Blue Cross of California Lumenos Plans

Blue Cross of California hit the nail right on the head with their release of the Lumenos plans. These plans speak directly to the healthy individual who seeks an affordable monthly premium with great catastrophic protection.

Preventative care is covered at no charge (provided you see an in-network-provider) making this an ideal option for the individual who rarely sees a doctor but 1-2 times a year. This means you incur no cost for procedures such as annual physical exams (for women this includes pap and mammogram). You can also purchase the Lumenos plans with or without maternity making it flexible for either gender’s needs.

These plans are HSA compatible. With an HSA (Health Savings Account) you can make tax deductible contributions to your account, and withdraw the money tax-free to pay for qualified medical expenses, including prescription drugs. An HSA will help you budget for medical expenses and not be taxed on your savings if you choose to fund them. Please take a look at my post on HSAs to get the full scoop on how they can benefit you.

Lumenos deductible options

• 1500 (3000 family)
• 3000 (6000 family)
• 5000 (10,000 family)

If you would like more detailed information on the Blue Cross Lumenos Plans (including rates) please feel free to contact me!

California Dental Insurance

California dental insurance plans typically offer $500-$1500 in maximum benefit per year. When it pertains to major oral surgeries this does not offer a whole lot of coverage. This is mainly due to the fact that dental insurance in California focuses more on preventative care to “prevent” large dental claims. While it is still better to have a California dental insurance plan than not, it is always wise to evaluate your options before you buy. If you do not understand your options it is best to have a California insurance agent help guide you.

In this blog post I am going to analyze a couple of the larger California dental insurance companies to help you make an informed decision when it comes time to purchase one of their plans. Many people have chosen poorly when it comes to their dental benefits; if you take the time to understand what is covered before you buy then you won’t have any surprises when you receive the first bill from the insurance company.

Today I will be covering California dental plans offered through Blue Cross of California and Delta Dental of California. In my opinion these are the 2 best stand alone carriers that will offer you dental insurance without having to already be enrolled on one of their health insurance plans.

The Dental Blue 100 Basic with Blue Cross of California

With the monthly premium at $20 per individual and $65 per family this California dental insurance plan has some serious value. It is perfect plan for the individual that only sees a dentist twice a year for 2 semi annual routine cleaning visits. With this plan you may seek care with any dentist that is a member of the Dental Blue 100, 200 or 300 Network but the savings will be the best within the 100 Network (contact me for details). You will have a $25 deductible (waived for preventative and diagnostic care if in network) and a $500 annual benefit max per year.

Preventative and Diagnostic Services (covered at 100%)

• Cleanings
• Exams
• X-rays
• Sealants
• Space Maintainers

Basic Services

• Fillings
• Stainless steel crowns for primary (baby teeth) and pulpotomies

Unfortunately there is no coverage for major services and Orthodontics under the Dental Blue 100 Basic plan but you will still receive a negotiated fee discount if you undergo major services with a Dental Blue provider (for more information on this please contact me).

Major Services Include

• Oral Surgery
• Endodontics
• Crowns (for adult teeth)
• Prosthodontics

If you require more care than the Dental Blue 100 Basic can offer you will most certainly want to take a look at the 3 other Dental Blue plans available. The Dental Blue 100 Plus, Dental Blue 200 Plus and the Dental Blue 200 essential will all cover major services but the waiting periods (the time you must be active on the plan before you can receive coverage benefits) range from 6 months to a year (please contact me for full details).

DeltaCare USA program with Delta Dental of California

The DeltaCare USA plan is an HMO program that provides comprehensive dental care (both preventative care and major services). It is a great match for someone that does not have a current dentist because it does not work like a PPO network. The HMO network is of course much more limited than the PPO but the coverage is much richer. There are no waiting periods and no coverage limit! Most PPO dental plans have a $1000 maximum benefit making the DeltaCare HMO plan a very wise choice provided you can find a close provider in your area of residence (for help locating your closest dental care facility please contact me).

What do the premiums look like?

• For a single individual you will pay an annual fee of $97 plus a one time enrollment fee.

