Health Insurance FAQs
Is it required to buy health insurance? Is there a penalty if I don't purchase health insurance?
In 2019, the Trump Administration repealed the health insurance individual mandate, removing the fine for not having health insurance.
If you apply for health insurance through Covered California, you will still have the opportunity to apply and qualify for subsidies. The Open Enrollment Period for purchasing health insurance in 2019 starts from October 15, 2018 and ends on January 15, 2019. If you would like your policy to become effective on January 1, 2019, then you will need to enroll and submit your application by December 15, 2018.
During this Open Enrollment Period, you can also update or change your health plan if you would like to do so. If you miss this time period, you will not be able to purchase health insurance at any point for the rest of the year, unless you qualify for special enrollment.
What is the penalty if I don’t have health insurance?
Penalty is one or the other; whichever one has the higher amount
% of Household Income
Adult: $95/Adult Child: $47.5/Child Up to a maximum of $285
Adult: $325/Adult Child: $162.5/Child Up to a maximum of $975
Adult: $695/Adult Child: $347.5/Child Up to a maximum of $2,085
Do I qualify for special enrollment?
You qualify for a special enrollment period 60 days following certain life events including:
- Legal separation or divorce
- Marriage or domestic partnership
- Cessation of dependent status (attaining the maximum age to be eligible as a dependent child)
- Birth, adoption, or placement for adoption
- Loss of coverage due to termination of employment or reduction in the number of hours of employment
- Relocating to California
- Returning from military active duty
- Release from incarceration
Do I qualify for federal subsidies?
Covered California and the IRS are connected in the sense where Covered California uses the household income and household size on the 1040 tax form to calculate health insurance premiums and check for eligible federal subsidies for the applicant.
Based on your annual household income, you may qualify for federal subsidies in the form of Medi-Cal, premium assistance, or cost-sharing reductions.
As long as you are a resident with a taxable income, you are required to have health insurance whether it’s through your employer, Covered California, etc. If you do not, you will be penalized and fined. To determine whether you qualify for premium assistance, please refer to the chart below:
What are HMO, EPO and PPO?
Here are the main differences among the three plans:
|Must choose a primary care physician||Y||N||N|
|Referrals are required to see specialists||Y||N||N|
|Benefits outside medical network||N||N||Y|
When choosing a health plan, take into consideration you and your family’s needs. If you have a primary care physician you want to see, make sure your primary care physician is in that network.
Which health insurance plan is right for me?
As you look for an individual plan, you might be asking yourself: What plan is right for me? Which plan do people like me choose?
If you’re a person who is in good health, you might want to consider a high-deductible PPO that’s compatible with a Health Savings Account. This option is best for people who seldom visit the doctor, and are looking for major medical coverage.
If you’d rather have more comprehensive individual health insurance coverage, such as preventive care coverage, consider a PPO or HMO plan with a lower deductible. You might not be able to use an HSA, but you’ll have coverage for routine doctor’s office visits and other preventive care. Typically, you’ll pay between $10 and $40 for a doctor’s office copayment depending on your plan. With this type of plan, you’ll also have major medical coverage.
Even if neither suggestion seems right for you, there are plenty of other options to choose from. What’s the best way to find out which individual health insurance plan is right for you? Get free quotes and get expert advice from a professional agent.
Which health insurance plan should I choose?
There are three types of plans: HMO, EPO, and PPO. In order to ensure that your family member receives the most health benefits at an affordable cost, please consult KCAL Insurance, a Covered CA Certified Insurance Agent, to help you find the most suitable health plan for you.
There are plenty of individual health insurance plans to choose from. Here are the most common types:
HMOs (Health Maintenance Organization). HMOs are one of the most affordable health plans available, and they offer comprehensive coverage. HMOs create networks of doctors, hospitals, clinics, specialists, and other care providers. Most HMO networks consist of thousands of health care professionals, ensuring you’ll have convenient access to medical care when you need it.
PPOs (Preferred Provider Organization). PPOs are affordable individual health insurance plans with an added benefit – you’ll have coverage with any health care provider. That means you can see any doctor or specialist you want, and your plan will cover the care. PPOs are great for flexible, comprehensive, and affordable health care.
Health Savings Account (HSA) Plans. There are 2 parts to HSA coverage: a high-deductible plan and a Health Savings Account. The high-deductible plan provides catastrophic coverage and features low monthly premiums. The HSA is a tax-free savings account where you save money to pay for routine medical expenses.
Fee For Service (FFS) Plans. FFS plan is a traditional form of individual health insurance. You get the care you need and then you’re reimbursed for a percentage of the cost.
