Purchasing health insurance is a must as it helps to afford the right treatment in need. You should never compromise with the coverage while purchasing health insurance. In addition, make yourself aware of the terms and conditions of your health insurance plan in order to avoid dispute in times of claim settlement. Read on to get an overview of health and dental insurance in California.

Types of health insurance plans

There are different types of health insurance plans in California and you can choose one that best fits your needs, lifestyle and budget. 5 types of plans are given below.

• Multiple Employer Welfare Arrangements (MEWAs) – It allows employer members of industry, trade, professional and other associations to create trust funds in order to provide health care benefits to the employees.

• Health Maintenance Organizations (HMOs) – The HMOs in California are regulated by the DMHC (Department of Managed Health Care). Under this plan, you can choose a primary care physician from the HMO network and if needed, he/she may refer you to a specialist.

• Self-insured health plans – This plan has gained much popularity among labor unions, large employers, municipalities, school districts, etc. These groups create a pool of money and then offers health care services to its employees. Most of these health plans fall under ERISA (Employee Retirement Income Security Act).

• Preferred Provider Organizations (PPOs) – Under this plan, you can choose your doctors among the list provided by your plan. If you visit a doctor outside the list of preferred providers, then the plan may cover only a portion of your health care expenses or may provide no coverage at all. PPOs in California are usually regulated by either DMHC (Department of Managed Health Care) or CDI (California Department of Insurance).

• Indemnity Plans – Under this plan, you can choose a hospital or doctor that you want to visit. Usually you need to pay a deductible amount when you go for such a health insurance plan.

Types of dental insurance plans

Like health insurance, there are also different dental insurance plans and you can choose one that suits your specific needs and requirements. The plans are discussed below.

• Dental HMO plans – Dental Health Maintenance Organization plans are usually referred to as prepaid plans wherein you need to choose one dentist/dental facility in order to coordinate all your oral health needs and requirements. Under this plan, your primary care dentist has to refer you if you need to visit a specialist.

• Dental PPO plans – If you choose Dental Preferred Provider Organization plan, then you’ll have to pay a certain percentage of a reduced rate when you visit a dentist from your PPO network.

• Fee-for-service plans – You’ll get greatest choice of dentists if you choose fee-for-service or indemnity dental health plans. However, you may have to pay more for your dental care if you choose a fee-for-service plan in comparison to what you may have to pay for a PPO plan.

If required, you can ask for an Independent Medical Review (IMR), wherein independent medical professionals, who are experts in the field, can review specific medical decisions that are made by the insurance company. CDI (California Department of Insurance) administers this IMR program. However, you cannot use IMR regarding any issue on the coverage offered by an insurance company.