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

www.health-insurance.com

http://www.yelp.com/biz/lee-insurance-services-lafayette-6

Open Enrollment and Renewal for 2015 Individual Health Plans

(Please Note: This information pertains only to those of you who are on Individual or Family Health plans.  This does not affect either Employer Group plans or Medicare.)

This past year just flew by.  But Open Enrollment is upon us again.  The Open Enrollment period runs from Nov. 15th through Feb. 15th.  (Any plan changes to start on the first of a month must be made by the 15th of the previous month.)   All of you should have received letters or emails from either your insurance carrier or from Covered CA, or from both.  Many of you may not need to do anything at all for your plans to continue.  However all of you who received subsidies through Covered CA will all need to take action.  Details on how to do this are at the bottom of this email.

NOTE: If you require assistance, but we are not your agent, you may designate us as your agent in order to receive our assistance.

If you have an ON Exchange Individual Health Plan

(i.e.  you obtained your Anthem Blue Cross or Blue Shield or Kaiser or Health Net plan through Covered CA, either with or without our assistance as your agent.)

You must “Renew” your plan if you want to continue receiving your subsidy for the 2015 year.  You do this by logging into CoveredCA.com using your User ID and Password.  Government regulations require that you so this in order to continue the subsidy.  If you don’t do this, the premium for your plan will jump up to the full non-subsidized rate and you will be billed for that.  Some may also lose the cost reduction feature on the Silver 70+ AV plans.  Details on how to do this are at the end of this email.

If you have an OFF Exchange Individual Health Plan

(i.e. you obtained your Anthem Blue Cross or Blue Shield or Kaiser or Health Net or Cigna health plan, outside of Covered CA.  You did not apply for a subsidized plan.   You may or may not have used us as your agent.)

Please read the letters from your insurance carrier carefully.  Most of your plans will continue and you may not need to do anything to continue.  However for some of you, especially those who are on Health Net plans, they have cancelled some plans and changed many from PPO to EPO.  You may want to research new carriers or plans.

How to “Renew” Your Covered CA Subsidized Health Plan

Log into your account on Covered CA by going to: www.coveredca.com and once you are on your account page choose Renew (yellow box).   Next will appear Household Plan Selection and click Renew Health Plan (yellow box).

On the next page, two boxes will appear: Choose either Keep the Plan you now have or Shop for a different plan.

If you want to keep your current plan click Keep (yellow box) and checkout (yellow box) check all boxes, put in your pin number, sign and click Enroll (yellow box). On the next page you can print out your confirmation page and make sure you click Done (yellow box). Submit your payment to the carrier no later than December 26, 2014 by either calling your carrier or logging into their website to pay online.

If you want to change your plan when you are on the page that says: Keep the plan you now have or Shop for a different plan you will “remove your plan” (yellow box) first and then click on “Shop for a different plan”. Next page you will review all plans and choose a new plan, check out, check all boxes, put in your pin number, sign and click “Enroll” (yellow box). You can print out your confirmation page and click Done (yellow box). Submit your payment to the carrier no later than December 26, 2014 by either calling your carrier or logging into their website to pay online.

Please contact us, Lee Health Insurance Services, at 925-284-2000 if we can be of assistance.

Phil Lee

www.health-insurance.com

http://www.yelp.com/biz/lee-insurance-services-lafayette-6

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

www.health-insurance.com

Tips on Applying to Covered California

Originally Posted on 3/25/2014
(This information relates only to Individual and Family health plans. Please ignore this email if you are on an Employer group plan, on Medicare or otherwise covered.)

Note: The last chance to apply for individual health insurance in 2014 is Monday March 31. However, based on our experience with past deadlines, Covered CA and possibly the insurance company websites may crash or be inaccessible on the last days. I highly urge you to apply before the end of Friday March 28th. If you miss the 3/31 deadline, you will have to wait until the end of the year to apply, and possibly pay a penalty.

Avoid these common mistakes on your Covered CA application:
• Designating an Agent — In order for us to help you during the enrollment process, and to troubleshoot problems, you must designate us as your agent on your online application. You do this by clicking “Finding Help Near You” on the upper right had corner of the screen. Please see screenshot instructions below:
https://www.dropbox.com/s/ckzl7m70h9brnt6/Agent%20Designation%20ScreenShots.docx
There is no cost to you to have an agent. And we provide free ongoing service and advice throughout the year.

• Remember your Username, Password and PIN — If you lose your login info, you will have to call Covered CA to reset them. Hold times may be as long as 3 hours, or not even be able to get through at all.

• Try to enter the correct information into the online application the first time around — some of the inputs are difficult to change unless you start a new application or call Covered CA (hold times may be as long as 3 hours.)

• Social Security Numbers — If you have already started an application with one (or one set of) Social Security Numbers, the system will not allow you to start a new application with any of those numbers.

