Lee Health Insurance Services

Applications to Covered CA On and Off Exchange Health Plans. Provider Search Update.

Phil Lee — Mon, 16 Dec 2013 03:52:34 +0000

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

There appears to be a great deal of confusion as to where to submit an application and the role of an agent.
Much of the confusion stem from the failure of the CoveredCA media advertising to mention that in addition to the Covered California Exchange, there is also a whole marketplace of health plans and insurance carriers available to consumers OUTSIDE of the Covered CA Exchange (Off-Exchange). The major difference is that you may only apply for a subsidy INSIDE the CoveredCA Exchange (On-Exchange). But if you don’t qualify or need a subsidy, you may apply outside where all the same plans are also available at the same rates, plus additional carriers and plan choices.

In addition, the Covered CA advertising also fails to mention that agents (Certified Insurance Agents) like myself are available to help consumers to quote, evaluate and apply to BOTH On and Off Exchange plans. And that there are no fees for our services. And no difference in premium. And that we offer free ongoing service.

(A) To apply to a plan INSIDE the Covered CA Exchange (On-Exchange):
You must go to www.coveredca.com to apply. Please designate me as your agent (look for “Find Help Near You”). Step by Step instructions for applying:
https://www.dropbox.com/s/9pas1gmsycqdrfx/Application%20Screenshots%20CovCA.docx

(B) To apply to a plan OUTSIDE the Exchange (Off-Exchange), please use the following links to apply:

Anthem Blue Cross (Deadline Dec. 23rd): https://brokerportal.anthem.com/ehb/web/bkr/acc/agentconnect/PHILIPLEE_1

Blue Shield (Deadline Dec. 15th):
https://www.blueshieldca.com/bsca/ApplyNow?xyz=I%2Bc68ZizpmLi

Health Net (Deadline Dec. 15th):
https://www.healthnet.com/portal/consumer/ca/getYourQuote.ndo?region=CA&a=10952

Kaiser: (Deadline Dec. 15th):
https://smu.kaiserpermanente.org/expressweb/ClearWorkspace.action?nextAction=/user/URLDecryptAction.action&refID=7o830apvbn8eyriuut5qmukks0hfomvhibykqt7emn1yam3vpqwgnp5t815gww

Note: If you miss the Dec. 15th deadline, you may still apply for a non-subsidized health plan through Covered CA. The only difference is that you will need to provide income and immigration information (to be shared by several Government agencies) even though you are not requesting a tax subsidy.

Provider Search

Anthem Blue Cross revised Provider Search
Go to www.anthem.com/CA
RHS under “Useful Tools”, click Find a Doctor.
On LHS Choose Doctor or Hospital #1
#2 Type Name of Doctor or Hospital
#3 Enter radius in miles and zip code.
#4 Enter State and Plan Type or network.
1. Plan Network for Covered CA Exchange:
a. Pathway X HMO Individual via Exchange
b. Pathway X PPO Individual via Exchange
c. Pathway X EPO Individual via Exchange
2. Plan Network for Non-Exchange:
a. Pathway HMO Individual
b. Pathway PPO Individual
c. Pathway EPO Individual

Blue Shield of CA Provider Finder
https://www.blueshieldca.com/fap/app/search.html
(Be sure to “Select a Plan” first before you search.)

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

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

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

Phil Lee — Fri, 13 Dec 2013 23:05:19 +0000

(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

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

Phil Lee — Sat, 23 Nov 2013 06:48:16 +0000

(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

Covered California Health Benefit Exchanges Open for Business

Phil Lee — Tue, 01 Oct 2013 06:13:23 +0000

Today, Tuesday Oct. 1st, Covered California, the State Individual Exchange, and SHOP, the State’s Small Business Exchange, will open for business.
Although they will open for business, the Exchange plans and rates may or may not be available for comparison on Tuesday. We will have to wait and see. As of Monday, none of the carriers have released their rates online on the quote engines. Even if Covered CA does have rates on their website tomorrow, many of the carriers may not have their non-Exchange plans available. We may not be able to see a complete picture of the marketplace until all plans are released and available online through the quote engines.
Once all the rates are available, then your certified insurance agent will be able to help you by running comparison reports of all the available options. We will be able to provide one-stop shopping of all plans available in the marketplace, inside or outside of the Exchange.
Just to recap. The two Exchanges account for only one portion of the total marketplace. There will also be individual health plans and group health plans available outside of these 2 State exchanges. Carriers that offer standardized (or metallic level) health plans within the Exchanges, also have to offer these same identical plans outside of the exchanges, and at the same prices. However, outside, carriers may also offer a broader selection of plans, in addition to the metallic plans.
Consumers and businesses are free to choose health plans either within the exchanges, or outside. But if you want to apply for a tax credit or subsidy, either as an individual or as a business, then you have to apply for a plan within one of the exchanges.
Comparing Health Plans
One thing to remember when comparing standardized metallic plans across different insurance carriers and when compared against non-standardized plans. Since benefit levels and coverage are regulated and standardized, there will not be much difference when comparing metallic plans across carriers. However, insurance carriers are still allowed to vary premiums and provider networks. These two will be the two most important features to pay attention to when comparing carriers.

