Individuals And Families Into Health Plans

Individual/Family Health Insurance

Serra Benefits has been fitting individuals and families into health plans for over 20 years. Our goal is to find the policy that gives you the best benefits for your insurance dollar based on your unique personal needs. We are appointed with all major health insurance carriers and offer health, dental, and vision insurance.

Call us today to review your options!

We are licensed agents and Covered California certified

With the individual health insurance market experiencing historical changes as a result of the PPACA (Patient Protection and Affordable Care Act) initiated in 2010, Serra Benefits has held steadfast through these changing times. We are certified with Covered California, our states healthcare exchange, which makes us even better able to evaluate your circumstances and help you make an educated and informed decision on the best policy. We can answer all of your healthcare questions and keep you up to date when the market changes again.

Types of Health Insurance

  • Health maintenance organizations (HMOs)
  • Preferred provider organizations (PPOs)
  • Exclusive provider organizations (EPOs)
  • High-deductible health plans (HDHPs), which may be linked to health savings accounts (HSAs)

Do you know the difference between HMO and PPO plans?

Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) are two of the most popular types of major medical health insurance plans. The major differences between HMO vs PPO plans can be found in the:

  • Size of the network
  • The cost of the plan
  • The ability to see specialists without referrals
  • The size of the in-network
  • The coverage for out-of-network services

The big difference between HMO and PPO for many individuals and families, is the primary care doctor. With an HMO, you will have a primary care doctor whom you and your family go through for most medical services. If you want to see a specialist for any reason, you will need a referral from your primary care doctor, which may mean an extra office visit. The trade off is that often times HMO plans have lower premiums. Some families or individuals might not care about having a primary care doctor as their outlet to all other medical services—deciding between an HMO vs PPO is very specific to each family or individual’s needs. Serra Benefits can help you decide what may be best for you.

Call us today at 760-439-9700 to enroll!

  • California legislation passed AB 414. It requires ALL California residents to purchase health insurance for themselves and their dependents to maintain minimum essential covereage (MEC). California is one of several states that are actively pursuing, or have already adopted, their own state wide individual mandates.
  • The new individual mandate for Californians starts in 2020. The penalty for not having insurance will mirror the one under the Affordable Care Act, which was $695 per adult (and $347.50 per child under 18) or 2.5% of annual household income, whichever is greater. That can amount to thousands of dollars a year
  • California Gov. Gavin Newsom’s new budget has infused significant funds to make health care coverage sold through its health insurance marketplace (Covered California) more affordable and has made new subsidies available to middle-income individuals earning between 400 to 600 percent of the federal poverty level (FPL).
  • Advance Premium Tax Credit (APTC) If at the end of the year you’ve taken more premium tax credit in advance than you’re due based on your final income, you’ll have to pay back the excess when you file your federal tax return. If you’ve taken less than you qualify for, you’ll get the difference back.
  • How does the tax credit (subsidy) work? The IRS pays your premium tax credit directly to your health insurance plan. Your monthly premium costs are lower as a result. … The only way to get premium tax credits is to buy from Covered California. If you bought from Covered California, it will send you a tax form, called the Form 1095-‐A

Open Enrollment

Applications for Covered California health insurance plans are accepted each year during open enrollment. Although these dates may vary slightly, the general time frame is October 15 through January 15.  Enrollments done October through December 15 will have a plan effective date of January 1. Enrollments done December 16 – January 15 will have a plan effective date of February 1. Outside of  this open enrollment window you may only enroll into a health plan if you have a qualifying life event. This is called a Special Enrollment Period. 

Special Enrollment

Consumers who experience a qualifying life event can enroll in a Covered California health insurance plan even outside of the open-enrollment period. This is called special enrollment. Below is a list of common qualifying life events for special enrollment that apply year-round.

  • Losing health coverage. For example: consumers who no longer qualify for Medi-Cal, or who lose health coverage through their job or spouse’s job.
  • Income changes so much that a current Covered California enrollee becomes newly eligible or ineligible for help paying for their insurance.
  • Turning 26 years old and no longer being eligible to stay on a parent’s plan.
  • For example: moving to California from another state or moving to a new region within California that allows a current consumer to gain access to new Covered California health insurance plans.
  • Having a child or adopting a child, receiving a child into foster care, or placing a child in adoption or in a foster home.
  • Getting married or entering into a domestic partnership.

Due Dates to Enroll after a Qualifying Life Event

Consumers have 60 days from the loss of coverage to enroll into a Covered California health insurance plan or  to change their existing Covered California plan. For example, if an individual loses coverage from an employer, they will have 60 days from the termination date to secure other coverage either through Covered Ca or direct with the carrier.  If 60 days pass and consumers do not sign up for health coverage, they will have to wait until the next open-enrollment period.



Contact us

If you have any questions on polices or have additional questions before get a free quote, please contact our offices today.

2821 Oceanside Blvd. Unit E
Oceanside, CA 92054

Phone: 760-439-9700
Email: or

CA License Number: 0C175088

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