Rules Governing California's Individual Health Insurance Market


Publication Date: April 2005

Publisher: California HealthCare Foundation

Author(s): Deborah Reidy Kelch

Research Area: Health

Type: Brief

Coverage: California


This issue brief examines the state and federal laws that apply to the individual health insurance market in California as of April 2005. It provides a comprehensive overview of the differences between individual and group coverage and explains the basic rules that apply to individual policies, including treatment for pre-existing conditions, guarantees on renewal, protections for higher-risk individuals who maintain their coverage, and regulations governing the transition from group to individual coverage. Individual coverage is the main alternative for those not covered through employment and not eligible for publicly subsidized health coverage. Nearly 8 percent of non-elderly Californians, or about 2.4 million people, are now participating in the individual insurance market. First published in June 2003 as a reference for consumer advocates, brokers, health policy leaders, and health plan staff.