Coveredca.com | Lee Health Insurance Services

Important Enrollment Updates for Individual and Family Health Plans – Covered California and Outside Plans

December 13, 2013 By Phil Lee

(The following information does not apply to you if you are on an employer group plan or on Medicare.)

Re: Deadlines, Plan Choices, Documents and Payments

Our phones have been ringing non-stop. In order to be able to help as many people as possible, I am sharing this information with you if you are trying to apply for an Individual/Family health plan (for under age 65) to start on Jan. 1st.

Applying to Covered California On Exchange Health Plans:
• The deadline for online applications for a Jan. 1st effective date is Monday Dec. 23rd.
• The main carriers you may choose from are Anthem Blue Cross, Blue Shield, Health Net and Kaiser.
• The coverage levels you may choose from are Bronze, Silver, Gold, Platinum plus Catastrophic (for under 30).
• The most popular plans we are seeing is Silver, followed by Bronze.
• You must go to www.coveredca.com to apply. Please designate me as your agent. Step by Step instructions for applying:
https://www.dropbox.com/s/9pas1gmsycqdrfx/Application%20Screenshots%20CovCA.docx
• After you submit your Covered CA online application, you may receive an email, phone call or letter from CC asking for documents such as bank statement, tax return, naturalization paper, etc. You must return these right away in order for your application to continue processing.
• After you are approved and deemed eligible by Covered CA, they will then forward your information to the insurance carrier. The insurance carrier will immediately send you a packet with ID card and an invoice for the first month’s premium. You must pay this invoice by Jan. 5th in order to have your coverage be effective on Jan. 1st.

Applying to Off Exchange Health Plan (outside of Covered CA):
• The deadline for online applications for a Jan. 1st effective date is:
– For Blue Shield, Health Net and Kaiser — Sunday Dec. 15th
– For Anthem Blue Cross — Monday Dec. 23.
• The main carriers you may choose from are Anthem Blue Cross, Blue Shield, Health Net, Kaiser and Cigna
• The coverage levels you may choose from are Bronze, Silver, Gold, Platinum plus Catastrophic
• The most popular plans we are seeing is Silver, followed by Bronze.
• You must use the following links to apply:

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

• After you submit your application online, you are done. Just watch for any communication from your insurance carrier. We will also monitor your application processing for you.

Please call us at 925-284-2000 if you encounter any problems in this process. If you have an urgent question this weekend (Dec. 14,15), please email me at [email protected].
Phil Lee
925-284-2000
www.health-insurance.com
www.HealthPlanTalk.com

Choose an On-Exchange or Off-Exchange Health Insurance Plan? How to Apply to Covered California or Outside.

December 4, 2013 By Phil Lee

Individual and Family Health Plans

I apologize for this lengthy post. But it contains critical information and links necessary for you to make a decision on which health plan to choose, and to apply to either a Covered California Exchange health plan, or to a plan outside of the Exchange.
It’s been a challenge to communicate such an enormous amount of information to so many people in such a short period of time. But we are determined to help you take care of this before the deadline of Dec. 23rd.

How to apply
(A) On-Exchange (CoveredCA) Plans — Plans that allow tax subsidies.
www.coveredCA.com
Please use these links below for paper applications and instructions on how to apply online.
(If these links do not open automatically when you click, please copy and paste the URL address onto the address line on your browser, and click return.)
(1) Link to, “Fillable Covered CA paper application”. This paper application form allows you to complete by typing in answers and then printing out. This form is much easier and takes one-fifth of the time to complete over the CoveredCA.com online application:

https://www.dropbox.com/s/olamsrnb43cv2xl/Fillable%20CovCA%20Application%20P%20Lee%20Agent.pdf

(2) Link to, “Application Screenshots Covered CA”. Step by Step instructions with screenshots on how to submit an application using coveredCA.com. It shows how to set up a User ID, password and then designate an Agent. You then continue to complete the application yourself:

https://www.dropbox.com/s/9pas1gmsycqdrfx/Application%20Screenshots%20CovCA.docx

(3) Link to Instructions for “Agent Designation ” on CoveredCA.com website. Step by Step Instructions with screenshots on how to designate Philip W Lee, License #0795681, as your Certified Insurance Agent to service your account:

https://www.dropbox.com/s/ckzl7m70h9brnt6/Agent%20Designation%20ScreenShots.docx

Please be sure to enter my agent license number so that we may continue to service your account and receive credit for doing so. (Agent Philip W Lee License # 0795681) There are no fees to you and you do not pay any additional premium for having an agent. You will however receive our ongoing helpful service.

