2018 Individual & Family Open Enrollment Gotcha’s!

We would like to point out a few helpful pieces of information for this year’s Individual & Families Open Enrollment to help make sure that you get the plan you’re expecting with the benefits you’re expecting.


  • First off, and this is a biggie … the two main carriers for PPO plans in the Individual & Families market of Southern California (Health Net & Blue Shield of California) have added deductibles for out-of-network coverage in the amounts of $5,000/individual and $10,000/family they have also changed the out-of-network/out-of-pocket maximums for these plans to be in the 10’s of thousands.
  • Oscar Insurance plans are being presented in (some) of your areas for the first time this year. Their plans include the USC and UCLA as well as the Providence networks. These plans are an EPO which means that they have no out-of-network component but tend to provide lower premiums if your physicians/facilities are in their preferred network
  • Lastly, please make sure that, whether you’re renewing an existing health plan or choosing a new health plan you always need to make sure that your preferred physicians and facilities are in, or still in, your carrier/plans preferred network. This means you’ll want to not only check the carrier’s website (which often has the most up-to-date information) but also with your physician’s/facilities billing department. When you’re checking make sure you provide the full name of the plan you have or are considering. This means you’ll want the carrier name, the type of plan (PPO/EPO/HMO), and the carrier’s name for the plan (i.e. Blue Shield of California – Gold 80 PPO). It is also key that you denote whether the plan is a Covered California plan (as this affects your coverage).


We wish you a successful Individual & Families Open Enrollment 2018 season. And please remember that you can always reach out to us at 818-253-1736, team@TheBenefits.Guru , or @CA_BenefitsGuru on Twitter.

Remember ……. We’re Here To Help!



TheBenefits.Guru Insurance Services Team