• Enrollee plus dependent $155 ($15 one time fee)

• Enrollee plus 2 or more dependents $225 ($15 on time fee)

Like the Dental Blue 100 Basic, preventative and diagnostic care are covered at no charge. There are many different major services which of course you will pay a specific co-pay amount. For more information on this please contact me and I will email (or mail) you a free brochure that describes the DeltaCare HMO in full detail.

California Health Insurance

In the world of California health insurance the average Californian will generally have many health care options available to them. The more health conditions one may have will of course limit these options but it is still important that you speak with a licensed health care professional who can keep you informed. Occasionally I will speak with a client who thinks they are uninsurable only to find that, after submitting their application they get approved at a slightly higher premium. Those people who do get turned down have the option of the MR MIP plan. MR MIP (Major risk medical insurance plan) is a government run health insurance policy that is funded through tobacco taxes. You can expect an inflated premium for the MR MIP plan due to it being a guaranteed issue plan that covers you regardless of health status. Uninsurable people may find they can work this plan into their budget with a little planning. It never hurts to ask for the details! My services are always free of charge and you will always get the most up to date accurate information.

Many Californians will shop around on the internet in order to find the cheapest monthly premium available. While I commend these people for taking the initiative to do their own health insurance research; many never thoroughly examine the health insurance plan at the time they purchase it. A simple glance at the health plan benefits is not enough! Try to imagine yourself in a few different emergency situations, and then ask a customer service representative (with the insurance company) or your insurance agent to explain how specific catastrophic situations will be covered.

California health insurance plans that you see marketed as though they are gold usually have some serious pitfalls to them. The paragraphs below are examples of current plans that are highly marketed because of cheap premiums. I am going to take a few moments and analyze these plans to show you their pitfalls. I’ll make up a few accident scenarios so you can see exactly what kind of coverage you will get on these highly marketed plans. For privacy reasons I cannot disclose the name of insurance carriers or the plan title but I asure you the following story is based off of a real insurance plan that is currently being marketed today!

Andrew and his wife decided to go skiing in Lake Tahoe for a weekend. A few months before their weekend get away Andrew put his wife and himself on Health Plan Plus 900 deductible (name must be changed due to law...but this plan is real and currently being sold in 2009). On the way down the mountain Andrew falls off his skis breaking a leg and fracturing a wrist. The ambulance ride, x-ray, lab and hospital stay rack up a bill of $4000. With the $900 deductible already satisfied Andrew is left with $3100 which the Health Plan Plus 900 will cover at 60% leaving him with a total out of pocket cost of $2140.

But wait…

Andrew was administered Vicodin and Oxycontin medication due to the pain. While the Health Plan Plus 900 covered the Vicodin at a $10 co pay the Oxycontin was a brand named prescription; brand named prescriptions are not covered and Andrew ended up paying the full price at $100. A month later he had to refill the Oxycontin Rx racking up a total cost of $210 in prescription medications!

There is more…

There is a limit of 2 office visit check ups on the Health Plan Plus 900. The first 2 follow up office visits for his wrist and leg were covered at a $40 co pay. Andrew ended up being in a cast for 6 weeks, he needed roughly 3 more follow up check ups for physical therapy sessions once his cast came off. Since Andrew already exhausted his 2 office visit maximum for the year he ended up paying the full amount for each therapy session at $200 each. All five office visits combined totaled $680, none of this amount applied to the co-insurance maximum for the year. This means Andrew only satisfied $2140 of a $4900 out of pocket max for the year (the office visits and Rx co-pays on the Health Plan Plus 900 do not count towards the deductible and out of pocket max). If Andrew has another accident this year he must satisfy another $2760 in out of pocket cost to reach the maximum of $4900. An accident means he must be admitted to the hospital for the $2760 to be satisfied, Rx co-pays and office visits won’t count.

I hope this example will show you the dangers of a plan like the Health Plan Plus 900. Of course, it is better to have this insurance plan than nothing at all but with a quick assessment of your options J.C. Lewis Insurance Services can help find you the right coverage at the right price!