(B) Off Exchange (non-CoveredCA) Plans — Non-standardized plans with no tax subsidies.
Apply by clicking the below links and following the online instructions:

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

Compare On and Off Exchange Plans

Side-by-Side Comparison Reports
If you have not already received customized side-by-side comparison proposals or reports from us, please ask me (email agent@health-insurance or call 925-284-2000). Please include your name(s), Dates of Birth, Zip Code(s) and email address. There are two reports: (1) On Exchange Proposal comparing plan inside the Covered CA Exchange, and (2) Off Exchange Proposal comparing plans outside of the Covered CA Exchange.

What you need to consider in your decision:

1) Do you qualify for a Tax Subsidy?
You may estimate your health plan premiums and subsidies using the Shop and Compare Tool Calculator on the Covered California website.

https://www.coveredca.com/shopandcompare/#calculator

If you know that you qualify for a subsidy, and want to take advantage of it, then you should apply to Covered CA, naming us as your Designated Agent (Instructions on Agent Designation are above).

If you know that you do not qualify for a subsidy, it will be advisable to consider plans that are outside of the Covered CA Exchange. Plans sold in the Exchange are also available outside of the Exchange at the same prices with the same benefits. But there will be a larger variety of plans to choose from outside. The plans outside the Exchange may have different provider networks and additional carriers.

Applications to plans outside the Exchange will not require you to divulge personal information like income and immigration status to Govt. entities like the IRS, CMS, HHS, DOL, NSA, Homeland Security, etc.

2) Are your doctors and hospitals listed in the Provider Network of the plan that you are considering?
Most Individual/Family plans, except for Health Net and Kaiser, whether in or out of the Covered CA Exchange, will have reduced or “skinny” provider networks. .These plans do not have the same full PPO or HMO networks that you may have been used to with pre-ACA plans. The provider search function in coveredca.com may not have up to date listings. However several of the carriers have posted “provider lists” on their own websites. There are links to these lists below. Please be aware that physicians are still negotiating with the carriers, and that these lists may change daily.

Anthem Blue Cross will only be offering a limited, reduced size provider network for their Individual/Family plans in and out of the Covered CA Exchange. This list is about 40% -60% of their full PPO network.
Blue Shield of CA will be offering a limited provider network for all their Individual/Family metallic plans in and out of the Covered CA Exchange. The new network will have 50% of the doctors and 70% of the hospitals of their previous full network.
Kaiser’s network will be the same in and out of the Exchange, and same as their current network.
Health Net has announced that they will be using the same provider network in 2014 as in 2013, i.e. their full PPO network.
Cigna will also be offering a reduced PPO network call the LocalPlus Net for their Individual plans in 2014. However, Cigna is allowing individuals to enroll (through Dec.14th) onto their 2013 plans. They will then renew these plans for one year on 12/31/13 (with a 5% increase for ACA taxes and fees), thus delaying ACA changes until Dec. 2014. These plans will retain the old provider network and drug formularies until Dec. 2014.

If you are not able to find a satisfactory provider network among the Individual and Family plans inside or outside of the Exchange, please give us a call at 925-284-2000. There may be other options such as small group plans.

To search for Doctors and Hospitals:

Anthem Blue Cross Provider Finder:
http://www.anthem.com/wps/portal/ca/popcontent?content_path=shared/f1/s0/t0/pw_e206382.htm

Blue Shield of CA Provider Finder:
https://www.blueshieldca.com/bsca/ApplyNow?xyz=I%2Bc68ZizpmLi

Health Net Provider Finder:
https://www.healthnet.com/portal/provider/providerSearch.do?region=CA

Cigna Provider Finder:
http://www.cigna.com/ifp-providers
Plans starting in 2013 have the OAP network (expansive)
Plans starting in 2014 will have the LocalPlus Network (narrower)

3) Are your prescription drugs on the Drug Formulary List of the plan that you are applying to?
Please be aware that carriers have told us that they may be reducing some of their prescription drug formulary lists prior to Jan. 1.
Some carriers are starting to post their formulary lists on their websites. But those lists may be updates frequently. Health Net has announced that there will be no change to their drug formulary list in 2014 from 2013.

For your convenience, I have attached a link to the online formulary lists for Anthem Blue Cross and Blue Shield. Please keep in mind that these lists may change.

Anthem Blue Cross Drug Formulary list can be found at:
http://www.anthem.com/ca/CAExchangedruglist4.pdf

Blue Shield Formulary List can be found at:
https://www.blueshieldca.com/bsca/documents/pharmacy/Standard_Formulary.pdf

4) Are you on a grandfathered health plan?
If you are on a grandfathered plan, you would have received a letter from your carrier notifying you of that.
If you don’t know, please call your carrier to find out.
If you do have a grandfathered plan, then it will retain its existing provider network, drug formulary list and benefit design.
If you find that the new ACA-compliant plans for 2014 do not satisfy the provider network, formulary list or pricing that you desire, then you should keep this grandfathered plan.

