Your Rights under California Health Insurance Law
(Copyright 2005 All Rights Reserved)
Individual Health Insurance:
In California, as in many other states, your health insurance options are somewhat dependent on your health status. However, your health insurance cannot be canceled because of your getting sick. Most health insurance is guaranteed renewable.
If you have had difficulty obtaining affordable individual health coverage because of your health condition, you may be eligible for Major Risk Medical Insurance Program (MRMIP) coverage for up to 36 months. When you exhaust MRMIP coverage, you will be guaranteed a health insurance policy in the individual market. You will not face a new pre-existing condition exclusion period. There are limits on what you can be charged for regarding this policy.
MRMIP coverage includes hospital and physician care, maternity services, prescription drugs, treatment for serious mental health illness, and other services.
The California Medi-Cal program offers free health coverage for pregnant women, families with children, elderly and disabled individuals with very low incomes.
Access for Infants and Mothers (AIM) is a state-run program that provides low-cost health insurance coverage for some middle-income mothers and their newborns with no health coverage or health coverage with limited maternity benefits.
The Breast and Cervical Cancer Treatment Program serves low-income California residents who have been screened and diagnosed with breast and/or cervical cancer. You must be a California resident, under the age of 65 with no comprehensive health insurance coverage or Medicare, must meet satisfactory immigration status, and have a monthly gross income at or below 200% of federal poverty level.
If your children are 18 years old or younger, do not have health insurance and meet other qualifications, they may be eligible to buy health insurance through the Healthy Families Program.
If you have lost your health insurance and are receiving benefits from the Trade Adjustment Assistance Program then you may be eligible for a federal income tax credit to help pay for new health coverage. This is the Health Coverage Tax Credit (HCTC).
If you are a retiree aged 55-65 and receiving pension benefits from Pension Benefit Guarantee Corporation, then you may also be eligible for the HCTC.
If you are not, HIPAA (Health Insurance Portability and Accountability Act), individual insurers are free to turn you down because of your health status and other factors. Except for policies sold to HIPAA eligible persons, state law does not limit how expensive individual health policies can be.
If you are HIPAA eligible, California law limits the premium you can be charged. If not, the state does not limit what you can be charged.
For more information, visit the California Department of Insurance at
Group Health Insurance:
If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This is called Cal-COBRA coverage. It can help when you are between jobs, or when you retire early and are not yet eligible for Medicare.
If you lose your group health insurance and meet other qualifications, you will be HIPAA eligible. You have the right to buy an individual health policy from any insurance company that sells individual coverage.
In California, newborns, newly adopted children and children placed for adoption are automatically covered under the parents’ fully insured group health plan for the first 30 days.
In California, your disabled child can remain covered as a dependent under your group health plan into adulthood. The state requires fully insured group health plans to accept late enrollees, although you might have to wait 12 months to enroll after you request admission to the plan.
In addition, California law provides some additional rights to women who are taking pregnancy leave.
Group health plans cannot apply a pre-existing condition exclusion period for genetic information, a pre-existing exclusion period for pregnancy, newborns, newly adopted children, children placed for adoption, provided they are enrolled within 30 days.
Group health plans can exclude coverage for pre-existing conditions for a limited time of 6 months.
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