| (This information concerns those who enrolled into Individual and Family Health Plans through the Government Exchange – Covered California – and received a Subsidy or APTC. It does NOT concern you if you are either on an Employer-Sponsored Group Health Plan or a Medicare Health Plan. This information pertains only to California and may not apply to other states.)
As a courtesy, we are passing this information onto you. |
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Covered California – Urgent Last Minute Alert
Blue Shield of California Plans to Shut Down for 1 Week in September to Save on Payroll Due to Obamacare Losses
http://www.bizjournals.com/sanfrancisco/news/2016/08/11/exclusive-losses-blue-shield-california.html
As reported by the San Francisco Business Journal, Blue Shield of California will be closed from September 3 to September 12 while its employees take the week of Labor Day off. Although Blue Shield announced there will be some customer service staff working that week we assume the phone lines will be jammed for the entire week.
It appears that Individual, Small Group and Medicare departments are affected by the shutdown.
We do not yet know whether the Blue Shield member portal, broker portal or employer portal will be accessible and will reflect current information during the shutdown.
ALL APPLICATIONS FOR BLUE SHIELD PLANS SHOULD BE SUBMITTED AS SOON AS POSSIBLE SO THEY CAN BE PROCESSED WITH AN ID NUMBER ISSUED BY FRIDAY, SEPTEMBER 2. APPLICATIONS ARE CURRENTLY TAKING 10-14 DAYS TO BE PROCESSED.
This is an unprecedented announcement by an insurance company. We will do our best to provide service to our clients during this shutdown, but if Blue Shield is closed our ability to provide customer service will also be severely impacted.
(NOTE: This information relates only to Blue Shield of California, a taxpaying non-profit insurance carrier that operates only in California. Please do not confuse this company with Anthem Blue Cross, or any other Blue Cross or Blue Shield organization in states outside of CA.)
Phil Lee
Lee Health Insurance Services (BLIS Corporation)
925-284-2000
Fixing Obamacare at Capitol Hill
Last week, I and my fellow board members from our agents and brokers’ Association of Health Underwriters (AHU) gathered at Capitol Hill in Washington, D.C. to visit with Congressmen and women from both sides of the aisle to discuss issues and challenges that affect health insurance for Americans. During the past 18 months since the ACA rollout, agents and brokers exceeded everyone’s expectations by excelling in their jobs, while the Govt. Exchanges and all other entities fell below expectations. Our association has received the recognition of lawmakers and regulators, and we strive to promote a system that would be more affordable, equitable, less bureaucratic to consumers and employers, while offering more choice and competition, and reducing the burden on taxpayers.
Thank you for your feedback and concerns which I incorporated into our conversations with legislators.
Phil Lee
Lee Health Insurance Services
www.health-insurance.com
800-286-7445
Obamacare: Enroll by Sunday 2/15 or Pay a Penalty
(Please disregard this if you have an Employer Group plan or have Medicare.)
For those of you who have not already enrolled into an Individual health plan, the enrollment deadline is this Sunday Feb. 15th.
After the Feb. 15th deadline, you will have to wait until the end of the year to enroll for Jan. 1, 2016. If you are uninsured, you may also face a penalty when you file your tax return in April 2016.
Possible Extension:
For those of you applying through Covered California for an On-Exchange health plan, if you start an online application before 2/15 but are not able to complete it on that day, we, as agents, have been given an extension to help you complete it, by 2/24. This extension is not available to the public and does not apply if you do not start an application by 2/15.
If you need help, please call us at 925-284-2000 or email [email protected] .
Phil Lee
Lee Health Insurance Services
925-284-2000
www.health-insurance.com
Avoid Penalty – Deadline Feb. 15th to Enroll into Individual Health Plan
Avoid Penalty – Deadline Feb. 15th to Enroll into Individual Health Plan
To avoid a penalty, the deadline to enroll into an individual health plan is Feb. 15th, 10 days from today. If you submit an online application by that date, you will be able to secure an Effective Date of March 1st. If you miss this deadline, you may not enroll again until the end of 2015.
This deadline does not apply to you if you experience a qualifying event during the year, such as a loss of Employer group coverage, a change in family status such as a marriage, divorce or newborn, a move out of the area, etc.
If you are uninsured, or insured only with a temporary or non-creditable health plan, you may face an IRS-assessed penalty for 2015 of up to 2% of your household income. (This is up from 1% in the 2014 tax year.)
