Covered California – Urgent Last Minute Alert

(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.

December 19, 2016

 

Consumer Outreach for Consent for Verification

Yesterday, Covered California sent an email to consumers that are at risk of losing their Advanced Premium Tax Credit (APTC) and/or cost-sharing reductions for their 2017 health insurance coverage.  Consumers need to ensure that they have provided their Consent for Verification as this allows Covered California to electronically verify their eligibility for tax credits.

The following two fields are provided to help identify those consumers who need to provide consent.

  • Years of Consent – provides the number of years the consumer provided consent to using their information for verification purposes.
  • Date of Consent- provides the date the consent was provided by the consumer to use their information for verification purposes.

Without taking action now, consumers who have not updated their consent will lose their premium assistance including federal tax credit and/or cost-sharing reductions (lower copayments, coinsurance and deductibles). Read our Consent for Verification Quick Guide for additional information.

LAST DAY to Enroll for January 1 Coverage

Consumers only have until midnight tonight, December 19, 2016 to enroll in a health plan for coverage beginning January 1, 2017. Plans selected after this time may have a February 1 or March 1, 2017 coverage start date.

 

Covered California Service Centers

Consumers that need last minute application support can contact the Covered California Consumer Service Center for the Individual Marketplace at 800-300-1506, which will be open tonight until midnight.

 

Upcoming Outage

Sunday, January 22 from 8:00 p.m. to Monday, January 23, 2016 at 6:00 a.m.

Phil Lee
Lee Health Insurance Services, BLIS Corporation
800-286-7445
www.linkedIn.com/in/philwlee
www.Health-Insurance.com
plee@health-insurance.com
Employee Benefits & Health Insurance

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)

www.health-insurance.com

925-284-2000

How One Pharmaceutical Company Priced Its Drug

I want to share with you the following WSJ article detailing how one major pharmaceutical company took advantage of the health care system to enrich itself, its shareholders and Wall Street with drug prices that produce “99% gross profit margins”.

I hope this will give you with some insight into the behind-the-scenes forces that are driving up health care costs.

How One Pharmaceutical Company Priced Its Drug

Phil Lee

Lee Health Insurance Services (BLIS Corporation)

www.health-insurance.com

925-284-2000

www.linkedin.com/in/philwlee   www.yelp.com/biz/lee-insurance-services-lafayette-7Affordable

 

Wall Street Journal 5/2/2016:

Valeant’s CEO Was Key Force on Pricing

Documents collected during a Senate investigation provide look at how Valeant arrived at sharp price increases

Michael Pearson, chief executive officer of Valeant, lobbied for aggressive price increases on acquired drugs in recent years. PHOTO: DREW ANGERER/BLOOMBERG NEWS

By  JACQUIE MCNISH and LIZ HOFFMAN

Updated May 2, 2016 10:33 a.m. ET

​In early 2015, when Valeant Pharmaceuticals International Inc.’s top brass met to set prices on a soon-to-be-acquired cardiac drug, some executives suggested slow, staggered price increases. Chief Executive Michael Pearson disagreed.

To reach Valeant’s internal profit targets, Mr. Pearson lobbied for a single, sharp increase. Hospitals could still make a profit at the higher price, he argued, which meant patients would still have access to the drug. The team deferred. The day it completed its February 2015 purchase of the drug, called Nitropress, Valeant tripled the cost.

The exchange, recounted in a document reviewed by The Wall Street Journal, shows in greater detail than was previously known how Valeant and its now-outgoing CEO Mr. Pearson pursued quick, aggressive price increases on acquired drugs in recent years—a strategy that sparked widespread backlash and landed Mr. Pearson in front of a Senate investigative panel last week.

A spokeswoman for Valeant, Laurie Little, said, “We heard very clearly the concerns raised by the Senate Special Committee on Aging, and the board is working to map out a new path for the company going forward. That will include consideration both of how best to set drug prices and of the appropriate role of patient assistance programs in helping to ensure that patients can obtain the drugs that doctors prescribe for them.”

At last week’s Senate committee hearing Mr. Pearson said Valeant was “too aggressive” with drug price increases.