Decision Time For Small Employer Groups (50 or fewer employees)
If you have an existing Small Group Plan, the following are some possible options that you may need to decide:
• Do nothing. Allow your plan to renew at the regularly scheduled renewal date in 2014. At that time, all ACA regulations and prices will be imposed. (An exception would be grandfathered plans prior to 3/23/2010).
• Renew early on Dec. 1st. Take advantage of carriers’ promotional RAF’s. Lock in rates and plans for 12 months. Delay impact of most of ACA-imposed regulations.
• Use Dec. 1st Early Renewal to change plans and lock in rates for 12 months.
• Use Dec.1st carrier RAF promotions to change to a more favorable rate or plan at another carrier.
• Renew on Jan. 1st to change to an ACA-compliant plan, and accept new rules on probation and family ratings.
• Change to another carrier on Jan. 1st or later (even after you have early renewed on Dec. 1st).
• Ask your Tax Advisor to help you calculate if your company may qualify for a Tax Credit. If so, you may want to consider buying an Exchange and ACA-compliant plan on Jan. 1st.

These decisions are complicated. Circumstances vary and every company’s options are different. You should consult with a certified insurance agent before making a decision.
Decision Time For Individuals and Families
If you already have an existing individual health plan. You may have to decide on one of these possible options. The following example is based on someone on an Anthem Blue Cross plan:
5. Do nothing. Allow Anthem to map your current plan to a comparable 2014 ACA-compliant plan on Jan. 1st. You will still have the opportunity, until March 31, to change to any other plan, inside or outside the Exchange.
6. If you have a grandfathered plan (prior to March 23, 2010), you may keep your plan and remain unchanged, except for the rate.
7. Use Anthem’s calculator tools online to compare plans and decide whether to change plans or not, and if so, whether to move to an Exchange or Non-Exchange plan.
8. Use the Covered CA Exchange’s coveredca.com online subsidy calculator to estimate if you and your family may qualify for a subsidy. If so, you may want to consider applying for an Exchange plan for Jan. 1. (Please keep in mind that if you apply for a subsidy, you will be required to disclose financial, personal and tax return info, which will be verified by different Govt. entities.)

These decisions are complicated. Circumstances vary and every individual’s options are different. You should consult with a certified insurance agent before making a decision.

Tips
• Anthem will be providing online decision tools: www.healthcareform4you.com, www.changemycoverage.com.
• The Exchange’s Covered California website will provide calculator tools for estimating if you might be eligible for a subsidy. www.coveredca.com.
• Your certified insurance agent will have powerful online Quote Engine tools to help you compare all plans in the marketplace, both inside and outside the Covered CA Exchange.
• Please remember that everyone’s personal situation is different. What may be the right move for a friend or family member may not be the right move for you. You have to tailor the decision to your own circumstances.

Key dates to remember:
• 10/1/2013 — Carriers release their 2014 Rates and Plans, for plans inside as well as outside the Covered California Exchange.
• 1/1/2014 — Implementation of the ACA (or Obamacare). All plans sold with this effective date or later must be ACA-compliant.
• 10/1/2013 – 3/31/2014 — Open Enrollment Period for all Individual and Family plans.
• 3/31/2014 — Last effective date to enroll into an Individual/Family plan without a special qualifying event.
• 10/15/2014 – 12/6/2014 — Open Enrollment Period for 1/1/2015 plans.

Phil Lee
800-286-7445
www.Health-Insurance.com
www.HealthPlanTalk.com

Children with Pre-Existing Health Conditions

Phil Lee — Mon, 24 Jan 2011 19:13:49 +0000

As part of Health Care Reform (the Patient Protection and Affordable Care Act of 2010, PPACA), children with pre-existing health conditions may no longer be denied coverage by individual health insurance plans. Although children are guaranteed to be accepted, carriers may offer coverage at a rate-up of up to 100% if there are pre-existing health conditions.

The Open Enrollment and Guarantee-issue period ends on March 1st, 2011. In order to take advantage of this new law, children must be enrolled by March 1st.

