Best Health Insurance Agencies in Pleasanton

FAQs

• Introduction

  If you're looking for health insurance for yourself or your family, an agent can help you save time, understand your options, and manage your costs. Insurance agents must be licensed in the state where they operate. They can provide information about on- and off-exchange plans to help you weigh all of your options, and they can see if you qualify for tax credits that can lower your monthly premiums. There's no cost to work with an agent, and they can help you save quite a bit by recommending the best plan for your needs. Here's what you should know before you get started.
  

• How does one file a report for health insurance fraud in Pleasanton?

  Depending on who committed the act, there are two ways to report health insurance fraud in Pleasanton. Contact the Fraud Division at 916-854-5760 if you wish to file a complaint against an employer, employee, medical or legal practitioner, or insurance company. If you want to report insurance agent or broker fraud, contact the Investigation Division at 1-800-927-4357.

• When must a health insurance company in Pleasanton decide whether or not to honor a claim?

  According to Insurance Code sections 10123.13 and 10123.147, health insurance carriers in Pleasanton and the rest of California must either pay a covered health insurance claim or notify the insured and the healthcare provider within 30 working days. The notice should state if the claim is contested or denied, along with the reasons for the decision. Claims not paid within the 30-working-day window will incur interest at 10% per year.

• What options does a Pleasanton employee have if they have lost or are about to lose their employer-based health insurance?

  In the event that your employer in Pleasanton no longer pays for your health insurance, you can maintain your current policy by paying the full monthly premiums. There are four types of continuation coverage: COBRA, Cal-COBRA, Conversion, and HIPAA. Employer-sponsored health insurance can be prolonged through these initiatives, although it is also recommended to look into individual or family health insurance plans.

• Does a Pleasanton individual need to retain the services of a lawyer to make a claim on his health insurance?

  Not necessarily. Simple and uncomplicated health insurance claims are unlikely to require the services of an attorney. You can also file an appeal or dispute with your insurer by contacting them directly. However, if your initial application for benefits was unfairly rejected, a lawyer can assist you in submitting an appeal and defending your rights and interests.

• What are the reasons for health insurance claim denial in Pleasanton?

  Some situations, including self-inflicted injuries, pre-existing conditions, and unnecessary cosmetic procedures, may be excluded from coverage. In addition, your health insurance claim may be denied if you fail to seek immediate medical attention or exacerbate injuries through irresponsible conduct. A claim may be denied if you intentionally injure someone. Unsupported claims and late premium payments can also lead to refusal. Lastly, Pleasanton insurers may cancel a policy and reimburse premiums if the initial application contains serious errors or omissions.

• How can you find affordable health insurance? 

  Affordable insurance is available through employers, Medicare, Medicaid, and the federal Health Insurance Marketplace, which offers subsidies in the form of tax credits. You can also purchase coverage through private insurance companies and independent agents. Nearly half of all Americans have employer-sponsored health insurance, and about 10% of the population is uninsured.

• What is health insurance?

  Health insurance policies are contracts that require an insurer to pay some or all of a beneficiary's health care expenses in exchange for a premium and deductible. Plans cover preventive care and emergency medical services arising from an injury or illness. They may also offer optional coverage for dental and vision.

• How do health insurance companies make money?

  Health insurance companies make money by collecting premiums from consumers and reinvesting the funds. Federal law requires insurers to put approximately 80-85% of collected funds toward claims, and 15-20% is used to pay for administrative expenses.

• What is subsidized health insurance?

  Subsidized health insurance is available exclusively through the Health Insurance Marketplace. This system applies federal tax credits that can reduce or eliminate premiums. Tax credits are available to consumers who earn up to 400% of the federal poverty level based on household size.

• What is a health insurance deductible? 

  A deductible is a fixed amount you must pay out-of-pocket before normal copays or coinsurance rates apply. Under the Affordable Care Act, some services, such as annual physicals and wellness screenings, must be covered at no charge.

• Is it illegal to not have health insurance?

  No. Starting in 2019, the federal government eliminated the penalty that applied to individuals who could afford health insurance but chose not to purchase it. Financial penalties still apply in California, Massachusetts, New Jersey, Rhode Island, Vermont, and Washington, D.C.

• Does health insurance cover therapy? 

  All Marketplace plans must cover behavioral health care services, including counseling, inpatient care, and substance abuse treatments. However, there are coverage limits, and preauthorization may be required.
  

• What is a copay?

  A copay is a fixed price that you pay at the time of service after your deductible is satisfied. Insurance companies set specific rates for primary and specialty care and other services, such as emergency room visits and X-rays. Alternatively, plans may have coinsurance rates that require beneficiaries to pay a certain percentage of covered charges.

• What is the Health Insurance Marketplace?

  The Health Insurance Marketplace is a federal service designed to help consumers compare and purchase subsidized health insurance plans that comply with the Affordable Care Act. A number of states operate their own insurance marketplaces, including California, Colorado, New York, and Pennsylvania.
  

• How can you find health insurance without a job?

  Individuals who don't have access to health insurance through their job can purchase ACA-compliant plans through the Health Insurance Marketplace. Off-exchange plans are also available through private insurers and independent agents. The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives certain individuals who are losing their coverage the right to maintain the same plan for a limited time period. 
  

• Can you cancel health insurance at any time? 

  Consumers can cancel their health coverage at any time. Cancellations may be effective immediately or at a specified date. However, you must wait until Open Enrollment to sign up for a new plan unless you qualify for a Special Enrollment period.

• Can you have more than one health insurance policy?

  It's possible to have primary and secondary health insurance. This is most common with Medicare and Medicaid beneficiaries, including dual enrollees and individuals who purchase supplemental plans. Secondary plans can cover some additional expenses, but you're still responsible for premiums and deductibles.

• Is health insurance pretax?

  Premiums for employer-sponsored health plans are generally deducted from the worker's pretax income. The same is true for voluntary contributions made to Flexible Spending Accounts and Health Savings Accounts that are paired with a qualifying high-deductible health plan.

• How long can a child stay on a parent\'s health insurance policy?

  Children can stay on their parents' health insurance plan until their 26th birthday. There's a 60-day special enrollment period following this date. Exemptions allow disabled adult children to remain on their parents' policy beyond this age.

• Do you have to pay a health insurance deductible upfront?

  In most cases, out-of-pocket expenses for approved services count toward your deductible. However, it's increasingly common for hospitals to request all or part of the deductible upfront when scheduling major services, such as CT scans and surgeries.

• Do employers have to offer health insurance?

  The Affordable Care Act requires companies with at least 50 full-time employees to make essential health benefits available to 95% of their workforce. Companies that choose not to offer such benefits may have to pay a penalty.

• Is there a tax credit for having health insurance?

  The Advance Premium Tax Credit is a federal tax rebate designed to lower the cost of health insurance plans purchased through the Marketplace. Eligibility is based on income and household size. Consumers can decide how much of their tax credit to put toward their premiums.