What are Obamacare's Essential Health Benefits?
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription Drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including dental and vision care
Related reading: Take Advantage of Obamacare’s 10 Essential Benefits
When can I apply for health insurance?
The 2019 Open Enrollment Period starts on October 15, 2018. Please feel free to contact us at KCAL! We’d be more than happy to help you enroll or switch insurance plans for 2019!
Open enrollment for Covered California health insurance plans happens once a year. During this open enrollment period, individuals can enroll, switch plans, and get subsidies. Unless you meet special conditions, open enrollment is the only time of year you can get a major medical plan that counts as minimum essential coverage in the individual and family market.
Can I apply for healthcare at any time?
Unless you qualify for special enrollment, you can only purchase health insurance during the Open Enrollment Period, which occurs only once a year.
The 2019 Open Enrollment period starts on October 15, 2018 and ends on January 15, 2019. If you would like your insurance policy to become effective on January 1, 2019, then you must apply by December 15, 2018. If you apply by January 15, 2019, then your new policy will become effective on February 1, 2019.
How can I apply for health insurance?
KCAL Insurance is a Covered CA Certified Insurance Agent, with more than 100 insurance agents. We are professionally trained to help you choose a health plan that is most suitable for you and to help you apply for government premium assistance. If you wish to apply for Covered CA, please bring the following documents to any KCAL office for our agents to assist you:
- Social Security Number (SSN) of entire household
- Proof of citizenship (U.S. passport) or proof of residence (i.e. green card) for entire household
- 2018 tax forms
- Proof of wages from the past month
If you are already a Covered CA member, please bring the additional documents with you when you come to our office:
- Current health insurance information (insurance card)
- Covered CA renewal notice that you received in the mail (green envelope)
How do I calculate my monthly premium and subsidy amount?
Covered CA partners with the IRS to determine the premium and subsidy amount based on a family’s household income, which is reported on the 1040 tax form each year.
How can I lower my monthly premium?
Move to a higher deductible plan. If you are a young, healthy individual who doesn’t anticipate any major health problems, you may want to switch to a higher deductible. Your premium will become significantly lower! However, if you are certain of high medical expenses, then the opposite would apply. You may want to switch to a plan with both a lowest possible deductible and lowest out-of-pocket expenses.
What will my deductible be?
Whether the insurance is individual or group, the amount of the deductible is determined at the time the policy is written and is decided by the person, group or business which sets up the health plan. You will also have out-of-pocket expenses besides the deductible mentioned above. These include the percentage of fees your plan does not pay and any uncovered medical services not included in your insurance policy.
How can I insure just my child?
When getting quotes for your child(ren) only, enter the child’s gender and birth date in the “Applicant” or first row. Additional children should be entered below in the “Child” rows, but not the “Spouse” row.
However, many health insurance companies require one policy per child. So if you have more than one child, try entering just one child to see a larger selection of plans and prices. Feel free to apply for each child separately.
When should I consider a Health Savings Account (HSA)?
Health Savings Accounts (HSAs) are becoming increasingly popular due to their flexibility and immediate tax savings. This plan is suitable for people who seldom need medical care but would like to prepare for any catastrophic ailments or injuries. Who is eligible for Health Savings Account?
- Not entitled to benefits under Medicare
- Be covered under a high deductible health plan
- May not be covered under any health plan that is not a high deductible health plan
- Not be claimed as a dependent on another person’s tax return
What are the advantages?
- Contributions to the account are tax deductible
- Amounts in an HSA belong to the individual and are fully portable
- Amounts in an HSA earn tax-free interest
- Unused amounts in the account at year-end remain available for future years
- Distributions are not taxed if used for qualifying medical expenses
Who should buy individual health insurance?
Anybody who does not have insurance. This may be for several reasons:
- People who work for a small business that does not provide a health plan.
- Those who do not obtain individual health insurance.
Can individuals with pre-existing conditions apply for health insurance?
Yes. Beginning in 2014, insurance companies can no longer deny coverage to individuals based on pre-existing conditions.
Workers’ Compensation Insurance FAQs
What is Workers' Compensation Insurance?
Workers’ Compensation Insurance is required in most states when you have W-2 employees. In some states the requirement may include that you cover your 1099 contractors. Workers’ Compensation insurance covers your employees’ medical and disability expenses caused by work-related illness and on-the-job injuries. In some states, owners, officers, partners and other principals can decline to participate in their own companies’ workers’ compensation coverage.
Employer’s Liability coverage, also included in these policies, protects your company in the event that an employee claims that his or her injury or illness was caused by your company’s negligence or failure to provide a safe workplace.