If your estimated 2015 household (MAGI or Modified Adjusted Gross Income) is between 138% and 400% of the Federal Poverty Line (FPL, equivalent to roughly between $16,106 and $46,680 annual income for a single person household), you may apply to Covered California for an APTC (Advance Premium Tax Credit or Tax Subsidy) to help pay the monthly premium on a creditable health plan. If not, you may apply for an Off-Exchange health plan at the same price without a subsidy. We can help you with both. If you income is below 138% FPL (or your children below 200% FPL), then you may qualify for Medi-Cal (California’s Medicaid).
Please call us at 800-286-7445 if you need help.
Philip W Lee
Lee Health Insurance Services
Employee Benefits and Health Insurance
[email protected]
www.Health-Insurance.com
Alert: Blue Shield California Individual & Family Health Plans – Problems with Billing and Payments
(This concerns Individual and Family Health Plans either through Covered CA or Off Exchange direct from Insurance Carriers. This does not concern you if you are on Medicare or on an Employer group plan.)
We have been alerted to the fact that a good number of our clients have been experiencing payment issues with their Blue Shield individual health plans. This problem has affected members’ plans enrolled through Covered California, as well as plans enrolled outside of Covered CA (Off Exchange plans). In some cases, this has resulted in the cancellation of plans, even where clients have made timely payments.
We have discussed these payment issues with Blue Shield’s management. They are ongoing, known issues to Blue Shield. The payments issues stem from multiple factors such as:
1. Blue Shield is the only carrier that uses an outside billing vendor (one called HPS). Problems in their interface with this vendor is what caused many of their billing issues.
2. Blue Shield has been having problems in their interchange of information with Covered CA. These problems stem from an electronic file called Form 834 that is sent to Blue Shield by Covered CA containing enrollment details.
3. In cases where a member’s income or subsidy amounts have changed, there have been problems with incorrect transmittals from Covered CA. Some of these subsidy issues have to be corrected at the Covered CA level before being transmitted to Blue Shield.
We are told that Blue Shield is working on correcting these issues. In the meantime, please let us know at 925-284-2000, if we can help.
Lee Health Insurance Services 935 Moraga Road, Suite 240, Lafayette, CA 94549
Ph: 925-284-2000 Fx: 925-284-5484 [email protected] www.Health-Insurance.com
Employee Benefits and Health Insurance
Last Minute Alert: Covered CA Deadline Extended to Dec. 21 for Individual Health Plan Enrollments
(Note: This alert relates only to Individual and Family health plans. It does not relate to Employers with group health plans, nor to Seniors with Medicare plans.)
We just learned tonight that Covered CA, the State Health Exchange, has extended the previous deadline for Jan. 1 enrollments, from Monday Dec. 15th to Sunday Dec. 21st at midnight. This extension applies only to Individual plans, and only to Consumer and Agent-assisted enrollments.
Covered CA also states that enrollments completed after Dec. 15th may see delays in invoicing as well as delays in proof of enrollment procedures. To facilitate faster enrollment, they encourage submitting applications as soon as possible, but no later than Dec. 21st.
Please call us, Lee Health Insurance Services, at 925-284-2000, if we can be of assistance.
Phil
Philip W Lee MBA
Lee Health Insurance Services, BLIS Corporation
800-286-7445
Health Plan Enrollment Deadlines
This is a friendly reminder of several deadlines that are approaching.
Deadlines for INDIVIDUAL & FAMILY HEALTH PLANS (Either On-Exchange Covered CA plans or Off-Exchange plans)
(1) Deadline to enroll or change plans for a Jan. 1st effective date is Monday, Dec. 15th
(2) Open enrollment runs from 11/15/14 to 2/15/15. The deadlines corresponding to each effective date are:
Deadlines for each Effective Date
12/15/14 for 1/1/15
1/15/15 for 2/1/15
2/15/15 for 3/1/15
(3) If you are currently receiving a subsidy, then you must Renew by logging into Covered CA with your User ID and Password in order to re-certify to continue receiving the subsidy. (4) If you are uninsured, you may enroll by Dec. 15th to avoid a penalty in 2015.
Deadlines for EMPLOYERS WITH SMALL GROUP PLANS
(1) Groups on Grandfathered or Grandmothered plans will already have renewed on Dec. 1st.
(2) All groups, whether Grandfathered or Grandmothered will have a chance to change to new ACA plans with another insurance carrier on Jan. 1st.
