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Comment by dot | Hacker News Reader

These premiums actually look pretty good. I was under the impression that non-employer based plans were much more expensive... Is there a catch? Do they have to cover pre-existing conditions in CA already? Are there coverage caps? Thanks for putting together the article, very helpful!

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Starting in 2014 - it will be illegal to have lifetime caps on health insurance. Also limits on "essential services" will be illegal. They are loosely defined as:

- Emergency services - Prescription drugs - Mental and behavioral health, and substance abuse treatment - Preventive, wellness, and chronic disease management - Pediatric services - Maternity and newborn care

Excluding based on pre-existing conditions will also be illegal starting in 2014. Until then - California has a health plan for pre-existing conditions here: http://www.pcip.ca.gov/Home/default.aspx and you can find information for all state here: https://www.pcip.gov/

PCIP is only an option if you've been uninsured for more than 6 months and have been denied insurance (or been offered a very high premium rate).

I imagine those premiums are for Tier 1 customers (in good health without pre-existing conditions). Insurance companies also offer plans at higher cost for various pre-existing conditions. Once you apply they evaluate your medical information and place you in a rate tier. Blue Shield for example has tier 1 through tier 6 (plus a special tier 7 for minors).

If you meet some other qualifications (in particular have had coverage for 18 months and have used up any COBRA options you have), you are entitled to a guaranteed issue plan in CA if you are declined for an underwritten plan:

http://www.hmohelp.ca.gov/dmhc_consumer/hp/hp_cobra.aspx

http://www.hmohelp.ca.gov/dmhc_consumer/hp/hp_hipaacp.aspx

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