What are the benefits of Workers' Compensation Insurance?
Workers’ compensation insurance provides for the well being of your employees and promotes a positive work environment. Be aware that some states have passed laws that make workers’ compensation mandatory once a business expands to four or more employees on payroll. Workers’ compensation insurance was created in order to pay employees’ medical expenses and loss of wages in the event of a job related injury or sickness.
What does Workers’ Compensation cover?
Workers’ Compensation Insurance covers all employees’ approved medical costs, temporary and permanent disability payments, and death compensation caused from work-related injuries or illness.
What are the penalties for not having Workers’ Compensation?
If the Division of Labor Standards Enforcement (DLSE) determines that an employer is operating without workers’ compensation coverage, they will face fines and penalties:
1. The DLSE can issue a stop work order and require employers to cease all business operations at the worksite until they furnish proof of workers’ compensation insurance.
2. Employers are still required to pay salaries until they reopen.
3. The DLSE will assess a penalty of a minimum of $1,500 up to $100,000 per employee.
4. If an employee gets hurt or sick because of work and the employer is not insured, the employer is responsible for paying all the bills related to the injury or illness.
How is workers’ compensation premium calculated?
Premiums for workers’ compensation insurance are calculated by the formula below:
Payroll x Classification Rate x Experience Modifier = Premium
Workers’ compensation premium is based on the estimated amount of payroll paid to employees during the 12-month policy period. Employers can make a single payment or in a monthly installment.
After the 12-month policy has lapsed, insurance companies will require employers to check the actual payrolls that were paid to employees, which could result in additional premiums being due or a decrease in premiums at the end.
Do I need to post a Labor Law Poster?
California law requires employers to post an updated Labor Law Poster annually in a conspicuous place where employees can easily see it during the workday. Any employer that fails to post the poster may be subject to citation and penalty up to $10,000.
The poster must state the name of the current workers’ compensation insurance carrier, the policy number and contact information. Employers also have to put the information of the workers’ compensation network next to the Labor Law Poster.
How do I get the Labor Law Poster?
You can get a free Labor Law Poster from our branch nearest you, or call us at 1-800-681-8288.
Auto Insurance FAQs
Am I covered under my personal policy if I also use my auto for business?
If you own your car and simply drive to and from your principal place of business, this is considered personal use and will be covered under your personal policy.
If in addition to commuting to work, you also use your vehicle for other business-related driving, such as traveling on sales calls or carrying tools, supplies, and equipment to a job site, this is considered business use. It may or may not be covered under your personal policy.
To ensure that you have the appropriate insurance for your needs, consult with a qualified insurance representative and check your policy for restrictions.
If I borrow someone else's car, what insurance pays?
If you’re driving someone else’s car and you get into an accident, the insurance on the borrowed car would be prioritized to pay for damages first. Your own auto insurance will serve as a secondary source if coverage on the first car was exhausted. See policy for details.
Can I convert my policy from term to permanent?
Yes, you can convert all or some of your term coverage to a permanent policy for a lifetime of coverage.
Do I need comprehensive and/or collision on all my autos?
You can make comprehensive and/or collision coverage choices individually for each of your insured vehicles.
After an accident, how do I file a claim against the other driver?
You can file a claim against the other driver by contacting that person’s insurance company or agent. You will need to give the other party’s insurance company your insurance information and let them know the type of claim you wish to make. If you need assistance, contact a KCAL Insurance claim professional.
Does my auto insurance policy cover rental vehicles?
Yes! At KCAL Insurance, the same coverage you have on your current auto policy also applies to any car you rent. So, for example, if you have collision and comprehensive coverage on your current auto policy, you’ll also have them when you’re renting a car for vacation, a pick-up truck for moving, or a temporary vehicle while yours is in the shop. Be aware that other insurance companies may not cover rental cars automatically.
How can I save money on auto insurance?
There are many things you can do to make sure you’re getting the best premium possible.
- Increase your deductible
- Maintain a good driving record
- Maintain a good credit rating
- Take a driver safety course
Research before buying. Learn which cars are the least expensive to insure. KCAL Insurance offers discounts for cars that have anti-theft devices, air bags, and anti-lock brakes, for example. KCAL Insurance can give you free, no-obligation quotes on any cars you’re considering purchasing; just call us with the VINs of the vehicles you’re interested in buying. Take advantage of KCAL Insurance’s multi-policy discounts, which provide discounts on certain coverage when you purchase two or more policies, such as an auto and homeowners policy.
How much auto insurance do I need?
