Frequently Asked Questions
Full-Time College Student on Parent’s Plan
Information Requested (Individual Medical)
What are HMOs (Health Maintenance
HMOs are an alternative to commercial insurance that
stresses preventive care, early diagnosis and treatment on an
outpatient basis. HMOs are licensed by the state to provide care
for enrollees by contracting with specific health care providers
to provide specified benefits. Many HMOs require enrollees to
see a particular primary care physician (PCP) who will refer
them to a specialist if deemed necessary.
What are PPOs (Preferred
plans allow you to choose a doctor or hospital from a list
of “preferred” providers in order to receive full benefits.
If you go to a doctor or hospital that is not on the list, the
plan may cover a smaller percentage or none of your costs. Check
with the insurance carrier BEFORE you use the plan to make certain
your physician or hospital is a contracting provider. Make certain
your doctor refers you to other providers who are on the list,
or who the carrier agrees to pay at the “preferred” rate.
My child is a Full-time
College student. Will my health insurance plan cover them?
medical plans cover full-time college students under their parent’s
group medical plan until the child turns age 24, regardless of
whether or not they live at home. Read your policy carefully
to understand how your particular insurance company handles full-time
college students and to what age they are covered. If your plan
is an HMO and your child's college is far from home, accessing
an approved provider may prove difficult. As an alternative,
consider purchasing health insurance coverage through your child's
college. Many colleges and universities offer low-cost health insurance
for students. Cost and level of coverage vary greatly from one
school to the next, but school-subsidized health insurance is often
less expensive than continuing coverage through your existing health
plan. Since health care is typically provided on-campus, it may
be easier for the student to access.
Can I return my policy?
you are accepted for individual coverage by an insurer, you have
a "free look" or review period which varies from 10 to
30 days. If you decide you do not want the policy, return it by certified
mail within the required period of time and request a full refund
of the premium paid. Employer group plans do not have a "free
What is the Birthday
When both spouses have health insurance that covers
their children, the birthday rule applies. The birthday
rule helps insurance companies coordinate benefits, assuring
that a medical bill is not reimbursed for more than 100% of the actual
cost of a claim. To prevent this, insurance companies typically designate
one parent's health insurance plan as the primary plan and the other
as the secondary plan. (That's why the patient questionnaire at your
doctor's office asks for information on primary and secondary coverage.)
The primary plan is responsible for paying covered expenses up to
the limits of the policy. If any unpaid costs are left over, the
secondary coverage kicks in. The birthday rule is often
used to determine which plan is primary and which is secondary. Under
this rule, the plan of the parent whose birthday occurs first in
the calendar year is designated as primary. The date of birth is
the determining factor, not the year. So it does not matter which
spouse is older. Like most rules, the birthday rule has
exceptions: If both parents share the same birthday, the parent who
has been covered by his or her plan longest provides the primary
coverage for the children. If one spouse is currently employed and
has health insurance through a current employer, and the other spouse
has coverage through a former employer (e.g., through COBRA), the
plan belonging to the currently employed spouse would be primary.
In the event of divorce or separation, the plan of the parent with
custody generally provides primary coverage. If the custodial parent
remarries, the new spouse's coverage becomes secondary. Read your
policy carefully to make sure you understand how your insurance company
handles dual coverage.
When I apply for
Individual insurance, what information will the insurance carrier
Insurance carriers screen applicants for individual
health insurance; so you will be asked to complete an application
and answer questions on your medical history. If your information
is incomplete or inaccurate regarding health history or age,
the company may deny benefits or rescind your coverage. Companies
frequently ask physicians for medical records and may require
you to take additional physical exams or blood tests. However,
they cannot ask you for an HIV test, except for disability
income and life insurance. People with anything serious in
their medical background may be charged a higher price for
coverage or may denied health insurance coverage at any price.
What is COBRA Continuation
COBRA is an extension of medical insurance benefits
for terminated employees and their dependants. For a thorough explanation
of COBRA continuation health visit the U.S. Department of Labor’s COBRA webpage.
What is Cal-COBRA Continuation
Cal-COBRA extends COBRA-like benefits (i.e. continuation
of coverage) to employees and dependent spouses and children of firms of less
than 20 employees. For
further information, visit the Cal-COBRA Highlights webpage.
