Before trying to select a health insurance plan you should have an understanding of the two primary forms of coverage being offered by most insurance carriers in California today.  They are HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Organizations).  The differences in premiums and benefits can be significant but, without meaning to oversimplify the matter, the basic benefit differences are: 

HMO

• You have less exposure to the cost of medical services; but,

• limited freedom to go to any doctor or other provider of your choice –--
  in most cases you must go to a gatekeeper doctor to obtain all services or referrals to specialists.

PPO

• You have the freedom to decide for yourself what doctor you want to see whenever you want; but,

• with a greater share of the cost for services through deductibles and co-payments.

Who should select an HMO?  

You have a limited income and need to know that, for the most part, your monthly premiums and small office visit co-payments (usually $10‰) will be your total financial exposure, other than small co-payments for prescriptions (usually $5‰ for generic and $10‰ for brand name pharmaceuticals).   

You do not object to or are willing to accept (to limit your financial exposure) the requirement that you see a primary care doctor for all of your medical needs and allow a review panel to decide whether or not you may see a specialist.  The panel may even determine what kind and which specialist you will be permitted to see.  (There are certain exceptions to these limitations but they are few.) 

Who should select an PPO?  

You are able and willing to bear a greater share of your medical expenses. 

You want the freedom to choose the doctor you will see at the time you feel you need to see one. 

You don’t want to be required to get approval or see anyone else first.  (Certain services do require a pre-certification review from the carrier or there could be an additional deductible charged.  The pre-certification review does not allow or disallow the service you would be seeking, it merely gives the carrier an opportunity to discuss the procedure with the provider to determine that it is the most cost efficient manner of treatment.) 

Groups have the ability to Mix ‘N’ Match these two options in many different configurations, within a single plan, thereby giving their employees the ability to select the health insurance plan they feel best fits their needs. 

Today there are three primary medical insurance carriers writing individual and family PPOs in California.  They are Blue Cross, Blue Shield and Health Net.  We have selected and are authorized agents for Blue Cross and Health Net.  There are several fine carriers offering medical insurance plans for groups in California and we have access to the leaders in the field.

   

             

For quotation and consultation on appropriate health insurance plans and rates please complete and submit our brief  individual/family or group questionnaire as appropriate to your situation. We will provide you with our recommendations by e-mail,  regular mail, fax or phone at your choosing.

The information on this site is intended for the use of individuals, families and groups domiciled in the state of California only.