Read details of this new law at:

http://www.insurance.ca.gov/0250-insurers/0500-legal-info/0200-regulations/HealthGuidance/Guide22441F.cfm

Check rates for children at:

https://health-insurance.com

Guarantee Issue Health Insurance Coverage for Children in California

Phil Lee — Sat, 08 Jan 2011 04:00:55 +0000

The California Department of Insurance has issued guidance on this one provision of the Health Care Reform legislation.
Insurers in California must now offer coverage to children on every non-grandfathered individual policy that it sells. The Open Enrollment Period goes from Jan. 1st 2011 to March 1st 2011.
Children, including those with pre-existing conditions who have previously been denied coverage, may now be guaranteed issue.
Click link below for full text of regulatory guidance from the California Department of Insurance:

http://www.insurance.ca.gov/0250-insurers/0500-legal-info/0200-regulations/HealthGuidance/Guide22441F.cfm

Click link below to obtain market rates:

https://health-insurance.com

Is Guarantee Issue Health Insurance for Children going into effect on Sept. 23rd ?

Phil Lee — Thu, 12 Aug 2010 00:09:13 +0000

Some of you have been asking us about this feature of the HCR (Health Care Reform) bill. I’m going to share with you a clarification that I received from Anthem Blue Cross. This one aspect of the massive HCR law, which will take effect on Sept. 23 applies only to the following:
1) If an overage dependent has been dropped from a health plan in the past due to having attained age 23, this dependent will be allowed to enroll, guarantee-issue, back onto the parent’s plan after Sept. 23rd, as long as they are not yet age 26.
2) The no pre-existing condition rule for children means that children (under age 18) will no longer have to be subject to the 6 month pre-existing condition waiting period (which currently applies to all PPO plans for individuals who did not have continuous coverage, or did not have prior creditable coverage making them eligible for the 6 month pre-existing condition waiting period waiver.)
3) Rule #2 above does not bar insurers from still denying coverage or ‘rating up premiums’ for dependents (with pre-existing conditions) who do not satisfy Rule #1 above.
4) Rule #4 above has since been revised by the regulators after further discussions and negotiations with insurance companies. The rules now mandate Guarantee Issue as well as the elimination of Pre-Existing Condition waiting periods for children.

Applying to the right California Health Insurance Plan

Phil Lee — Thu, 11 Jun 2009 23:40:22 +0000

Depending on your health condition, you may not be accepted into some plans like individual and family health plans.
Since health plans and rates are vastly different between the individual/family health insurance market, the Small Group market, the Cobra and HIPAA markets. You need to determine which is the most advantageous plans to apply to first. Usually this would depend on which plans have the lowest rates. If in the event you do not qualify for your top plan choice, you need to determine which alternatives to explore and in what order.
Frequently this is dependent on certain deadlines. For example you may be given 45 days after your termination from an employer to decide if you want to accept the Cobra that you are offered. Or you may have a 63 day window to decide if you want to apply for a guarantee-issue HIPAA plan after your Cobra expires.
In addition, the cost of each of these alternatives will have to figure into your decision. If you are unable to figure out the best course of action on your own, you may need the assistance of an experienced health insurance agent to help you select the most appropriate plans to apply to in different markets and in different orders or priority, based on your personal health and medical care needs, your pre-existing conditions, your guarantee-issue options, your risk tolerance and your budget.

Who should buy Individual and Family Health Insurance Plans

Phil Lee — Thu, 11 Jun 2009 22:36:19 +0000

Health insurance plans are not always provided by employers. In the 60 or so years since World War II it has become customary for employers to provide workers with their health insurance plans. But this was not always the case. During the wage freeze of WWII, Employers were not allowed to raise wages to entice women to join the workforce. Their solution was to provide benefits, starting with health insurance coverage. This has since become an entitlement.

If you are:
1. 0 through 64 years old.
2. Currently uninsured.
3. If you are paying too much for your current health plan.
4. If you change jobs frequently and prefer to have an individual plan as a backup in case you are disabled.
5. If you are self-employed.
6. If you own a small business.
7. If your employer does not offer group health insurance.
8. If your employer offers to pay for an individual health plan on your behalf.
9. If you don’t like the choice of plan offered by your employer.
10. If you are on COBRA.
11. If you are on an expensive guarantee-issue HIPAA mandated health plan.
12. If you are on an expensive out of state health plan.
13. If you are on a health discount program that are frequently disguised as affordable health insurance. These plans are dangerous and are not true health insurance.
14. If you have been laid off or are in between jobs.
15. If you are forced to seek individual coverage due to a divorce.
16. If your employer’s plan does not offer you the providers you need.
17. If you missed your employer’s open enrollment period for coverage.
18. If you got dropped from your parents plan due to age (19 to 24) or lack of full time student status.
19. If you retired before age 65 and need to bridge coverage to age 65.
20. If it costs too much to cover your spouse and children under your employer’s plan.
21. If you just started your own business.
22. If you just immigrated to the U.S.
23. If you plan to travel to other states or countries for a part of the year.
24. If you are uninsured and don’t want to rely on government run county or state hospitals and clinics.
25. If you are a physician with your own medical practice.
26. If you are on a work visa in the U.S.
27. If you are visiting the U.S. for an extended period of time.
28. If you are a Foreign Student.
29. If your College or University does not offer any medical care outside of an on-campus clinic.