- How high should my liability coverage limits be? No one can predict exactly how much you would have to pay if you were to cause an accident. Ask yourself how you would pay for any damages exceeding your coverage limits. The higher your liability coverage limits are, the more likely your policy will be able to pay all of the damages.
- How high or low should my collision and comprehensive deductibles be? Higher deductibles lower your premium but increase the amount you must pay out of your own pocket if a loss occurs. Ask yourself how much you would be willing and able to pay on short notice in order to save on your premium.
- Should I carry collision and comprehensive coverage?
You may be required to carry collision or comprehensive coverage if your vehicle is leased or financed. Once you have paid off your car, and its value decreases, you might consider dropping this coverage to save money on premiums. However, consider whether the savings would be enough to offset the risk of having to pay the entire cost of repairing or replacing the vehicle.
How much liability coverage do I need?
Auto insurance, like all types of insurance, will protect you against a financial loss if you are involved in an auto related accident. All 50 states require a minimum liability insurance to legally operate a vehicle on a public road, which differs from state to state. Buying insurance at these minimum limits will be enough to legally operate a vehicle on the road but usually it’s not adequate protection. If you are at fault for an accident, your auto liability insurance will pay for the other party’s injuries and damage to their car or property. The insurance company will defend the lawsuit at their expense, so the coverage limits will not be affected. If the insurance company pays the full limit of insurance, thereby exhausting all coverage, the responsible party or vehicle owner may be sued or may have to pay out of pocket for the other person’s loss.
If I loan my car, would I be covered if there's an accident?
Yes. With a KCAL Insurance auto insurance policy, anyone who drives your car with your permission is covered under your policy. See policy for details and restrictions. Note: If someone pays you to use your car, you will not be covered.
Should I buy extra insurance protection on a rental car?
The coverage you have on your current auto policy also applies to the cars you rent. But if you don’t carry collision or comprehensive on at least one insured vehicle, you may not have this coverage on a rental car, depending on state law. To be safe, check with your agent or call KCAL Insurance’s customer service center to confirm your coverage.
What discounts are available for auto insurance?
Discounts, Discounts, Discounts. Auto insurance companies have a variety of discounts available to help lower your insurance cost, but the discounts may vary from company to company. Our agents are trained to assess our client’s situation and find the best discounts to ensure they aren’t overpaying. Some of the common discount categories are listed below: Good Driver Discount: If you qualify, this one is automatically added to every policy. In CA, the definition of a good driver is a person with at least 3 years of driving experience (so you have to be at least 19 years old). You can only have gotten 1 minor ticket OR 1 at-fault accident within the last 3 years, but this accident can not have caused anyone any injuries. Even if a $1 claim was made by you, anyone in your car, or anyone in the other car, it could cause this accident to be considered at fault with injury, which could in turn cause you to lose the good driver discount. You can’t have any major violation like racing, speeding over 100, hit and run or other major violations within the last 5 years. Driving under the influence, DUI or DWI, will stay on your record for 10 years and will not qualify you for the good driver discount, which would make at least a 20% difference in premium.
- Good Student Discount
- Mature Driver Discount
- Driver Training Discount
- Occupation Discount
- Special license and degrees
For more discounts, please check with your agent. Please drive carefully. To avoid accidents, don’t multitask in the car. Obey traffic regulations and go to traffic school to waive tickets when possible – your wallet will thank you for driving safely.
What happens if I'm a passenger in a friend's car and I'm injured as a result of an uninsured motorist?
If your friend has Uninsured Motorists (UM) or Underinsured Motorists (UIM) protection, you would be covered under your friend’s policy. If your friend doesn’t have UM or UIM, you would receive protection under your own UM or UIM coverage. Note: Some states specify the order in which policies can be pursued for UM/UIM coverage.
What is a deductible?
It’s the amount of out-of-pocket expenses you must pay before an insurer will cover your costs. For example, if your auto insurance policy has a $500.00 deductible and you were in an auto accident causing $800.00 worth of damage, you are responsible for the first $500.00 (deductible) of the damage. The insurance company will pay the remaining balance, which in this example is $300.00. You may select different deductibles for collision and comprehensive coverage.
What is not covered under my auto policy?
Wear-and-tear, freezing, mechanical breakdown, and road damage to tires by potholes are not covered by your auto insurance policy. Check your policy for other restrictions.
What is the difference between collision and comprehensive coverage?