• Withdrawing an application in order to restart a new one — it may take up to 2 weeks before you will be allowed to start a new one. By which time, you may be past the deadline.

• Entering the wrong income amounts into the online application — Before signing and submitting the application, be sure to check the income amounts carefully. If you submit an erroneous income amount, it may be difficult to change later without having to submit an Income Change, or withdrawing the application

• Household Members — Household members include dependents, but only those dependents who are claimed as dependents on your tax return. If they are adult children, or elderly parents who are not claimed as dependents on your tax return, they are not considered dependents.

• Household Income — You must include income from all household members who are considered part of your legal or tax household, even if they are not applying for coverage. You must carefully check the correct boxes or circles to indicate this on your online application.

• 3 Categories of Coverage Depending on Your Income — There are 3 categories. (1) If your HH income is below 138% of the Federal Poverty Line (FPL), (or for children, 250% of FPL), you will be automatically slotted into Medi-Cal (the CA version of the federal Medicaid or welfare program). As you know, very few providers accept Medi-Cal. (2) If your HH income is between 138% and 400% of FPL, then you are eligible to receive a subsidy (Advanced Premium Tax Credit) to help pay the monthly premium. Furthermore, if your income is between 138% and 250% of FPL, in addition to the subsidy, you will also be eligible to receive Govt. assistance for reduced Copays, Deductibles and Max. Out of Pocket costs. These plans go by names like Silver 77 or Silver 93. (3) The last category of Coverage is for those with HH income over 400% of FPL. For those in this category, there is no subsidy from the Govt. You may purchase any plan outside of the Covered CA Exchange. Although you may purchase these plans inside the CovCA Exchange as well, for full price, it is advisable to go outside the Exchange (using the links below) because: (a) You will not need to provide income, immigration, or other private information outside, (b) Your private data will not be shared with Govt. agencies like the IRS, Homeland Security, etc. and not submitted to Govt. databases for verification, (c) there are more plans and more carriers available outside than inside, (d) the online application process with the insurance carriers outside of the Exchange is faster, shorter and the websites function much more smoothly, (e) the prices are the same whether outside or inside the CovCA Exchange, it’s just that subsidies are not available outside.

Links to Apply to OFF Exchange (non-subsidized, non-CoveredCA) health plans:
Anthem Blue Cross: https://brokerportal.anthem.com/ehb/web/bkr/acc/agentconnect/PHILIPLEE_1
Blue Shield: https://www.blueshieldca.com/bsca/ApplyNow?xyz=I%2Bc68ZizpmLi
Health Net: https://www.healthnet.com/portal/consumer/ca/getYourQuote.ndo?region=CA&a=10952
Kaiser: https://smu.kaiserpermanente.org/expressweb/ClearWorkspace.action?nextAction=/user/URLDecryptAction.action&refID=7o830apvbn8eyriuut5qmukks0hfomvhibykqt7emn1yam3vpqwgnp5t815gww

How to apply to Covered CA and Outside marketplace:
https://www.dropbox.com/s/hqbjyqdxcecrs1j/How%20to%20Apply%20to%20CovCA%20or%20Outside2.docx

We offer one stop shopping and can help you with all of these plans. Please call us at 925-284-2000 if you encounter any problems in this application process. We are prepared to help you.
Thank you for reading.
Phil Lee
www.health-insurance.com
925-284-2000

Obamacare Deadlines – March 15 and March 31

Originally Posted 3/7/2014
(This E-blast pertains to people buying individual and family plans only. Medicare plans and employer plans are not affected by this announcement.)

1. Obamacare Deadlines – March 15 and March 31

MARCH 15TH IS THE LAST DAY TO SIGN UP FOR AN INDIVIDUAL HEALTH PLAN WITH AN APRIL 1, 2014 EFFECTIVE DATE.

Saturday, March 15th is the deadline to sign up for an individual plan with an Effective Date of April 1, 2014. This deadline applies to Covered California subsidized plans AND non-subsidized plans purchased directly from an insurance company.

Our office will be closed on Saturday, March 15th. If you need help choosing and applying for a plan you MUST call us by March 14.

To apply to Covered California and designate us as your agent or to apply to a non-subsidized plan please follow the link below.

March 31, 2014 IS THE LAST DAY TO BUY HEALTH INSURANCE FOR 2014.

The Effective Date of insurance coverage will be May 1, 2014. This deadline applies to Covered California plans AND non-subsidized plans purchased directly from an insurance company.

If you do not have insurance as of May 1, 2014 you will be subject to a penalty (tax) of the greater of $95 or 1% of adjusted gross income. And you will have to wait until Nov. to apply for Jan. 2015.

Please call us if we may assist you in securing coverage for 2014.