To recap, apply to Covered CA (with us as your Designated Agent), if:

a) You qualify for a sizable Tax Subsidy
b) Your doctors and hospitals are in the plan’s reduced network.
c) Your prescription drugs are in the plan’s Formulary List and you do not need to obtain prior authorization from the new Exchange plan to continue an expensive prescription medication.
d) You do not want to consider any of the Off-Exchange health plans.
e) You do not want to keep a grandfathered plan which may have a more favorable provider network or drug formulary list.
f) You are comfortable with the fact that Covered CA will be sharing your PII (Personal Identifiable Information), PHI (Private Health Information) and financial information with other government and non-government entities that may include the IRS, Dept. of Homeland Security, Center for Medicare Medicaid Services, US Dept. of Health & Human Services, Dept. of Labor, Dept. of Insurance, Dept. of Managed Health Care, the State of California and Equifax.
g) You are comfortable that the Covered CA website will provide adequate security and protection against hacking and identity theft.

If you are not comfortable with all of the above, you may consider an Off-Exchange plan, or another carrier not on the Exchange like Cigna, or a small group plan.

Documents that Covered California may request from you when you apply to On Exchange plans. (These will not be required for Off Exchange plans.)
• Your W-2 wage statement
• Your Bank Account Statement
• Your IRS 1040 form showing your household AGI income
• Your current health plan information such as ID card, plan summary, billing statement, cancellation notice, notice of mapping, premium increase letter, letter of grandfathered status, etc.
• Drivers License, Passport, Resident Alien ID card or naturalization papers.
Thank you for reading these lengthy emails.

Please call me at 925-284-2000 if you have any questions. You may get updates on my blog at http://www.healthplantalk.com/

Very sincerely,

Phil Lee
www.health-insurance.com
925-284-2000

Filed Under: Covered California, Group Plans, Health Care Reform, Individual/Family Plans Tagged With: ACA, Affordable Care Act, Anthem Blue Cross, Blue Shield, Blue Shield of California, California Department of Insurance, California Health Benefit Exchange, California Health Exchange, California Health Insurance, Cigna, Covered California, Covered California Health Exchange, coveredca.com, Family Health Insurance, Family Health Plans, Group Health Insurance, HBEX, Health Care Plans, Health Care Reform, Health Care Reform Act, Health care subsidy, health insurance, Health Insurance California, Health Insurance Exchange, Health Insurance Marketplace, Health Net, Health Plans California, Health Savings Account, Health Savings Accounts, health subsidy calculator, HIX, Individual Health Insurance, Individual Health Plans, Kaiser, Obamacare, Patient Protection and Affordability Act, Patient Protection and Affordable Care Act, PPACA, Prescription Drug Formulary, Provider Network, tax subsidy

We are Ready to Help you Make a Decision About Your Health Plan

November 22, 2013 By Phil Lee

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

News this past week (Quite a lot has happened):
• 12 month Delay in Cancellations
Obama’s press conference last week called for a delay of 12 months to the millions of plan cancellations letters that consumers have received. The President vetoed similar bills submitted to him by Congress to remedy this, but preemptively, offered up his own version, an “administrative fix” which did not give him the legal authority to force a delay, but basically passes the problem down to the States and the insurance carriers.
Although many States have instituted this delay, many have not, including California.

• California Cancellations
In California, Dave Jones the Insurance Commissioner was in favor of a delay, but the final decision rested with the head of Covered CA, Peter Lee, who thought otherwise. The Covered CA Board decided yesterday not to follow Obama’s recommendation for a 12 month delay in cancellations. Cancellations scheduled for Dec. 31 and March 31 will go into effect as planned.

• Dec. 15th Application Deadline Extended to Dec. 23rd
It was announced today that the Dec. 15th deadline for enrolling into a health plan with an effective date of Jan. 1st, has now been extended to Dec. 23rd. This new deadline will apply to all individual plans on or off the Covered CA Exchange. You will have one extra week to enroll for a Jan. 1st plan.

• Off Exchange Rates and Benefits Released
Insurance carriers in CA have now released rates and benefits for all their Off-Exchange health plans, i.e. those plans that are outside of Covered CA and not eligible for subsidies. We now have all the information necessary to help you make a decision.
• Annual Open Enrollment Period (AEP) for all individual plans
The AEP for 2014, which was previously scheduled to begin on 10/15/14, has now been delayed to 11/15/14, after the midterm elections.