Comprehensive coverage pays for physical damage to your auto caused by things such as fire, theft, hail, vandalism, and animals. These events are called “perils” in your policy. Some examples of a comprehensive loss include:
- Your auto is struck by debris that falls from an overpass
- Your auto is damaged by a tree falling on it
- Your auto is partly or totally submerged in water
- Your auto is maliciously scratched
- Your auto’s tires are slashed
- Your auto’s windshield is cracked by a stone
Collision coverage pays for physical damage if your auto is hit by another vehicle or runs into an object. This coverage will pay for damage to your auto regardless of who causes the accident. Some examples of a collision loss include:
- Your auto strikes or is struck by another auto
- You hit a pedestrian, damaging your auto (the pedestrian’s injuries are covered under liability coverage)
- Your auto hits debris lying in the road
- Your auto strikes a tree or fence
- Your auto is struck by a shopping cart
What is Underinsured Motorists (UIM) coverage?
UIM protects you and your passengers when an accident is caused by someone who has auto insurance but is underinsured.
Who are covered drivers under my auto insurance policy?
You, members of your family who live in your house, and anyone who uses your car with your permission are covered under your auto policy. See policy for details.
Why do I need Uninsured Motorists (UM) coverage?
Some drivers don’t have auto insurance, even when they’re legally required to have it. If you’re involved in an accident with an uninsured driver, that driver may not be able to pay for your damages. UM coverage protects you and your passengers from injury-related damages caused by either an uninsured driver or a hit-and-run driver. In a few states, damages to your car may also be included.
Will higher deductibles lower my auto insurance premium?
Absolutely. The higher your deductible, the lower your premium. That’s because you’re willing to pay a higher amount in the event of an accident. Always make sure that you will be financially prepared to handle a higher deductible in the event of an accident. Consult KCAL Insurance for a free auto insurance quote with various deductibles to see how they affect your premium.
Will my insurance rates go up if I make a claim?
Adjusting insurance premiums is not an easy decision. We want to assure you that we are doing everything we can to keep your insurance costs at KCAL Insurance equitable, while providing you with quality service. If an accident or loss occurs, certain factors can result in an increase to your policy premium, including:
- Determination of fault
- Amount of damages paid
- State regulations
- Previous accident and violation (conviction) history
- Type of accident or violation
- Severity of accident or violation
Homeowners Insurance FAQs
I own antiques and fine art. What kind of coverage would adequately protect them?
Certain valuable items, such as antiques and fine art, may have limited coverage under basic home insurance policies. To insure them properly, you should add a Scheduled Personal Property (SPP) endorsement to your home, condo, or renter’s insurance policy.
If I have a loss, do I need to show proof of what was in my home?
You will be asked to provide a list of all items that were destroyed or damaged. MetLife Auto & Home recommends that you take the time now to make a room-by-room list of everything you own, including when you bought the items and how much they cost. If you prefer, you can videotape the contents in your home. We also suggest keeping receipts or credit card statements for higher value items, such as furniture, appliances, rugs, and expensive clothing.
What's Condo / Townhouse Insurance Policy?
People who own and live in a condo or townhome will generally have a condo or homeowner association. The community association will typically obtain a master insurance policy that protects the building structures and cover common area liability. The insurance premium will be divided among all homeowners within the community and paid through their monthly association fees. Often, the insurance purchased by the association will only have coverage for the exterior of the home or have very limited interior coverage. A Condo / Townhome policy will fill in the gap to cover what the master policy doesn’t. Interior structures and fixtures like wall to wall carpet, dry walls, kitchen cabinets and bathroom fixtures can be covered with this type of policy. The owners’ personal belongings like clothing, furniture, and electronics are not covered by the master policy.
What's Dwelling Fire Insurance Policy?
Many Americans invest in residential real estate to earn rental income and/or build equity through appreciation of home values. To protect your investment from disasters or legal issues, insurance policies are purchased. Dwelling Fire insurance policies are typically issued for residential homes (up to 4 units) that are rented to others or not owner occupied. This policy is issued in the owner’s name and will safeguard the structures on the property. The policy can optionally cover personal properties like furniture or appliances that belong to the landlord. Premise liability may also be included or added to the policy up to $500,000.
What's Homeowners Insurance Policy?
Your home is not only the place where your family lives and grows, but often it’s one of your household’s largest investments or assets. Homeowners insurance offers financial protection for your family, pays for repairs and replaces damaged property. This type of policy is for residential properties that are owner occupied. Typically, this type of policy can insure a structure of up to four families/units. This is a comprehensive policy that will protect both your property and your personal/family liability.
What's Renters Insurance Policy?
