Question: My present insurance coverage is under Covered California through Health Net. My husband is the primary owner to this account but at this time he is unemployed. My employer is offering me a SIMNSA Insurance which has an office in Chula Vista California. The provider services are based in Tijuana, Mexico. I do not speak the language nor familiar in the Tijuana area. Crossing the border from U.S. to Mexico is a nightmare (the minimum is 2 hours going and 2 hours coming back in the U.S. This makes me uncomfortable since I don't speak Spanish. My question is can I legally reject/decline to the offered insurance? What will be the consequence in my part if I do reject this offer? (Note: SIMNSA is the only insurance company offered by the employer.) Will I lose my Health Net insurance since this is subsidized.
Answer: SIMNSA plans offered in the US are ACA compliant and meet the meet the minimum value and provide essential health benefits. Most services require no co-payment at the time of treatment. Some select services require a $5 to $10 co-pay, after which all services are covered at 100%. Unfortunately. you have to cross the border into Mexico to see a provider (except for emergency coverage in the US). You can opt out of the SIMNSA offer from your employer, but you will no longer be eligible for premium assistance (subsidy) through Covered California because you have access to employer-based coverage. Assuming your employer pays all or most of your monthly premium, I advise you enroll yourself and your husband in SIMNSA and plan on using it for any major medical expenses that may arise. If you prefer, you can pay cash to see medical providers in the US side for routine care. That expense would be much less than carrying an additional health insurance policy without premium assistance.