Types of Coverage

Types of Coverage

Insurance may be offered in different types of policies, either a group or individual.

Group Insurance

A group health plan is a health plan you get through your job, union or as a retiree.

Sign Up for a Group Health Plan

  • When you start a new job, ask how to sign up for a health plan, when the plan starts, and what you will pay.
  • Look at all the plans your employer offers. Try to find the one that has the most benefits and any particular doctors you need.
  • Most employers have open enrollment in the fall of each year. Open enrollment is when you can change your benefit choices. For example, you can change health plans if your employer offers more than one plan.
  • You can add new dependents to your health plan when you join the plan, during open enrollment, or when you marry, have a baby, or adopt a child.
  • You can keep your dependent children on your plan until they turn 26. You may be able to add a domestic partner. When you add someone to your health plan, your monthly premium may go up.

Waiting Periods

California law prohibits health plans from imposing any waiting or affiliation period on group health coverage, other than that imposed by the employer sponsoring the group health plan. Waiting periods for pre-existing conditions are prohibited.

When Group Insurance Ends (COBRA)

Federal COBRA and Cal-COBRA are laws that help you keep your group health plan for a certain amount of time if your job ends, your hours are cut, or you change jobs and there is a waiting period before your new health plan starts. Your employer must notify you within 15 days after your group health plan ends that you qualify for a conversion plan. Your health plan must receive your application and first premium payment within 63 days after your group health insurance ends. You will have to pay the premiums yourself. However, it may cost less than individual health insurance, which is insurance that you buy on your own, and the benefits may be better. If you qualify for Federal COBRA or Cal-COBRA, you cannot be denied coverage because of a medical condition.

These laws also allow your spouse, former spouse, or child to keep health insurance after your job ends, after divorce, or your death.

Get a letter from your health plan that says how long you were insured. This is called a Certificate of Creditable Coverage. You may need this letter when you get a new group health plan or apply for an individual health plan.

Individual Insurance

Individual health plans are plans you buy on your own, for yourself or for your family.

Starting in 2014, individual health plans are no longer allowed to refuse to cover you or charge higher premiums because you have a pre-existing condition.

Covered California can help you determine if you qualify for Medi-Cal or a federal subsidy, and they can discuss other available coverage options and pricing. You can contact Covered California by phone at (800) 300-1506, TTY: (888) 889-4500 or by visiting their website at www.coveredca.com.

Individual Conversion Plan (HIPAA)

If you have had health insurance for the last 18 months without a gap of more than 63 days, you may have the right to buy a HIPAA individual plan. However, you must first use up Federal COBRA and Cal-COBRA if you qualified for it.

If you previously had health coverage under a HIPAA plan or an Individual Conversion Plan, that coverage is most likely no longer available. However, you may have health coverage available under Covered California (the California Exchange) or Medi-Cal. For more information, please contact Covered California at (800) 300-1506 | TTY: (888) 889-4500 or visit their website at www.coveredca.com. You may also contact your previous health plan for additional information.