California Health Insurance


You have just completed an online form requesting a free health insurance quote, and moments later, you are being inundated with phone calls from insurance agents hoping to get your business. Try not to become overwhelmed or annoyed by these “pesky sales people” because they are not telemarketers. Most of them are well-trained state-licensed professionals who can help you make the right decision regarding which health plan is the best and most affordable for your individual or group coverage needs.
You may be under the misconception that if you buy your health plan directly from the insurance company, and cut out the “middle person,” you will save money. This is not the case. Insurance companies rely on agents for most of their business, and that’s why they pay them commissions for bringing in customers. It does not cost a consumer one penny more to use a licensed California health insurance agent to obtain their insurance coverage.
There are many differences between California health insurance and other states, including how it is applied.
For example, while Blue Cross and Blue Shield are one company in other states, here in California, each is separate and applied to individually as Anthem Blue Cross of California and Blue Shield of California.
California health insurance law AB 1672 is an improvement over the federal HIPAA law that covers all states in that it includes the following concerning California group coverage:

  1. Individuals with pre-existing medical conditions may change over to a new group health plan without an exclusionary period.
  2. It allows small businesses and professional organizations to have access to health plans providing they have between 2 and 50 full-time employees.
  3. It keeps insurance rates from climbing after a claim is filed.
  4. Employees who have health problems may change jobs or health plans without being rated higher for having pre-existing conditions.
    That said, the very best health insurance agent for your individual and business needs is an “Independent Agent.” Why? Because they represent multiple insurance carriers, not just one. An independent agent can help you select the most appropriate cost-effective plan offering the most benefits for your dollar as available from the major carriers, rather than feeding you just one company’s line of health plans, which may not suit your particular needs. Many people are too complacent and settle for what their current insurance company has to offer. They could use a right independent agent to sort through the many plans available from multiple insurance carriers to find and provide the best choice of options.
    Another misunderstanding you may have is that insurance agents set the premium rates for the health insurance plans they sell. Thinking if you shop around, you may get a better price for the same program. Excellent rates are based on your age, zip code, or county in which you reside and are entirely controlled by the insurance companies. Every agent uses the same rate guides set by the insurance companies. The condition of your health may affect your premium, which may be rated up after the insurance company’s underwriting department has reviewed your medical records. Again, the insurance company, not the agent, determines that outcome.
    Now, let’s talk about the benefits of having the right insurance agent representing you. Most consumers neither know nor understand the benefits of a health plan being offered and need the expertise of an agent to explain the benefits to them in full. For example, do you know what the difference is between an “out-of-pocket maximum” and an “annual deductible?”
    An out of pocket maximum is the most you will have to pay in a given year for deductible and coinsurance for covered benefits before your insurance starts to pay 100% of most expenses until the year ends.
    An annual deductible is usually the amount you pay each year before your health plan starts paying anything for covered services. Generally, the higher the deductible, the lower the premium. Individual functions, such as prescription drugs, carry separate deductibles. Plans may vary, and sometimes benefits will kick in before you have to meet the deductible.
    A knowledgeable health insurance agent can be a guide through the maze and help you choose the right plan to meet your needs and budget while obtaining the most benefits for your dollars spent. An agent will also make clear how the benefits of a generic prescription may differ from the benefits of a brand prescription on a particular plan.
    After you have a health plan in place, a right, caring agent will remind you to pay your premium on time, so the insurance company doesn’t cancel you. Your agent can also be an enormous resource for assistance if you run into a problem with a health insurance claim. Instead of waiting on hold at the insurance company’s 800 number for thirty to forty- five minutes, call your agent and explain your problem and if you have chosen the right agent, you will get help. You may save yourself lots of time and frustration, maybe even some money by having an expert in your corner where your best interests come first.
    My name is Diane Le Montre, License # 0D18343, your California Health Insurance Specialist with more than 25 years of experience. I am an Authorized Independent Agent for the major California health insurance companies, including Anthem Blue Cross, Blue Shield of California, Health Net, Cigna, Aetna, UnitedHealthcare, and Kaiser.
    Let me guide you through the maze of obtaining proper health insurance coverage for you, your family, or business with an individual or group plan based upon your specific needs. I will find the best coverage for your insurance dollar by analyzing the various programs of the major insurance companies I represent.
    My experience of having worked for insurance companies as a health insurance claims auditor and being an independent health insurance agent gives me the advantage of knowing the health insurance business on both ends, from coverage to claims.

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