Dozens of documents collected during the Senate investigation provide a deeper look at how Valeant arrived at sharp price hikes on some of the drugs it sells. The documents underscore the challenges Valeant faces now that it has promised to roll back some prices and rely less on acquisitions for which price increases are a major driver. That pivot has investors and analysts concerned about where Valeant’s profits will come from and how it will service the $30 billion in debt it carries.

Related Video

Valeant CEO Michael Pearson testified at a Senate hearing investigating drug pricing Wednesday that he and the company made mistakes and “Valeant was too aggressive.” Watch an excerpt of his testimony. Photo: AP

Concerns over the company’s reliance on price increases, its accounting and other business practices hammered Valeant stock, which has fallen more than 85% since its high last summer. Valeant has said it is comfortable with its liquidity.

William Ackman, a major Valeant shareholder and recently appointed director, told the Senate committee that he and other new directors have “stabilized” a company that has made “significant mistakes.” The company’s stock has gone up about 27% over the past month as the company filed a long-overdue annual report, hired a new CEO and reached an agreement with lenders to avoid a technical default.

Under Mr. Pearson, a former McKinsey & Co. consultant, Valeant earned a loyal following on Wall Street for its profitable strategy of buying existing drugs with price-increase potential rather than developing them in-house. “Bet on management, not on science,” he often said. While Valeant did have a research program, Mr. Pearson said that most of Valeant’s R&D products are reformulations of existing drugs, such as a new delivery method for a glaucoma medicine, according to the Senate documents.

Valeant’s pattern of price increases, including on Nitropress, was the subject of a page-one story by the Journal last year. That strategy drew criticism amid broader political scrutiny of pharmaceutical costs. The Senate panel last week—the third in a series of hearings on drug pricing—focused on four Valeant drugs in particular, including Nitropress and Isuprel, which Valeant acquired from Marathon Pharmaceuticals in February 2015.

The other two drugs, Cuprimine and Syprine, are used to treat Wilson’s disease, a rare ailment involving a buildup of copper in the body, and were acquired by Valeant in 2013. Months after it raised the price of the cardiac-care drugs in 2015, Valeant sharply raised its price tags on Cuprimine and Syprine.

The price of Cuprimine has risen 5,787% to $26,189 since 2013, with most of the increase occurring in the summer of 2015, according to an analysis prepared by Senate committee staff for the hearing. The cost of Syprine jumped 2,934% to $19,783 during the same period. A doctor testified at last week’s Senate hearing that a liver transplant, an alternative treatment for Wilson’s disease, is now cheaper than a lifetime of Valeant drugs.

The Senate analysis referred to wholesale acquisition costs that hospitals and other purchasers pay for drugs.

Although the four drugs made up only a fraction of Valeant’s $10.3 billion in 2015 sales, they ranked among Valeant’s 30 most profitable drugs as measured by net profit, Valeant Chief Financial Officer Robert Rosiello told the Senate committee last month in a written response to questions.

So valuable were Syprine and Cuprimine that when a senior Valeant official learned that Valeant’s customer-service group lacked a way to log inquiries from patients complaining about their rising costs, he wrote in an email that “for these…drugs we need to find a way asap.” He inquired about purchasing software to track their complaints. “These patients are too valuable to lose,” Laizer Kornwasser a former Valeant executive vice president, wrote, according to the Senate hearing documents.

Mr. Kornwasser didn’t immediately respond to requests for comment.

At the 2015 meeting on Nitropress, which was attended by Valeant’s then-finance chief,Howard Schiller, Mr. Kornwasser and other top executives, some of the executives recommended gradual price increases to avoid alienating core hospital buyers of the drug, the Senate documents show. Mr. Pearson argued it wasn’t an “exorbitant” price for a drug that saved lives and represented only a fraction of hospital costs, according to the documents.

Upon completing its purchase of the two drugs in February, Valeant sharply raised the price of both Isuprel and Nitropress.

A month later, when a Deloitte consultant studied further price-tag spikes on the two drugs, the consultant asked a senior Valeant executive in an email: “Are you ok with the above assumptions? They are leading to high gross margins (more than 99%).”

The Valeant executive replied in an email that the analysis “looks right, and I’m not surprised they are extremely profitable.”