How to apply to Covered CA and Outside marketplace:
https://www.dropbox.com/s/hqbjyqdxcecrs1j/How%20to%20Apply%20to%20CovCA%20or%20Outside2.docx

We offer one stop shopping and can help you with all of these plans. Please call us at 925-284-2000 if you encounter any problems in this application process. We are prepared to help you.
Thank you for reading.
Phil Lee
www.health-insurance.com
925-284-2000

Update of Obamacare Deadlines

Originally Posted 1/15/2014

(This information applies only to Individual and Family health plans. It does not apply to Employer Group plans or to Medicare plans.)

Covered California Payment Deadlines:
For those of you who applied for Individual/Family coverage with an Effective Date of Jan. 1st., either On Exchange (Covered CA), or Off Exchange (from the insurance carrier). Some of the deadlines for initial premium payments have been extended. Those deadlines are:
Blue Shield, Jan. 15th
Health Net, Jan. 15th
Anthem Blue Cross, Jan. 31st
Kaiser, Jan. 31st
Open Enrollment Period Continues
If 1) your plan was cancelled, or
2) you were mapped to a new plan by your insurance carrier, or
3) you opted for an extension to March, or
4) you are on a grandfathered plan, or
5) you are simply uninsured
You may still apply to a new or change insurance carriers before March 31st.
Open Enrollment Application Deadlines:
For Feb. 1st start dates, the deadline is Jan. 15th.
For March 1st start date, the deadline is Feb. 15th.
For April 1st start date, the deadline is March 15th.
For May 1st start date, the deadline is March 31st.
Last day of Open Enrollment for 2014 is March 31st.

We offer one stop shopping and can help you with all of these plans. Please call us at 925-284-2000 if you encounter any problems in this application process. We are prepared to help you.
Thank you for reading.
Phil Lee
www.health-insurance.com
www.HealthPlanTalk.com
925-284-2000

Obamacare — What You Should Do Next with your Health Plan

(This information applies only to Individual & Family health plans. It does not pertain to Employer group plans, employee plans or Medicare plans.)

Today, everything has changed once again! In a press conference this morning, President Obama announced that he wants policy cancellations to be delayed for one year.

How and whether this will be implemented will be decided by the HHS (Dept. of Health & Human Services), the California Insurance Commissioner, Dave Jones, and each insurance company. The final information will trickle down to us after these decisions are made. We don’t know yet when that will be.

Our phone has been ringing non-stop since this announcement. I will give you what we know and suggest some next steps.

1. Before you make any move, please follow the instructions on the piece “Choose an On or Off Exchange plan” to figure out if: (a) you qualify for a subsidy, (b) if your providers are on the network of the 2014 plans and (c) if your prescription drugs are on the formulary lists of the 2014 plans.
2. If you are on a grandfathered plan, you do not need to change anything unless you want to. Your plan will continue as is with the same benefits, provider network, and formulary lists.
3. If you are on a plan where you have received a cancellation notice for Dec. 31. This may be delayed until Dec. 2014. We are waiting for information on this.
4. If you have received a notice that your plan will be “mapped” to a new plan Jan. 1st, this also may be delayed until Dec. 2014.
5. If you want to change plans on Dec. 1st, please contact us.
6. If you received a large rate increase and want to consider other carriers and plans on Dec. 1st or Jan. 1st, please contact us.
7. If you qualify for a subsidy and want a Covered CA plan, please contact us for advice, online enrollment instructions and a paper application.

Please contact me know if you would like me to receive the following attachments:
A. “Choose On or Off Exchange plan” helps you to choose a plan inside or outside the Exchange (with screenshots).
B. “Fillable CoveredCA application” is a fillable Covered CA paper application in pdf format.
C. “Application Screenshots CovCA” takes you step by step to start an application, set up a Profile and Designate an Agent with screenshots).
D. “Agent Designation Screenshots” shows you how to designate an Agent (with screenshots).

Phil Lee
www.health-insurance.com
www.healthplantalk.com
800-286-7445

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Lee Health Insurance Services | Healthcare Insurance Agency, Individual Health Insurance, Family Health Plans, Group Medical Insurance, Small Business Health Insurance, Whole & Term Life Insurance, Dental Insurance, Health Care Reform Assistance, Covered California Insurance Exchange Plans, Medicare Supplement Insurance, Medicare Advantage, Medigap Plans, Anthem Blue Cross, Kaiser Permanente, Blue Shield of CA, Health Net, Cigna, Aetna, Contra Costa County CA, Pleasant Hill, Danville, Concord, Berkeley, Martinez, Albany, Oakland, San Ramon, Alameda, Santa Clara, Campbell, Milpitas, Cupertino, Sunnyvale, Saratoga, Fremont, Palo Alto, Newark | 935 Moraga Road, Suite 240, Lafayette CA 94549 (925) 284-2000 or Toll-Free, (800) 286-7445