Although the home you live in is not yours, that doesn’t mean you don’t need any insurance protection. People who rent can protect their personal belongings like cameras, TVs and even jewelry by purchasing a renters policy. This policy will protect your belongings from theft, fire, wind, hail, airplanes, vehicles, etc. Renters insurance also provides the same liability protection as homeowners insurance, but this policy is typically a fraction of the cost of a homeowners insurance policy.
What is Medicare?
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). For more information, please visit Medicare.gov
Medicare is the medical health plan designed by the US government for individuals who are 65 or older. Certain younger individuals with disabilities or End-Stage Disease may also qualify for Medicare. This plan can help pay for partial medical costs, but does not include full coverage or most long-term care costs.
Who is qualified for Medicare?
If you are a United States citizen or a green card holder who has legally stayed in the US for more than 5 years, and fulfill any of the following requirements, you can apply for Medicare:
- People who are 65 or older,
- People who are younger than 65 but have received disability benefits for over 2 years due to any disability,
- People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD) or Amyotrophic Lateral Sclerosis (ALS).
What are the four different parts of Medicare? What is the difference between Medicare Parts A, B, C, and D?
Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (Medical Insurance): Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
Medicare Part C (Medicare Advantage Plans): Offered by a private company that contracts Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
Medicare Part D (Prescription Drug Coverage): Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
When you apply for Medicare at the Social Security Office, after joining Part A and Part B, you still need to purchase Part C and Part D through an insurance agency. You need to make sure you have Prescription Drug Coverage in order to avoid the liability for a lifetime penalty or the cost generated from prescription drug purchase, which will increase your economic burden.
What is Medicare Advantage (Part C)?
Medicare Advantage Plans are comprehensive medical plans offered by private health insurance companies. Part C can provide coverage for outpatient surgery, emergency room/ambulance, primary care physician, special care and etc. The insured would only need to pay the low-amount deductible.
Part C also provides coverage for prescription drug purchases, which is also covered under Part D. Besides all the benefits mentioned above, Medicare Advantage also provides benefits for vision, dental, acupuncture, hearing aid and medical transportation, which are not covered under any other plans.
Part C can be categorized into two types: PPO and HMO
PPO: Medical cost will be taken care of by the insurance company and original Medicare. You can choose any in-network doctors for services and it provides coverage through 50 states.
HMO: The insurance company and independent practice association (IPA) have shared responsibility for your medical cost. The insurance company will pay for high cost services such as hospitalization and emergency care while IPA will pay for low cost services such as preventive care. You will need a referral from the assigned primary care physician (PCP) before you can see any other health care professionals, which has to be within 30 miles of your residence.
Part A and B only cover 80% of the medical cost, how I can get the rest covered?
Option One: Purchase Medicare Supplement + Prescription Drug Coverage (Part D)
Medicare Supplement provides coverage for the out-of-pocket amount not covered in Part A and Part B. Part D provides coverage for costs generated from prescription drug purchases.
Option Two: Purchase Medicare Advantage (Part C)
Medicare Advantage not only provides coverage for the out-of-pocket amount not covered in Part A and Part B, but it also covers the cost generated from prescription drug purchases. Meanwhile, it also provides other medical benefits.
How much does Medicare cost?
Hospital Insurance (Medicare Part A): If you live in the US for more than 10 years, and have paid federal Medicare tax when you were working, then you will receive free Part A coverage; if you are already 65 years old, but haven’t worked over 10 years, you have to pay a monthly premium for Part A up to $441 per month.
Medical Insurance (Medicare Part B): In 2016, the monthly standard premium for Part B is $121.80. However, if your retirement income is over $85,000 for a single person or $17,000 for a retired couple, you have to pay a higher monthly premium for Part B as the standard request. One thing you need to pay attention to is if you don’t apply for Medicare Part B during the Initial Enrollment Period, you may need to pay higher Part B premium for joining later.
Medicare Advantage (Part C): The premium depends on which plan you enroll in.
Prescription Drug Coverage (Part D): The premium depends on which plan you enroll in.
When can I apply for Medicare?
If you are eligible for Medicare because you are 65 years old, the Initial Enrollment Period begins three months before you turn 65, including the month of your 65th birthday, and ends three months later.
Whether you are retired or already starting to receive Social Security, you need to contact the Social Security Office three months before turning 65 years old to apply for Medicare.
You can apply for Medicare during your Initial Enrollment Period (IEP). The IEP is the seven months surrounding your 65th birthday. It includes the three months before you turn 65, the month you turn 65, and the three months after.
If you have current employer insurance, you can also sign up while you are still working and for up to eight months after you stop working or you lose your coverage. This window of time is called the Part B Special Enrollment Period (SEP).