Important Information to Know:
1. Those Cancellations that were delayed to March
Only some of you, but not all of you, have received letters from your carriers (Anthem Blue Cross, Blue Shield or Health Net) notifying you that your current health plan’s cancellation date has been extended to March 2014. And that if you wish to accept this delay, you must notify them in writing.
This is a tempting delay to accept, but you should understand that you may have to satisfy two deductibles in one year, instead of one. The reason is that you will be satisfying one deductible from Jan. to March, then start a whole new deductible after March. The deductible satisfied in the first 3 months do not carry over to your new plan in April.
For the same reasons, even if the open enrollment period does go to March 31st, you may want to enroll on Jan.1st to avoid the two deductible problem.

2. Although you may apply to Covered CA for a health plan, even if you do not qualify for a subsidy, this is not advisable for these reasons:
a) There are 3 buckets of health plans in the Individual marketplace: On-Exchange plans, Off-Exchange plans and Off-Off-Exchange plans. All the plans offered inside the Covered CA Exchange, the metallic plans, are also available outside of the Exchange at exactly the same premium and same benefits. We call these “mirror plans” of “Off-Exchange” plans. They are similar, but may not use the metallic names of Bronze, Silver, Gold and Platinum. The only difference is that these plans do not have subsidies.

b) Inside the Exchange, you are required to report personal and financial information like your income.

c) Inside the Exchange, your personal and financial information will be shared with government agencies like the IRS, Dept. of Homeland Security, INS, HHS, CMS and their contractor Equifax.

d) Inside the Exchange, you may be subject to retroactive audits and recalculations years down the road, by the IRS, for any errors in reporting.

e) Outside the Exchange, there will be many more plan designs and rate levels available, besides the “metallic plans”.

4. If you do not qualify for a subsidy, then you should consider a health plan outside the Exchange. All plans are guarantee-issue regardless of pre-existing conditions, you will not be asked for any health or financial questions. And your information will not be shared with any government agency.

Next Steps
A. Use the Covered CA Calculator to see if you qualify for a subsidy (See instructions in my piece “Choosing an On or Off Exchange Health Plan”)

B. Ask for a comparison proposal that compares all plans inside and outside of the Covered CA Exchange. Email me at [email protected] or call 925-284-2000.

C. Ensure that your doctors and other providers are on the network of the plan you are applying to. (See instructions in my piece “Choosing an On or Off Exchange Health Plan”)

D. Ensure that your prescription medications, especially Brand Name drugs are on the formulary list of the plan that you have chosen. (See instructions in my piece “Choosing an On or Off Exchange Health Plan”)

Decision
a) If you decide to keep a Grandfathered plan, then you do not need to do anything. Your plan will continue at the rate that the carrier has notified you of.

b) If you are eligible for a subsidy, then you must apply to a Covered CA Exchange plan.

c) If you are not eligible for a subsidy, or you choose to voluntarily forgo any subsidy, and your current plan is being cancelled, then you may apply for an Off Exchange health plan.

d) If you find that your providers are not on any of the 2014 plans, but your current plans is going to be cancelled. There is one possibility. You may apply to a Cigna 2013 Off-Off-Exchange health plan by Dec. 14th for a Dec. 15th effective date. This application requires underwriting and approval. But Cigna will renew your plan on Dec. 31st. They will add a 5.8% increase for ACA-related taxes and fees. Then allow you to keep the plan with full provider network (instead of the narrow 2014 networks up until 12/31/2014. This move allows you to delay your transition to ACA plans until 2015. Hopefully, there may be better options at that time.

Applying for a Covered CA On-Exchange Health Plan:
• Apply online at www.coveredca.com. Set up an ID and password. Find and designate me as your agent (Philip W Lee License #0795681) so that we may help you with this enrollment and continue to service you in the future. Please ask me for my Step by Step Application Screenshot instructions for setting up an account and designating an agent.

• Apply using a Fillable Paper Application. Please ask me for a copy of the fillable paper application where you can simply type you information on the form, print out, and send or fax to us for processing Print and Hand Complete an Application. Please ask me for a copy of the fillable paper application which you may print out blank, handwrite your answers on the form, and return to me. (Fax 925-284-5484 or email [email protected] or mail Lee insurance Services, 935 Moraga Rd., Ste. 240, Lafayette CA 94549)

Applying for an Off-Exchange Health Plan:
• Apply Online at Carrier Website. The following links to the insurers are encrypted with my agent info so that the insurer will recognize that we are helping you so that we may monitor and troubleshoot any problems for you.