What is Tonik?
Tonik Health was created by
the largest health insurance company in California. TONIK is a brand
name referring to Blue Cross of California’s Individual health
plans specifically designed to appeal to and service the active lifestyle
needs of nineteen to twenty-nine year olds.
How much does Blue Cross’ Tonik Cost?
varies based on your zip code and age. Click on get an instant
Tonik Health Quote If you have previous medical conditions you
may be asked to pay a little more.
Do you have to be younger than 29 to qualify
No, while TONIK is marketed towards young
adults between the ages of 19-29, anyone under 65 can apply and
How long will it take me to be approved
If Blue Cross of California requests additional
information in order to review your medical history, it will
take a little longer. Otherwise, most of our TONIK applicants,
without a previous health conditions, are approved in just one
What are the three TONIK plans and how
are they different?
TONIK plans are the "Thrill Seeker”, the "Part-Time
Daredevil” and the "Calculated Risk Taker.”
How do I Apply for Tonik?
Either contact a Sales Associate or apply on-line.
What is an HSA?
Health Savings Accounts (HSAs) are tax-advantaged personal savings
accounts that may be established in combination with HSA eligible
high-deductible health plans. HSAs were approved with the passage
of the Medicare Prescription Drug, Improvement and Modernization
Act of December 31, 2003. HSAs are available to all market segments,
including individual and family plans, and small, midsize and large
groups. Almost everyone with an HSA-eligible high-deductible health
plan can get an HSA. Funds in HSAs may be accumulated over the
years and may be distributed on a tax-free basis to pay for, or
reimburse, qualified medical expenses. The remaining covered medical
expenses are then paid as indicated by the has-eligible high-deductible
health plan. Clients should be advised to contact their financial
or tax advisors for more detailed information on HSAs, including
information about how to establish a new HSA or how to replace
an existing MSA.
Who can establish an HSA?
Individuals or eligible employees can establish
an HSA if they: are covered by an HSA-eligible high-deductible health
plan on the first day of the month that they establish the HSA. Could
not be eligible for Medicare benefits but do not have Medicare coverage
are not listed as a dependent on another individual's tax return.
Individuals or eligible employees cannot establish an HSA if they
are covered by a health plan that doesn't qualify as an HSA-eligible
high-deductible health plan, except for permitted insurance.
What advantages do HSAs have over Medical
Savings Accounts (MSAs)?
HSAs are portable. HSA-eligible
high-deductible health plans have lower deductible requirements and
higher out-of-pocket limits than MSAs, making the accounts more flexible
and accessible than MSAs. HSAs, unlike MSAs, may be offered as part
of an employer's "cafeteria" plan.
HSA tax-deductible contribution limits are greater than those for
MSAs. An employer and employee are both permitted to contribute to
an HSA in the same year (unlike MSAs where either the employer or
employee may make contributions in the same year, but not both). "Catch-up" contributions
are allowed for HSAs for people between the ages of 55 and 65 (starting
at $500 per year in 2004).
What is an HSA-eligible high-deductible health
To qualify as an HSA-eligible high-deductible health plan
a plan must satisfy certain requirements with respect to deductibles
and out-of-pocket maximums. See the table below for specific requirements.
Individual At least $1,000 Not to exceed $5,000 Family At least $2,000
(Deductible applied to the family as a whole - family must incur
covered medical expenses in excess of $2,000, or minimum family deductible
if higher, before plan benefits are paid to any member of the family)
Who may contribute to an HSA?
HSAs are open to almost everyone with an HSA-eligible
high-deductible health plan. Eligible and qualified individuals,
employees and employers may contribute to an HSA. In addition, contributions
can be made by others on behalf of the individual covered by the
HSA-eligible high-deductible health plan with the contributions deductible
by the covered individual (May 15, 2004, Treasury Guideline).
What are the limits for contribution to
According to the Treasury/IRS
guideline dated May 15, 2004, "Annual HSA contribution limits in 2004 are the lesser
of: 100% of the deductible amount on the accompanying high-deductible
health plan; or $2,600 for self-only accounts and $5,150 for family
accounts (these dollar amounts will be indexed for inflation in future
years)." The amount is also reduced by any contribution to an
existing Archer MSA.
What are the limits for contribution to
Visit the U.S. government HSA webpage.