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Health Insurance California Companies Question & Answers

2014 January 6
by Sarah Fields

Sandy asks…

Why does the pharmacy always give me generic?

Just curious as to why they always give me generic meds instead of brand name? I know they’re the same thing, but still curious. Is it because insurance companies want to save money? More profit for pharmacy? I have blue shield blue cross federal employee health insurance in California. Shouldn’t the pharmacy ask you which you prefer, though it might be a few extra bucks?

Sarah Fields answers:

It is required by law to give you generic, if the physician doesn’t request brand and if it is cheaper than brand. You have to request brand to override a physician’s substitution ok on the rx. Generics are more profitable than brands for a pharmacy. With branded products, you are lucky to break even. Many insurances will not cover a brand or raise co-pays very high once the generic becomes available

Richard asks…

Are health insurance rates a state or federal matter of approval?

I read this story today: “The Obama administration is asking Anthem Blue Cross to justify its plans to raise health insurance premiums…”
Health and Human Services Secretary Kathleen Sebelius sent a letter to the company’s president on Monday calling the planned increases extraordinary and difficult to understand. She wrote that the company has an obligation to provided a detailed justification for the rate hikes to the public.”

I thought that health insurers were state regulated and regulated by the NAIC–not the Secretary of Health and Human Services.

Anthem is in California if that makes a difference.

Sarah Fields answers:

Rates are filed in each STATE, not federally, except for Medicare.

The obvious conclusion is, that the Obama administration has no idea how health insurance companies work.

Chris asks…

Where do self-employed people go to get health insurance?

I’m in California, if that helps. I know it’s a funny time to be asking about health insurance-recent news and all-but I suddenly think I should have it and didn’t realize it was tax deductible, to boot. Haven’t had any since 2001 when employed by a company.
Any suggestions appreciated.
P.S. When I phone shopped for some a couple of years ago the prices seemed crazy exorbitant!

Sarah Fields answers:

You can check with your other providers and see if they offer health options, look for local brokers – many work with sole proprietors and on line. I personally carry Blue Cross Blue Shield and I believe they are also in Calif. The premiums can be high but check with your accountant – they can also be legitimate business expense.

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