital, and surgical care.
- 10 U.S.C.A. Chapter 55 (commencing with Section 1071) (CHAMPUS).
- A medical care program of the Indian Health Service or of a tribal
organization.
- A state health benefits risk pool.
- A health plan offered under 5 U.S.C.A. Chapter 89 (commencing with Section
8901) (FEHBP).
- A public health plan as defined in federal regulations authorized by Section
2701(c)(1)(l) of the Public Health Service Act, as amended by Public Law
104-191, the Health Insurance Portability and Accountability Act of 1996.
- A health benefit plan under 22 U.S.C.A. 2.504(e) of the Peace Corps Act.
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