Individuals and families can click on the links below to get health insurance quotations for all plans offered by the carriers instantly on-line. You can also submit the individual/family on-line applications by simply clicking on the "Apply On-line" links provided on each website, filling out the form and clicking "Submit". It's that simple!

HMO ( Health Maintenance Organization):

An HMO requires you to choose a Primary Care Physician (PCP) from an Individual Practitioner Association (IPA) or Primary Medical Group (PMG) ( a clinic of doctors). The doctor acts as a “Gatekeeper” and controls your access to other doctors. You generally need to get a referral from your PCP to see a specialist. HMO plans will have co-pays for most services and 100% coverage for many others. Some lesser coverage HMO’s have deductibles for hospitalization. Access to providers is limited to the IPA or PMG. Usually no benefits will be paid for seeing providers outside the IPA or PMG unless approved prior to seeing them. Some HMO’s allow you to go to a specialist without a referral for a higher co-pay and one HMO allows you to go to a PPO doctor for a higher co-pay.

An HMO is only as good as the PCP you choose and the IPA or PMG they are with. These are the physicians and specialists who will be providing your care. You want to make sure your physician is a listed PCP and that the provider group has a good selection of specialists in every specialty. (If you need a particular specialist you want to make sure your PCP will have a choice of specialists to refer you to). You may want to contact your doctor’s office to see what their experience is with the HMO you are considering. The key to having a good experience with an HMO is your doctor’s ability to work within that HMO’s system.

PPO ( Preferred Provider Organization):

A PPO does not require you to choose a PCP or get referrals to see a specialist. A PPO plan allows you to go to a network of doctors without referrals. With a PPO plan your co-pays and percentages for services will be higher and you will usually have a deductible. You will have some benefit if you see a provider outside the network. PPO premiums are usually less than HMO’s and can provide substantial savings.

Most carriers will have several PPO’s to choose from. Some will offer small co-pays and deductibles and others will have larger co-pays and deductibles. The difference in premiums may be more than the benefit of the higher plan. Take a look at your usage of health insurance in the past and see which plan makes sense for your situation. Remember that you may have this plan for several years and as you get older your usage may increase. If you want to upgrade your plan in the future you may have to reapply and the carrier can decline your request, so think about your choice carefully. You can downgrade your plan usually without reapplying.

Health Savings Accounts:

HSA’s are available from many carriers since January 1, 2005. To open an HSA you need to have an HSA compatible plan, a high deductible PPO plan where all services are subject to the deductible, be under 65 and not on medicare, and not claimed as a dependent on another person’s tax return. A bank establishes the HSA account. You fund the account at the beginning of the year. The amount is generally limited to 100% of the deductible amount for the year. For 2005, the maximum amounts are $2650 for an individual and $5250 for a family. There are also catch up contributions for individuals between 55 and 64 years old. You can use the funds for expenses and then what ever is left builds up like an IRA account. The downside is that the banks charge high fees for transactions and many people choose to leave the funds in the account and pay cash for expenses. This creates another IRA vehicle for retirement. HSA’s are becoming popular since the premiums are low and they create another source of retirement and tax deductions for contributions to HSA’s. While a person is under 65 they can use the funds to pay for medical expenses including dental, long term care, medicare, and COBRA policies and not pay taxes on the funds being withdrawn. For a complete listing of allowable medical expenses refer to IRS publication 502. If the funds are used for non medical expenses then they are taxed for early withdrawal plus a 10% penalty. After 65 you can use the funds for allowable medical expenses, tax free. If you use it for other expenses you only pay the appropriate taxes, without the 10% penalty. After age 65 you can no longer contribute. You can also designate your spouse as a beneficiary for the funds. There are currently over 26 HSA compatible plans in California. We can provide additional information about HSA’s upon request.

For quotation on small or large group health insurance, please contact us.