Anthem Blue Cross: https://brokerportal.anthem.com/ehb/web/bkr/acc/agentconnect/PHILIPLEE_1

Blue Shield of California: https://www.blueshieldca.com/bsca/ApplyNow?xyz=I%2Bc68ZizpmLi

Health Net:
(Online link pending)

Kaiser:
(Online link pending)

Cigna:
(Online link pending)

Getting Paper Applications to Us

• Fax to us anytime at: 925-284-5484
• Email to: [email protected]
• Mail to: Lee insurance Services, 935 Moraga Rd., Ste. 240, Lafayette CA 94549
• Deliver in Person: We are open on Weekdays (except holidays) from 9 am to 5 PM. After hours, there is a mail slot at the door to our office. If you live nearby and find it more convenient to drop off your application, you may simply slide it through the slot. We will attend to it as soon as our office opens again.

It would give us immense pleasure to see that you are all taken care of before your respective deadlines.
Phil Lee
www.health-insurance.com
www.healthplantalk.com
800-286-7445

Filed Under: Covered California, Health Care Reform, Health Savings Accounts, Individual/Family Plans Tagged With: ACA, Affordable Care Act, Anthem Blue Cross, Blue Shield, California Department of Insurance, California Health Exchange, California Health Insurance, Covered California, Covered California Health Exchange, coveredca.com, Family Health Insurance, Family Health Plans, guarantee issue coverage for children, guarantee issue health plans for children, HBEX, Health Care Plans, Health Care Reform, Health Care Reform Act, Health care subsidy, health insurance, Health Insurance California, Health Savings Account, Health Savings Accounts, health subsidy calculator, Individual Health Insurance, Individual Health Plans, Individual Mandate, Individual Subsidy, Obamacare, Patient Protection and Affordability Act, Patient Protection and Affordable Care Act, PPACA, pre-existing conditions, tax subsidy

Obamacare — What You Should Do Next with your Health Plan

November 14, 2013 By Phil Lee

(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

Filed Under: Health Care Reform, Individual/Family Plans Tagged With: ACA, ACA compliant health plans, Affordable Care Act, Anthem Blue Cross, Blue Shield, California Department of Insurance, California Health Exchange, California Health Insurance, children health insurance, cost reduction, Covered California, Covered California Health Exchange, coveredca.com, Delay health plan cancellations, Family Health Insurance, Family Health Plans, Guarantee issue health insurance, guarantee issue health plans for children, HBEX, Health Care Plans, Health Care Reform, Health Care Reform Act, Health care subsidy, health insurance, Health Insurance Marketplace, Health Net, Health Plans California, health subsidy calculator, Individual Health Plans, Individual Mandate, Obamacare, Patient Protection and Affordability Act, Premium Assistance, tax subsidy

Covered California –Should you Choose an On Exchange or Off Exchange Health Plan?

November 13, 2013 By Phil Lee

(This information applies to Individuals and Families under age 65. It does not apply to you if you are an Employer, have an Employer Group plan, or are on Medicare.)

Please read this before making your decision

Should you Apply to a Covered California Exchange health plan now, or wait until the Off Exchange health plans are released (late Nov.)?

What you need to consider in your decision:

A) Do you qualify for a Tax Subsidy?
You may estimate your health plan premiums and subsidies using the Shop and Compare Tool Calculator on the Covered California website.

https://www.coveredca.com/shopandcompare/#calculator

If you know that you do qualify for a subsidy, and want to take advantage of it, then you should apply to Covered CA, naming us as your Designated Agent (Instructions on Agent Designation are attached).

If you know that you do not qualify for a subsidy, it will be to your advantage to consider plans that are outside of the Covered CA Exchange. Plans sold in the Exchange are also available outside of the Exchange at the same prices with the same benefits. There will be a larger number of plans to choose from outside. The plans outside the Exchange may have different provider networks.

In addition, applications to plans outside the Exchange will not require you to divulge personal information like income and immigration status to Govt. entities like the IRS, CMS, HHS, NSA, Homeland Security, etc.

B) Are your doctors and hospitals listed in the Provider Network of the plan that you are considering?
Most Individual/Family plans, whether in or out of the Covered CA Exchange, will have reduced or “skinny” provider networks. These plans do not have the same full PPO or HMO networks that you may have been used to with pre-ACA plans. The provider search function in coveredca.com may not have up to date listings. However several of the carriers have posted “provider finders” on their own websites. Please be aware that physicians are still negotiating with the carriers, and that these networks may change daily.

Anthem Blue Cross has notified us that they will only be offering a limited, reduced size provider network for their Individual/Family plans in and out of the Covered CA Exchange.
Blue Shield of CA has notified us that they will be offering a limited provider network for all their Individual/Family metallic plans in and out of the Covered CA Exchange. The new network will have 50% of the doctors and 70% of the hospitals of their previous full network.
Kaiser has notified us that their network will be the same in and out of the Exchange, and same as their current network.
Health Net has not yet announced their decision on provider networks.

