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Health Insurance California Broker Question & Answers

2013 October 28
by Sarah Fields

Thomas asks…

i have found a health insurance broker, how do I tell if they’re any good or have bad reports from customers?

I have found a health insurance broker…how do I tell if they are any good? I can’t find too much information on them on the internet, but I did check them out on the department of insurance for California.

Sarah Fields answers:

You can’t really tell. There’s no agency that keeps track of that, or even that rates what’s good or what’s bad.

If they spend time with you, return your calls promptly, and explain the coverages, they’re good.

Betty asks…

Best place to purchase health insurance?

I am starting my own small business and need health insurance for my family. I won’t go with Kaiser, please don’t ask why. I need an HMO with no deductable or a very low deductable because in my area the Blue Cross, Blue Shield, HealthNet networks have pretty good doctors and hospitals within their “approved” networks. It will be a family-owned sole prop business. I live and work in California, but if there is value in incorporating in another state for the purpose of taxes or prices on health insurance, I guess I could do it…because I have not formally formed the corporation yet. I used to be under the impression that the best prices for Heath Insurance came when you worked for a big company, but things seem to have changed. I recently worked for another smalll family-owned business, and they got very good rates by incorporating and claiming a Headquarters in Washington. What is the best strategy to get the best insurance at the lowest rates for a small group- one family? Thanks!

Sarah Fields answers:

The misconception is that a person who owns a business can purchase group health insurance. Here are the facts, companies like Blue Cross, Blue Shield, HealthNet, have specific requirements for qualification for a business or what is known as “Group” insurance. Here are some of the major things you will need, first off you need at least two full time employees, these employees will need to be on payroll. You will need to show proof most common is a DE-6 (this is submitted to EDD to show withholding tax for employees, it will itemize payroll -hours worked, and withholding tax- if your employees are paid as independent contractors, you will not qualify for group health insurance). If you only have one employee on a DE-6 and you are the owner, you will need to show your Tax returns. Since your company is new, you should also be aware that the companies listed above also have a half of the quarter rule in business. You will need to also have Workers compensation insurance, in Ca. State Fund is the most popular for new companies. Another requirement is that you will be required to pay at least 50% of the employees cost, (not dependent) and also you in order to qualify your group you will need to meet participation, for the above companies it is normally 70-80% meaning that if you have 10 employees at least 7 will need to apply, unless they can prove that they have other insurance with a spouse (employer based). Here is the reality, no law says that you as a small business owner must offer health benefits, it is difficult enough to start up a business, you can purchase Individual/ family plans from the carriers listed above, qualification is based on your “health condition”. I would advice you contact a broker, here in Ca. Literally thousands available (I am one) I would advice interviewing several (call around) and pick someone who who mix well with.

Donald asks…

What kind of health insurance do i apply for?

I have a one year old son and he has had medi-cal off on and they give me so many problems and i’m tired of him having medi-cal. I recently reapplied because they stopped it again, but this time i added his father on there since he has no type of medical insurance either.4 weeks went by and i haven’t recieved anything in the mail so i call and ask what is going on. The lady was extremely rude to me and tells me they denied my application because they never recieved a packet that requested birth certificates,social securities, proof of income etc. And i tried to explain to her i never recieved the packet that requested any of that and that’s why i was calling to let them know and she said “well they already denied you so you need to apply again” i’m tired of medi-cal my poor son deserves better.so i was wondering if anyone knew of something else i could apply for? it’s just for my son and his father i’m still under my moms insurance so i don’t need it but i have to apply for them since i’m the mother of my child obviously. We live off of $400 every 2 weeks and have other things to pay for.so please someone help!

Sarah Fields answers:

It would be better to have his father apply. If you apply, then you will have to pay for insurance for yourself, even though you don’t need it. If the father applies, then he can pay for only himself and the child, both of whom need it.

He (or you, if he refuses) apply for normal, regular health insurance. Nothing special. In particular, you don’t apply for any “affordable” insurance. Prior to approximately age 50, insurance that is not officially designated “affordable” costs less. (“Affordable” means that the price for everyone is slightly more affordable than regular insurance for someone 60-64 years old, even though it is much less affordable than regular insurance for someone your age.)

I’m guessing you are between 19 and 30 years old, which means that the price for the least expensive plans in California would probably be between $50 and $140 per month per person. You can apply online or at a local broker or agent. Even if you want to use a local broker or agent, you can use ehealthinsurance.com to see what plans are available where you live and what the prices are, so you have an idea of what to expect when you meet with the broker or agent.

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