Anthem Blue Cross to Discontinue Individual Health Plans in Most Counties in California

Anthem Blue Cross announced that they will discontinue selling Individual medical plans in CA in 2018 except for three counties, Santa Clara, Stockton/Modesto, and Redding.

I received the following email from Anthem to agents and brokers last week with details about this decision. Please click on the link below:

Anthem Announcement

Please review the following to be sure that you will actually be affected by this:

  • This change only affects those on Individual Health Plans, NOT Employer Group plans or Medicare plans.
  • It affects both On Exchange (Covered California), as well as Off Exchange health plans.  It affects both subsidized as well as non-subsidized plans.
  • It does not affect “Grandfathered” plans.
  • It will take effect on Jan. 1st, 2018.
  • This change does not affect these 3 counties: Santa Clara, Stockton/Modesto and Redding.

We might be able to help you find alternatives as soon as the insurance carriers such as Blue Shield, Health Net and Kaiser release their new rates for Jan. 1, in either September or October.

Phil Lee

Lee Health Insurance Services (BLIS Corporation)


The Pitfalls of Leaving Original Medicare & Supplement Plan for Medicare Advantage HMO

(This information concerns Medicare Health Plans.  It does not concern you if you are either on an Employer-Sponsored Group Health Plan or on an Individual & Family Health Plan)

We frequently hear stories about seniors who made this change hastily because they attended a meeting, or an agent came to their home.  Frequently these agents would represent a limited number, usually just one, Medicare Advantage HMO plan.  They typically do not give prospects an adequate overview or understanding of the entire universe of plans in the marketplace because they have limited knowledge and products to offer.   They don’t fully explain the consequences of your making such a switch.

If you are contemplating such a change, you should not do so lightly.  You should only do this after much thought and research.  It’s not a matter of simply changing plans or changing carriers.  It’s nothing short of changing  from one world of plans, Original Medicare with Medicare Supplement, to another entirely different world of plans, Medicare Advantage.

These are the issues you must consider:

  1. This change may not be reversible in the future because Medicare Supplement plans are not guarantee-issue, except at age 65.  Supplement plans do not have an annual open enrollment period as Advantage plans do.   If you ever want to go back to Medicare Supplement from an Advantage plan, you will have to be medically underwritten and approved on your application before you will be enrolled.
  2. 90% of our clients choose Medicare Supplement F plans because of the freedom to choose their own providers anywhere in the country, and also because of the freedom from Copays, Coinsurance and Deductibles for all medical costs, excluding Rx.  However over the years, many non-clients have approached us for help to make the difficult transition from Medicare Advantage, such as Kaiser back to Original Medicare and Supplement.  This process is not easy, and is full of tricky timing and health approval issues.
  3. Medicare Advantage HMO plans like Kaiser Advantage or Scan Health require you to use only those doctors that are in their network.  You will not have the option to see any outside doctors such as from UCSF, Stanford, etc.  You will be required to obtain referrals and authorization for all specialists, procedures, etc.
  4. Advantage plans do not include Foreign Travel benefits.
  5. Kaiser Medicare Advantage does not cooperate with independent agents.  So we will not be able to service you on your Medicare plans at all.
  6. CMS (Center for Medicare & Medicaid Services) has ruled that Medicare Supplement F plans can no longer be offered to new enrollees after the year 2020. If you think you might want a Medicare Supplement F plan in the future, you must enroll before 2020.
  7. Medicare Trial Period and Medicare 24 Month Rule – Under very limited circumstances, Medicare beneficiaries who enroll in an Advantage plan at age 65 may have a 12 to 24 month Medicare Trial Period where they may switch back to Original Medicare, a Medicare Supplement plan and a Medicare PDP (Rx) plan, guarantee-issue.   But it must be done within 24 months from age 65 Medicare ICEP (Initial Coverage Enrollment Period).

Phil Lee

Lee Health Insurance Services

Last Chance to Enroll into a Health Plan in 2015

(This information relates only to Individual and Family Health Plans, not Medicare or Group plans)

If you are uninsured and do not have a special Qualifying Event, Thursday April 30th is the last day that you may enroll into an Individual Health Plan using the Govt.’s special extension by claiming that you are unaware of the uninsured penalty.

If you apply by April 30th, you will receive a June 1st effective date. Otherwise, you will have to wait until the end of the year.
In order to apply for coverage during this extended enrollment period to a plan either On or Off the Covered California health exchange, most carriers require you to do so through a certified agent. Anthem Blue Cross further requires the application to be on paper through an agent.

At Lee Health Insurance Services we would be happy to serve as your agent. As always, there are no costs, no fees for our services. The premium rates you pay are the same approved and regulated rates whomever you get them from. If you qualify, you will receive the tax subsidies that you are eligible for based on your household income.
Phil Lee
Lee Health Insurance Services

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

Update on Enrollment Deadlines: Extensions for OFF Exchange Plans

(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.)

ON Exchange (Covered CA) plans:

As reported earlier, the 12/15/14 deadline has been extended to midnight Sunday 12/21/14.  Online applications only.  This applies to all Covered CA Exchange plans from Anthem Blue Cross, Blue Shield and Kaiser.


OFF Exchange plans (outside of Covered CA and direct with insurers):

Anthem:  The deadline has been extended to midnight Sunday 12/21/14.  Applications must be on paper.

Blue Shield: There are no extensions.  The deadline passed on 12/15.  (If you still want Blue Shield but do not need a subsidy, you may still apply through the Covered CA portal.  But you will still have to provide income and immigration status to the Govt.)

Cigna: The deadline has been extended to Friday 12/19/14 at 5 pm PST.

Health Net: The deadline has been extended to midnight Sunday 12/21.  Online applications only.  Applicants are encouraged to pay their initial premium by 1/1/2015, without waiting for their NOA (Notice of Acceptance).  You may use HN’s 24-hour payment line at 1-800-539-4193. You will hear the amount due as soon as HN has your enrollment in their system.

In all cases, the application extension plus the time required to process the files will impact timely receipt of the NOA (Notice of Acceptance) letters, initial premium bills, delivery of ID cards and policy descriptions.

If you need help, please call us at 925-284-2000 or email

Phil Lee


Covered California Announces Extension of Deadline to April 15th

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

Covered California announced that they are extending the March 31st deadline to buy health insurance through its Exchange website to April 15th. There are conditions. You may fulfill these conditions by working with a Certified Insurance Agent, like me. We are prepared to help you. Please call us at 925-284-2000 or email

Re-cap of announcement from Covered CA:
1. If you were unable to create an online account or start your online application because of technical difficulties you can contact me, a Covered California Certified Insurance Agent, to explain that you attempted to get through on March 31 and experienced difficulties. You will have until 11:59 p.m. April 15 to complete your application and choose a plan. Your coverage will be effective May 1.

2. If you created an online account and completed the first page of the application by 11:59 p.m. March 31, 2014, you will be able to complete your application for the open-enrollment period, either by yourself online or with my help. I am a Certified Insurance Agent. You must complete your application and select a plan by 11:59 p.m. April 15. Your coverage will be effective May 1.

In addition, for those applying to OFF-Exchange (i.e. non-Covered CA, non-subsidy) plans, we understand that Blue Shield and Health Net’s online application links are both still working.

Please call us at 925-284-2000 if you still need help getting coverage.

Phil Lee
Lee Health Insurance Services

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

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


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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