If you are not able to find a satisfactory provider network among the Individual and Family plans inside or outside of the Exchange, Please give us a call at 925-284-2000. There may be small business group plans with wider networks — as long as you have a business with 2 or more employees.

To search for Doctors and Hospitals:
Anthem Blue Cross Provider Finder:
http://www.anthem.com/wps/portal/ca/popcontent?content_path=shared/f1/s0/t0/pw_e206382.htm

Blue Shield of CA Provider Finder:
https://www.blueshieldca.com/fap/app/search.html

C) Are your prescription drugs on the Drug Formulary List of the plan that you are applying to?
Please be aware that carriers have told us that they may be modifying and likely reducing some of their prescription drug formulary lists prior to Jan. 1.
Some carriers are starting to post their formulary lists on their websites. But those lists may be updates frequently.

For your convenience, I have attached a link to the online formulary lists for Anthem Blue Cross and Blue Shield. Please keep in mind that these lists may change.

Anthem Blue Cross Drug Formulary list can be found at:
http://www.anthem.com/ca/CAExchangedruglist4.pdf

Blue Shield Formulary List can be found at:
https://www.blueshieldca.com/bsca/documents/pharmacy/Standard_Formulary.pdf

D) Are you on a grandfathered health plan?
If you are on a grandfathered plan, you will have received a letter from your carrier notifying you of that.
If you do not know, you need to call your carrier to find out.
If you do have a grandfathered plan, that health plan will retain your existing provider network, drug formulary list and benefit design.
If you find that the new ACA-compliant plans for 2014 do not satisfy the provider network, formulary list or prices that you want, then you may keep this grandfathered plan.

To recap, apply now to Covered CA (with us as your Designated Agent) if you are certain that:
1. You qualify for a Tax Subsidy
2. Your doctors and hospitals are in the plan’s reduced network.
3. Your prescription drugs are in the plan’s Formulary List and you do not need to obtain prior authorization from the new Exchange plan to continue an expensive prescription medication.
4. You do not want to consider any of the non-Exchange health plans. (You have to wait until Nov. 15 or later for details on these outside plans.)
5. You do not want to keep a grandfathered plan which may have a more favorable provider network or drug formulary list.
6. You are comfortable with the fact that Covered CA will be sharing your PII (Personal Identifiable Information), PHI (Private Health Information) and financial information with other government and non-government entities that may include the IRS, Dept. of Homeland Security, Center for Medicare Medicaid Services, US Dept. of Health & Human Services, Dept. of Labor, Dept. of Insurance, Dept. of Managed Health Care, the State of California and Equifax.
7. You are comfortable that the Covered CA website will provide adequate security and protection against hacking and identity theft.

If you are not comfortable with the incomplete information right now, I would recommend waiting until after Nov. 15 when more is known.

Documents or information you may need to make your decision and apply for coverage?
• Your W-2 wage statement
• Your IRS 1040 form showing your household AGI income
• Your current health plan information such as ID card, plan summary, billing statement, cancellation notice, notice of mapping, premium increase letter, letter of grandfathered status, etc.
• Drivers License, Passport, Resident Alien ID card or naturalization papers.

Caution:
We are informed by the insurance carriers that the Provider Network lists and the Prescription Drug Formulary lists posted online have not been finalized, and that there may be changes to these lists.
Please be aware that if you qualify for a federal subsidy to help pay the premium, this subsidy may change at any time should your income change or should the laws change.
Please be aware that an application to the Covered CA Exchange requires you to submit sensitive PII (Personal Identifiable Information) and PHI (Private Health Information) to a Government entity which may share this info with several other Govt. and non-government entities that may include the IRS, Dept. of Homeland Security, Center for Medicare Medicaid Services, US Dept. of Health & Human Services, Dept. of Labor, the Dept. of Insurance, Dept. of Managed Health Care, the State of California and Equifax.
There may be other, as yet undiscovered, risks related to your application to Covered California.

Philip W Lee
www.health-insurance.com
www.healthplantalk.com

Filed Under: Health Care Reform, Health Savings Accounts, Individual/Family Plans Tagged With: ACA, Affordable Care Act, Anthem Blue Cross, Blue Shield, BlueCard program, Bronze Plan, California Health Exchange, California Health Insurance, Catastrophic Health Plan, Catastrophic Plan, children health insurance, Covered CA Exchange, Covered California, Covered California Health Exchange, coveredca.com, Drug Formulary List, Family Health Insurance, Family Health Plans, Gold Plan, Grandfathered health plan, grandfathered plan, Health Care Plans, Health Care Reform, Health Care Reform Act, Health care subsidy, health insurance, Health Insurance California, Health Insurance Marketplace, Health Net, Health Plans California, Health Savings Account, health subsidy calculator, hospital network, Individual Health Insurance, Individual Health Plans, Individual Mandate, Individual Subsidy, Kaiser, metallic health plans, Mirror Plans, Non-Exchange Plans, Obamacare, Off Exchange Plans, Off Off Exchange Plans, On Exchange Plans, out of network coverage, Patient Protection and Affordability Act, Patient Protection and Affordable Care Act, PHI, physician network, PII, Platinum Plan, PPACA, Premium Assistance, Prescription Drug Formulary, Provider Network, Qualify for Subsidy, Reduced network, Silver Plan, Skinny network, tax subsidy