If you do not enroll during these times, you can enroll during the General Enrollment Period (GEP), which is January 1st through March 31st of every year. Your coverage will start July 1st of the year you enroll. You may face a late enrollment penalty if you were eligible for Part B before you enrolled during the GEP. If you have been receiving Social Security Disability Insurance (SSDI) for 24 months, then you are automatically enrolled in Medicare in the 25th month you receive SSDI.
What is the result for not applying for Medicare on time?
If you don’t apply for Medicare Part B during the Initial Enrollment Period, you can still apply between January 1st and March 31st each year. The premium will be effective in July of the same year. However, for each 12-month period delay, your monthly premium for Part B will increase by 10%.
Besides that, you need to purchase Part C and Part D through your insurance agency. Without Prescription Drug Coverage (Part D), you will be liable for a lifetime penalty and the costs generated from prescription drug purchases will increase your economic burden.
If my employer has provided me with group health insurance, do I still need to join Medicare?
If you are 65 and older and still covered under you or your spouse’s group health insurance, you can delay the Medicare application until you lose the group health coverage, and then apply to join Part B during Special Enrollment. There is no penalty.
Business Insurance FAQs
What are my coverage options?
Flexibility is the key to success. Whether you own a small, medium, or large business, we can tailor a business package policy that is appropriate for you and your business. Our agents are specialists specified to each department, thus, they scout for every detail to better serve your business needs by offering an array of limits and deductibles as well as enhancement options in specialty markets. Please call our toll free number (800) 681-8288 to speak with one of our representatives.
What are the benefits of Business Owners Insurance?
Commercial insurance is designed to help protect many of the risks your business may encounter, including:
- Damage or destruction to your business vehicles
- Certain liability exposures resulting from the operation of your business vehicles
- Damage or destruction to your office equipment or inventory
- Loss of income in case you have to suspend your business temporarily due to a covered loss
- Certain business related liability exposures such as wrongful entry or search, libel, slander, and even certain offenses arising out of your business’s advertising
- Risks to your cargo while in transit or storage
- Theft or loss of tools and equipment
- Crime coverage including robbery, burglary, even employee dishonesty
What are the benefits of Commercial Auto Insurance?
- Liability Coverage: In case you’re sued as a result of an auto accident.
- Collision Coverage: Helps cover physical damage to your vehicle due to collision or upset.
- Comprehensive Coverage: Helps cover physical damage to your vehicle due to fire, theft and glass breakage.
- Rental Reimbursement Coverage: Helps cover the cost of a replacement vehicle for a specified period of time when your vehicle is disabled due to an insured loss.
What is Business Liability/Commercial General Liability Insurance?
Commercial General Liability Insurance Protects Your Business From Common Liabilities.
Your business is exposed to liabilities every day. The only way to protect your assets is to carry adequate business liability insurance. A Commercial General Liability (CGL) insurance policy is the first line of defense against many common claims.
General Liability insurance covers claims of bodily injury or other physical injury or property damage. It is frequently offered in a package with Property insurance to protect your business against incidents that may occur on your premises or at other covered locations where you normally conduct business. Commercial General Liability enables your business to continue operations while it faces real or fraudulent claims of certain types of negligence or wrongdoing.
Travel Insurance FAQs
If I want to go back to China to treat a pre-existing condition, will the insurance company provide coverage for my medical costs?
No. The coverage will be denied. Travel insurance only provides medical coverage for incidents taking part on your trip, but not the specific reason for going on the trip.
What is the minimum number of days of coverage for Foreign Student Insurance?
The minimum number of days of coverage is 30 days.
If I need to travel to more than one country, do I need to submit an application for each country I go?
No. You only need to submit once. When filling out the application form, please use the last country you are traveling to as your destination country.
Do I have to wait until I arrive in the USA and then go to KCAL’s office to fill out the application for travel insurance?
You can also apply online at KCAL’s official website: http://www.kcal.net. Find “Individual >Travel > Travel Abroad Insurance.” Click on “Visit USA Healthcare” and choose the period of time you want to get covered.
Does travel insurance provide coverage for onset of chronic disease during the trip?
No. Travel insurance does not provide coverage for existing medical conditions.
Do I have to pay anything else besides the daily premium?
When you apply for travel insurance, aside from the daily premium, you also need to pay the $5 one-time processing fee for each application submitted.
How long will it take for my travel insurance to become effective?
The fastest your travel insurance can become effective is one day after you submit the application.
If I am a Green Card holder, and I want to travel back to my country of citizenship, how should I purchase travel insurance?
You cannot purchase travel Insurance if you are going back to your country of citizenship.
Life Insurance FAQs
Can I renew my term life policy after the initial term expires?
