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Individual HMO Health Insurance in Southern California

Health maintenance organizations (HMOs) offer medical-insurance coverage to people who do not qualify for government-sponsored plans, and for whom group coverage is unavailable. In southern California, consumers can choose among such providers as Kaiser Permanente, Anthem Blue Cross, Aetna and Cigna. The California Department of Insurance also offers assistance to resolve consumer complaints about HMOs.

  1. Health Maintenance Organizations

    • Health maintenance organizations (HMOs) are typically less expensive than other types of health plans but they require that plan members seek services from doctors and hospitals within the plan's network. Most HMOs require members to select a primary care provider, as all services are coordinated through this physician. Referrals to specialists and requests for procedures and hospitalizations must go through him in order for the HMO to pay for services. The California Department of Managed Health Care regulates all HMOs in the state.

    Seeking HMO Coverage

    • Finding HMO individual plans in Southern California can be done online. Websites such as ehealthinsurance.com offer customers the ability to obtain HMO quotes. These sites display a side-by-side comparison of the health plans that may be available, showing each plan's premiums, deductibles, copays and co-insurance. You can also visit the websites of the HMO insurers themselves to obtain quotes. Individuals must complete an application that goes through an underwriting review. Based on the application, the HMO approves or denies coverage.

    HMO Plans

    • Kaiser Permanente, one of the oldest HMOs in the country, began in the state and has a presence in southern California, where it has a wide-reaching range of facilities and providers. Other individual HMO plans available in southern California include Anthem Blue Cross, Aetna and Cigna.

    Complaint Process

    • When southern California residents have a complaint against their HMOs, they can file a formal complaint with their plan. According to state regulations, HMOs must have a complaint process and are required to respond and resolve the complaint within 30 days. When the complaint is unresolved in this time, the California Department of Managed Health Care (DMHC) can assist. The DMHC is also available as a rexsource for answering residents' questions about HMOs.

      The state of California also provides other resources to help residents maneuver through the health insurance maze to find coverage, answer questions and field complaints. Contact the California Department of Insurance's consumer department for assistance.

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