 

 

Understanding Special Enrollment Period (SEP) and Qualifying Events (QE)

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

The year-end Open Enrollment Period for Individual Health Plans ended on January 31, 2016.  However, certain individuals may still be able to apply for a health plan in 2016. This special circumstance is called the Special Enrollment Period (SEP).  You need to have a Qualifying Event (QE) to qualify.  Here’s what you need to know.

You can buy health coverage outside of the open enrollment period when you have a qualifying life event—through a special enrollment period (SEP).  Most SEPs last 60 days from the date of the qualifying life event.
Qualifying life events for a SEP include:

  • Getting married or entering a domestic partnership
  • Child aging off a plan
  • Gaining a dependent or becoming a dependent through marriage, birth, adoption, or placement for adoption or foster care
  • Permanently moving to a new area that has different health plan options
  • Employer coverage not being considered minimum essential coverage
  • Losing other healthcare coverage that is considered minimum essential coverage, such as due to job loss, termination of employer health plan by the employer or expiration of COBRA coverage
  • Returning from active military service
  • Change in eligibility for advance premium tax credit or cost-sharing subsidies

Please note that voluntarily terminating other health coverage or being terminated for not paying premiums is not considered a qualifying event.

All insurance companies will require written proof that you have an acceptable qualifying event.  When enrolling during an SEP, please make sure to include qualifying events verification documents in the application.

This is a link to Blue Shield of California’s interpretation of the ACA laws regarding SEP and QE’s.  Different carriers may have slightly different interpretations and requirements.

https://bliscorp.egnyte.com/dl/QJhtXag1KT

Phil Lee

Lee Health Insurance Services (BLIS Corporation)

www.health-insurance.com

925-284-2000

www.linkedin.com/in/philwlee   www.yelp.com/biz/lee-insurance-services-lafayette-7Affordable

 

Premium Reimbursement is a Costly Violation

(This information relates only to Employer-Sponsored Group Health Plans.  It does not concern either Medicare Plans or Individual and Family Health Plans)

Re: Premium Reimbursement by Employers (outside of an ACA-Approved Group Health Plan) is a Costly Violation

Starting on July 1st, the IRS will begin assessing a penalty of $100 a day (per employee for each affected employee) to employers who continue to pay for employees’ individual health plans.  Please click below link to this article.

http://eba.benefitnews.com/news/regulation/premium-reimbursement-is-a-costly-violation-2746335-1.html?zkPrintable=true.

We would be happy to help your company find affordable solutions to comply with local and federal requirements regarding health insurance.

Phil Lee

Lee Health Insurance Services
800-286-7445

www.linkedIn.com/in/philwlee

www.Health-Insurance.com

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
800-286-7445
www.health-insurance.com

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 agent@health-insurance.com .

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
plee@health-insurance.com
www.Health-Insurance.com

Alert to Individuals who Received Tax Subsidies or APTC to Pay for Covered California Health Plans – Form 1095A

(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.)

Re: IRS Form 1095A and Form 8962

Covered California, the California health insurance exchange, will shortly be sending out a form called the IRS Form 1095A to all individuals and families who received tax subsidies in 2014 to help pay for their Individual/Family health plans. This is required by the federal ACA law (Obamacare) and will be sent out by Jan. 31st.
These forms will show, in detail, by month, the amount of APTC (Advance Premium Tax Credit or Tax Subsidy) that the recipient received in helping pay the premium for their subsidized health plans in 2014.
These individuals will be required to use this Form 1095-A to obtain information needed to complete Form 8962 (Premium Tax Credit (PTC)). They must then complete IRS Form 8962 and file it with their 2014 Tax Return by April 15.
Those who enrolled into Off-Exchange health plans need not be concerned, since they did not receive any tax credit, you will not receive a 1095A. Only those who applied for a health plan through Covered CA AND who received an APTC to reduce the premium paid, will be receiving these 1095A forms.
Those enrolled into Medi-Cal (California Medicaid), those on Medicare, and those enrolled on employer group plans are not affected by the above.

Disclaimer: We are not qualified to give tax advice. If you have any questions concerning either Form 1095A or Form 8962, please contact Covered CA, your tax adviser, the IRS or go to the IRS website links below:
www.irs.gov/uac/About-Form-1095-A
www.irs.gov/uac/About-Form-8962

Philip W Lee, MBA
Lee Health Insurance Services
www.health-insurance.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