ACA Obamacare and Covered California Health Plans – What to do now

October 28, 2013 By Phil Lee

ACA and Covered CA Health Plans
What should you do now?

(This info applies to Individuals and Families under the age of 65 who are not on Medicare)

As you have probably been reading in the media, the ACA rollout and the California version, Covered California, is a disaster right now. Their contractors are scrambling to try to fix the mess on the CoveredCA.com website. We have been advising all of our clients, even if they already know that they want to enroll into the subsidized Covered CA exchange, that they wait until late in Nov. The deadline to apply for a 1/1/14 effective date is 12/15/13. You still have time.

The main problems are: 1) No reliable source to confirm if one’s doctors are in the reduced limited provider networks, 2) No info yet (rates, benefits, networks and formulary lists) for the off-Exchange plans, 3) The Covered CA website is not fixed yet, 4) No way to check prescription drug formulary lists on the reduced or limited drug formularies within the Exchange plans.

There is a paper, and pdf file version of the Covered CA enrollment application form that is much more reliable than the glitchy coveredca.com website. Please contact Lee Insurance Services at 925-284-2000 for a copy. You may submit a completed form to them to process for you.

As part of their ongoing service, Lee Insurance will review, correct, submit, confirm, monitor, troubleshoot and provide ongoing support for all applications that you submit to them. There are no fees for the free service, they are paid a nominal ongoing commission by the insurance carrier to provide you with their excellent local support.

Philip W. Lee
800-286-7445
www.Health-Insurance.com
www.HealthPlanTalk.com

Filed Under: Health Care Reform, Individual/Family Plans Tagged With: ACA, Affordable Care Act, Anthem Blue Cross, Blue Shield, California Health Insurance, children health insurance, Covered California, Covered California Health Exchange, coveredca.com, Family Health Insurance, Family Health Plans, HBEX, Health Care Plans, Health Care Reform, Health Care Reform Act, Health care subsidy, health insurance, Health Insurance California, Health Insurance Marketplace, Health Plans California, health subsidy calculator, Individual Health Insurance, Individual Health Plans, Individual Subsidy, Obamacare, Obamacare rollout, Patient Protection and Affordability Act, Patient Protection and Affordable Care Act, PPACA

Why you should not rush into a Covered California Exchange health insurance plan right now.

October 16, 2013 By Phil Lee

• The CoveredCA.com online enrollment is still hampered by glitches and delays.
• Most of the carriers are only offering “skinny” networks of slimmed down providers within the Exchange plans.
• The Covered CA website and the carrier websites have either not been able to do Provider searches, or have been giving wrong results.
• The carriers have not yet released rates and details for their Off-Exchange health plans. This means that you cannot right now get a complete picture of what all is available in the marketplace.
• There will be 3 categories of health plans available on Jan. 1st.: Covered CA Exchange plans, Off-Exchange Mirror (Standardized) plans, and Off-Exchange non-Standardized plan.

You will have time to make a proper decision once all the information is out.
• The open enrollment period extends to March 31.
• The deadline for the Jan. 1st enrollment is Dec. 15th.
How to decide whether to buy an On-Exchange plan or Off-Exchange plan:
• If you know that you qualify for a Subsidy (Premium Assistance), then you have to purchase an Exchange plan such as a Bronze plan in order to get the subsidy.
• If you know that you don’t qualify for a subsidy, then you should purchase an Off-Exchange plan or Off-Off-Exchange plan, without subsidy.
• To find out if you may qualify for a subsidy, go to www.coveredca.com.

What to do Next?
• Certified Insurance Agents are expected to have the ability to provide you with complete quotes for all plans in the marketplace (in and out of the Exchange) sometime in Nov.
• The health insurance carriers are expected to have the correct provider network list online by Nov.
• There is no cost to use Insurance Agents who are certified by Covered CA to provide this ongoing service to you.