(3) If you are dissolving an Employer Group plan and allowing employees to buy individual plans, they need to enroll by Dec. 15th for a Jan. 1st start. (Note that Individual health plans have significantly smaller Provider Networks than Group plans, and smaller Drug Formulary lists. Each of your employee will need to research their providers and formularies carefully before making a switch. Not all employees will qualify for subsidies. Employers are not allowed to use pre-tax dollars to pay for employees’ Individual plan premiums.)
Deadlines for SENIORS ON MEDICARE PLANS
(1) The deadline to change from a Medicare Advantage MA-PD plan (HMO or PPO) to another is Dec. 7th.
(2) The deadline to change from a Medicare Prescription Drug PDP Plan to another is Dec. 7th.
(3) For Medicare Supplement (or Medicare Gap) Plans there is no deadline and no renewal is necessary. These plans will continue as long as you continue paying the premium.
(4) For those of you who received termination notices from Scan Health and Health Net Medicare Advantage plans, you must enroll before Dec. 31st for a Jan. 1st effective date. Since some carriers will be closed during the holidays, you should submit these applications 2 weeks before Dec. 31.
(5) If you are on a Medicare Advantage MAPD plan and wish to switch to a Supplement plan and a PDP plan, you may do so, guarantee issue, only under 13 specific conditions. Otherwise, underwriting approval may be required and the timing of the switch can be tricky. The ideal time to make a change is between Oct. 15 and Dec. 7th, and as early as possible during this window. This should not be done without the assistance of a knowledgeable agent.
Please contact us, Lee Health Insurance Services, at 925-284-2000 if we can be of assistance.
Phil Lee
Clarifying Confusing Names For Obamacare Plans
We have been preparing for the next Open Enrollment period for purchasing individual and family medical insurance plans, which begins on November 15, 2014 and ends on February 15, 2015.
One thing I’ve discovered is that the insurance companies, California State government and the Federal government all have different names for insurance plans offered through Covered CA, the state-run exchange for buying health insurance.
Here’s a list of all the different names I’ve come across in CA that essentially all refer to the same plans, the Covered CA plans.
- Covered CA plans
- Obamacare plans
- Exchange plans
- CA State Exchange plans
- Marketplace plans
- HBEX (Health Benefit Exchange) plans
- HIX (Health Insurance Exchange) plans
- Health Care Reform plans
- PPACA (Patient Protection & Affordability Act) plans
- ACA (Affordable Care Act) plans
- Federal Healthcare.gov plans
- On-Exchange plans
These names are confusing and misleading, as many of you discovered last year. The solution is to simply remember that there are 2 markets: On-Exchange and Off-Exchange.
1) If you do not qualify for a subsidy you do not have to buy from the Covered CA website. You can buy Off-Exchange plans with no Govt. subsidy. You can avoid the technical problems and onerous information requirements of the Covered CA website by applying for a plan through our website www.health-insurance.com, or calling us at 925-284-2000. There are no fees for our services and the premium for your plan is the same whether or not you use an agent.
2) If you qualify for a subsidy due to your income, you can use our expertise as your certified agent to apply to Covered CA, and to receive ongoing assistance from us. These are called On-Exchange Plans. In fact, it is advisable to use a certified agent to apply to Covered California plans because they have up-to-date information on changing plan designs, provider networks, drug formularies, and a dedicated broker support team at Covered California for support. Certified insurance agents enrolled between 40% and 80% of individuals, inside and outside of Covered California.
Applying for a subsidy (also known as the Advance Premium Tax Credit APTC) by applying to Covered CA may require you to submit documentation to verify information such as income, immigration status and employment. The information you provide is subject to verification by the IRS, Dept. of Homeland Security, Dept. of Labor, etc. either at the time of application or at a later date.
Here’s a simple chart to help you figure out which type of medical insurance plan you may qualify for in 2015:
| The 2 Markets for Individual Health Plans | |
| ON Exchange |
OFF Exchange |
| Possible Tax Subsidy based on income |
No Tax Subsidy |
| Marketplace | OFF-Marketplace |
| Covered CA | NON-Covered CA |
| Government Exchange | NON-Government Exchange |
| Limited number of insurance plans | Broader number of insurance plans |
Please keep these terms handy when reading about or shopping for health insurance. When in doubt, call us at 925-284-2000.
The 2 markets for Individual Health Plans:
(1) On Exchange: Tax Subsidy based on income, Marketplace, Govt. Exchange, Limited insurance plans.
(2) Off-Exchange: NO Tax Subsidy, NON-Covered CA, NON-Government Exchange, Broader number of insurance plans.
As always, for our assistance, please call 925-284-2000 or go to www.Health-Insurance.com.
Phil Lee
Lee Health Insurance Services