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HEALTH CARE REFORM
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HealthCare.gov Take health care into your own hands. go now>>
Anthem Health Care Reform Website Making health care reform work for you. go now>>
Anthem Health Care Reform Provision Table go now>>
Interview with California Insurance Commissioner on KCRW (March 23, 2011). read & listen now>> |
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FREQUENTLY ASKED QUESTIONS
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Answers to common questions about health insurance & travel insurance. go now>> |
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HSA RESOURCES
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HEALTH SAVINGS ACCOUNT RESOURCES HSA Bank.com go now>> Sterling Bank (HSA) go now>> |
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HELP US HELP YOU Our agents are here to be your guide to finding insurance and your advocate for using your insurance. Visit our agents. go now>> |
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MANAGE YOUR GROUP POLICY ONLINE Make changes, print claim forms, find contact numbers, make online payments. go now>> |
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MANAGE YOUR INDIVIDUAL/FAMILY PLAN ONLINE Make changes, print claim forms, find contact numbers, make online payments. |
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Applications and Appeals can be supplemented with personal letters and letters of recommendation from doctors, which give more detail to the conditions in question.
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MEMBER & PATIENT ADVOCACY
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The California Office of the Patient Advocate works with many of these groups to make sure consumers get information about their health care rights. read more>> Health Action Network allows you to reach out to local legislators. Elected officials welcome input from their constituents. Communications from “back home” help them understand how public policy issues affect the people they represent. read more>> Access for Infants & Mothers (AIM): You have a baby on the way! The State of California wants to help you get good health care during your pregnancy, even if money is a little tight. Going without prenatal care can cause many problems for you and your baby. read more>> California Department of Health Care Services has a mission is to protect and promote the health status of Californians through the financing and delivery of individual health care services. read more>> Healthy Families (California) State sponsored low-cost insurance for children, teens and pregnant mothers. Includes news and coverage details for each county. read more>> Healthy San Francisco is a new program created by the City of San Francisco that makes health care services accessible and affordable for uninsured residents. read more>> List of Preventive Care Services: Preventive Care vs. Diagnostic Care: What is the difference? Which Preventive Care services are covered in my plan. read more>> |
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PLAN BENEFIT DEFINITIONS
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Health Insurance Plan Benefit Descriptions
You will see the following terms in the description of the benefits of your health insurance plan. Here are some definitions of some of these important terms:
-A Co-Pay for doctor visits is a defined payment for the visit alone that is not subject to the deductible (applicable from Day 1 of the policy - whether you have met the annual deductible yet, or not). *All other services (incl. Labs & Radiology, inpatient/outpatient hospital services, etc. are usually above and beyond the office visits and are subject to the deductible.
-A Annual Deductible is the amount that must be paid out in a calendar year (Jan 1 - Dec 31) before the insurance coverage begins to pay out at a percentage (co-insurance). *Usually, medical care services generally have a negotiated "insurance rate", for which you will be responsible to pay the entire amount of until you have met the annual deductible.
-Co-insurance is a percentage that represents the portion of medical service bill(s) that the member will be responsible for once the annual deductible has been met. The insured member continues to pay the co-insurance rate until the Annual Out-of-Pocket Limit has been met. *Usually, the % that is published represents the member's responsibility, not the carrier's responsibility.
-Annual Out-of-Pocket Limit is the maximum amount that the insured member will be responsible to pay out of his/her own pocket in a calendar year (besides the monthly premium). *Not all services apply towards the annual out-of-pocket limit.
*Note plans have separate Annual Deductibles and Annual Out-of-Pocket Limits for In-Network services and Out-of-Network services.
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