Phil Lee
www.health-insurance.com
www.HealthPlaTalk.com

Filed Under: Health Care Reform, Individual/Family Plans Tagged With: ACA, Affordable Care Act, Anthem Blue Cross, Blue Shield, California Department of Insurance, California Health Exchange, California Health Insurance, children health insurance, Covered CA, Covered CA Health CAre Exchange, Covered California, Covered California Health Exchange, coveredca.com, Family Health Insurance, Health care exchange, Health Care Plans, Health Care Reform, Health Care Reform Act, Health care subsidy, health insurance, Health Insurance California, Health Insurance Marketplace, Health Net, Health Plans California, health subsidy calculator, Individual Health Insurance, Individual Health Plans, Individual Mandate, Individual Subsidy, Obamacare, Patient Protection and Affordability Act, Patient Protection and Affordable Care Act, PPACA

Implementation of ACA (Health Care Reform)

August 20, 2013 By Phil Lee

California Health Care Insurance Exchange Updates
Many developments have occurred since my last update. I will give a brief recap of the most important items that may impact your personal health care insurance situation.
Due to the large number of regulations and sheer volume of information related to health care reform. I will give you brief summaries of the most important items, in bullet point fashion. I have divided the items into 4 categories so that you only need to read the category that’s relevant to you.
You may choose to buy health plans either inside the California Exchange (Covered California) or outside. The only difference is that if you want either a subsidy or a tax credit, you have to choose an Exchange plan.

Your objective should be to:
1. Be insured.
2. Find the most affordable plan for your needs.
3. Qualify for a subsidy or tax credit, if you are eligible.

Individuals and Families
1. Major carriers participating in the Individual Exchange will be Anthem Blue Cross, Blue Shield, Health Net and Kaiser.
2. The guarantee-issue rule for individual health plans will go forward as planned on Jan. 1st. Individuals and Families may enroll between Oct. 1st 2013 and March 1st 2014. Enrollment effective dates will be Jan. 1st or later.
3. Starting on Oct. 1st, Individuals and Families may start choosing and applying for Individuals health plans within Covered California (the State Individual Exchange) or from plans available outside the Exchange. Plan choices within the Exchange are likely to be more limited than plan offerings outside of the Exchange. However, if one needs a federal subsidy based on their income, they may only apply for plans within the Exchange.
4. Agents who are certified by the Exchange may offer health plans both inside and outside of the Exchange, and may assist consumers in applying for subsidies.
5. Federal and Cal Cobra will continue to be offered to terminated employees.

Small Groups (under 50 employees)
1. Major carriers participating in the Group Exchange, aka SHOP, will be Blue Shield, Health Net and Kaiser.
2. Tax credit will be available to employer groups with low salaried employees.
3. Most insurance carriers allow existing groups to renew early in Nov. or Dec. of 2013 so that they will not be subject to the new Jan. 1st ACA-compliant plans and rates for another 12 months.
4. 2 employee groups consisting of only the owner and spouse will no longer be allowed.
5. 1099 employees will not be considered employees for group eligibility.
6. Employer groups in CA must have 51% or more of its employees in CA in order to qualify. Out of State employees may enroll in an Individual/Family plan in their own state.
7. Agents who are certified by the Exchange may offer health plans both inside and outside of the Small Group Exchange, known as SHOP.
8. Flex Spending Account Salary Deferral limit of $2500 for 2014.
9. Employer Model Notices requirement – On Oct. 1st or within 14 days of hire.

Large Groups (50+ employees)
• The employer mandate to provide a minimum level of health insurance to employees, along with the associated penalties; have been delayed to Jan. 2015.

Medicare
• ACA and the Exchanges are not expected to affect Medicare.

For More Information:
Please go to the official website for the California Exchange, aka Covered California, at www.coveredca.com. You will find:
• Summaries of Exchange plans that will be available.
• Sample rates for Exchange plans for your age in your zip code.
• A calculator to help give you some idea if you might qualify for a subsidy.

Phil Lee
www.Health-Insurance.com
www.HealthPlanTalk.com

Filed Under: Group Plans, Health Care Reform, Individual/Family Plans, Medicare Plans Tagged With: ACA, Affordable Care Act, Anthem Blue Cross, Blue Shield, California Department of Insurance, California Health Insurance, CCHP, Covered California, coveredca.com, Employer Tax Credit, Family Health Insurance, Family Health Plans, Group Health Insurance, Group Health Plans, guarantee issue health plans for children, HBEX.ca.gov, Health Care Plans, Health Care Reform, Health Care Reform Act, Health care subsidy, health insurance, Health Insurance California, Health Insurance Marketplace, Health Net, Health Plans California, health subsidy calculator, Individual Health Insurance, Individual Health Plans, Individual Mandate, Individual Subsidy, Kaiser, Medicare Plans, Obamacare, Patient Protection and Affordability Act, PPACA, Sharp Health, Small Business Tax Credit, Western Health