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Health insurance currently purchased in the individual market provides less comprehensive coverage, paying an average of 55% of actuarial value, compared to 80-90% actuarial value for group coverage. Although the individual and small group health insurance markets may share more features in the future, today they are quite different.
California’s small group health insurance market, which covers employer groups with 2 to 50 workers, has been shaped by guaranted issue and other protections in a 1992 state law. In 2014, individuals will benefit from many of the protections now seen in the California group health insurance market. Based on poverty levels, many of today’s insured and uninsured in California are likely to be eligible for subsidies in 2014.
Of the 2 million who already purchase individual health insurance, about 40 percent would qualify for subsidies and another 18 percent would be eligible for Medi-Cal if 2014 rules were in effect today. Among the uninsured, 2.8 million (39 percent) may be newly eligible for Medi-Cal in 2014 based on their income. Another 3.4 million (almost half of the uninsured) may be eligible for subsidies to purchase individual health insurance coverage in 2014.


The remaining 15 percent of the uninsured are in families whose incomes are above 400 percent of the federal poverty level, making them ineligible for subsidies. More than 1 million of the uninsured are undocumented immigrants, who would not qualify for subsidies and would be excluded from Covered California. Currently, Individual premiums for older insureds are as much as five times higher than younger insureds. Kolla garna upp forlagets (Gale, Making of Modern Law) hemsida, dar det kan finnas mer information.
But the Affordable Care Act (ACA) of 2010, will propel these market segments into greater importance than their current numbers would seem to warrant.
The individual health insurance market, in which enrollees pay for 100 percent of their coverage, is characterized high deductible PPO plans because of the sensitivity of its purchasers to rates.
This web site is owned and maintained by California Health Benefit Advisers, LLC, which is solely responsible for its content. In 2014 the individual mandate and the subsidies available through the Covered California will double or triple the size of the individual health insurance market and offer new purchasing opportunities for many small businesses and their employees.


As a result, enrollees in small group coverage typically pay a fraction of their premium and are insulated from the actual cost of health insurance.
These factors, combined with the federal requirements to obtain coverage, will alter the California health insurance landscape.
Younger insureds will experience increased premiums and older insureds reduced premiums in many instances.
New types of health insurance products will be sold and the way coverage is priced will change to conform to reformed market rules.



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california insurance code bad faith



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