You can renew your policy annually after its initial term expires, up to age 95 (80 in New York). Note, however, that premiums will likely be much higher after the initial term, and will continue to rise each subsequent year. If you anticipate needing coverage much beyond the initial term, consider buying Permanent Life instead, or converting to Permanent Life.
How can I save money when buying life insurance?
You can lower your premiums and save money in the long run by purchasing now while you are young. Premiums for the same coverage increase the older you become. The longer you wait, the more you risk developing a health condition that could increase your premium further, or make you unable to become insured.
If you want Permanent Life but you’re on a budget, consider some Term for now. You can save money initially by buying some Term Life in combination with Permanent Life. Later on, if your budget increases, consider converting the Term policy to Permanent Life. Consider group life insurance offered through your employer. It may be available at a low cost. But keep in mind that your group coverage may end or become more expensive when you leave your job.
How do I know what term to select?
Every life situation is different, so you will need to take your personal obligations into account. Things to consider could be the number of years you have left on your mortgage, or if you have children, the number of years until they complete college. For example, if you have young children and plan to send them to college, you may want to consider at least a 20 year term life policy.
How much insurance do I need?
If you were to pass away, consider what your spouse and dependents would need in order to cover day-to-day as well as larger expenses, to live comfortably and have financial stability. Don’t forget to include savings for college and retirement. Also consider the effect of inflation over time; the amount needed twenty years from now is likely to be significantly higher than today.
How much will life insurance cost me?
Premium rates for life insurance are typically based on factors such as age, sex, height, weight and health status, including whether or not you smoke or participate in high-risk activities or occupations.
The type of policy you purchase will also affect the amount of the premium. Rates for term insurance are typically lower, at least at younger ages. Premium rates for permanent policies like Whole Life are typically higher at earlier ages, but do not increase as you age. Lastly, paying premiums monthly or quarterly rather than annually will result in higher premiums.
In addition to protection, what am I trying to accomplish with my life insurance?
Some life insurance policies can help you pay for major expenses like college tuition and estate expenses, or provide additional income for retirement or emergencies. Remember that Term Life Insurance pays a death benefit only, while different types of Permanent Life Insurance—Whole, Universal, and Variable Universal Life—can supplement your income through withdrawals or loans against a policy’s cash value.
What are some of the reasons for converting to a permanent life insurance policy?
Unpredictable events can leave you in a great deal of debt later in life as a consequence of paying for your grandchild’s college education or purchasing a vacation home. Inheriting significant wealth also calls for action to plan the taxes and estate settlement costs. Permanent policies allow accumulation of cash value tax advantages that can supplement your retirement at times of need.
What are the tax advantages of life insurance?
Death benefits are generally income tax-free. In the case of Permanent Life Insurance policies, cash values accumulate on an income tax-deferred basis. That means that you would not have to pay income tax on any earnings in the policy as long as the policy remains in effect. In addition, most policy loans and withdrawals are not taxable. However, if you surrender your policy or it lapses, you may have income to the extent that distributions and/or withdrawals exceed your policy basis (i.e., total premiums paid less prior distributions).
Pursuant to IRS Circular 230: The information contained in this website is not intended to (and cannot) be used by anyone to avoid IRS penalties. This website supports the promotion and marketing of insurance products. You should seek advice based on your particular circumstances from an independent tax advisor.
What if I already have insurance coverage?
If you already have a life insurance policy, it’s a good idea to review it every few years to make sure it still meets your needs. Check to make sure all beneficiaries and other information are current. Do any of the “ifs” below pertain to you? If so, it might be time to speak with your representative. If you…
- Were recently married or divorced
- Have a child or grandchild who was recently born or adopted
- Provide care or financial help to a child or parent
- Want to ensure that financial resources are available to provide assistance or long-term care for a loved one
- Purchased a new home recently
- Have children or grandchildren who are about to enter college
- Refinanced your home mortgage in the past six months
- Receive an inheritance
- Retired or your spouse has retired
- Have started a business
What term lengths are available?
Depending on your age, level term life insurance protection is available for 10, 15, 20, or even 30 years.
Why should I choose a reputable insurance company?
In addition to being financially secure, the life insurance company you choose should have a good claims payment history, good customer service and competitive pricing. We encourage our clients to make sound and informed financial decisions by reviewing independent ratings by sources such as Standard and Poor’s, A.M. Best, Moody’s, Fitch, and Weiss Ratings.
Will my beneficiaries have to pay income tax on my policy's death benefit?
Your death benefit will generally be free from income taxes. It is guaranteed as long as the policy remains in force.