Health Care Subsidy | Lee Health Insurance Services

Clarifying Confusing Names For Obamacare Plans

September 19, 2014 By Phil Lee

We have been preparing for the next Open Enrollment period for purchasing individual and family medical insurance plans, which begins on November 15, 2014 and ends on February 15, 2015.

One thing I’ve discovered is that the insurance companies, California State government and the Federal government all have different names for insurance plans offered through Covered CA, the state-run exchange for buying health insurance.

Here’s a list of all the different names I’ve come across in CA that essentially all refer to the same plans, the Covered CA plans.

Covered CA plans
Obamacare plans
Exchange plans
CA State Exchange plans
Marketplace plans
HBEX (Health Benefit Exchange) plans
HIX (Health Insurance Exchange) plans
Health Care Reform plans
PPACA (Patient Protection & Affordability Act) plans
ACA (Affordable Care Act) plans
Federal Healthcare.gov plans
On-Exchange plans

These names are confusing and misleading, as many of you discovered last year. The solution is to simply remember that there are 2 markets: On-Exchange and Off-Exchange.

1) If you do not qualify for a subsidy you do not have to buy from the Covered CA website. You can buy Off-Exchange plans with no Govt. subsidy. You can avoid the technical problems and onerous information requirements of the Covered CA website by applying for a plan through our website www.health-insurance.com, or calling us at 925-284-2000. There are no fees for our services and the premium for your plan is the same whether or not you use an agent.

2) If you qualify for a subsidy due to your income, you can use our expertise as your certified agent to apply to Covered CA, and to receive ongoing assistance from us. These are called On-Exchange Plans. In fact, it is advisable to use a certified agent to apply to Covered California plans because they have up-to-date information on changing plan designs, provider networks, drug formularies, and a dedicated broker support team at Covered California for support. Certified insurance agents enrolled between 40% and 80% of individuals, inside and outside of Covered California.

Applying for a subsidy (also known as the Advance Premium Tax Credit APTC) by applying to Covered CA may require you to submit documentation to verify information such as income, immigration status and employment. The information you provide is subject to verification by the IRS, Dept. of Homeland Security, Dept. of Labor, etc. either at the time of application or at a later date.

Here’s a simple chart to help you figure out which type of medical insurance plan you may qualify for in 2015:

The 2 Markets for Individual Health Plans

ON Exchange	OFF Exchange
Possible Tax Subsidy based on income	No Tax Subsidy
Marketplace	OFF-Marketplace
Covered CA	NON-Covered CA
Government Exchange	NON-Government Exchange
Limited number of insurance plans	Broader number of insurance plans

Please keep these terms handy when reading about or shopping for health insurance. When in doubt, call us at 925-284-2000.

The 2 markets for Individual Health Plans:

(1) On Exchange: Tax Subsidy based on income, Marketplace, Govt. Exchange, Limited insurance plans.

(2) Off-Exchange: NO Tax Subsidy, NON-Covered CA, NON-Government Exchange, Broader number of insurance plans.

As always, for our assistance, please call 925-284-2000 or go to www.Health-Insurance.com.

Phil Lee

Lee Health Insurance Services

www.health-insurance.com

Covered California Announces Extension of Deadline to April 15th

April 2, 2014 By Phil Lee

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

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

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

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

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

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

Phil Lee
Lee Health Insurance Services
www.Health-Insurance.com
Blog: www.HealthPLanTalk.com

Filed Under: Affordable Care Act, Covered California, Health Care Reform, Individual/Family Plans Tagged With: ACA, Affordable Care Act, Anthem Blue Cross, Blue Shield, California Health Exchange, California Health Insurance, Covered California, Covered California Health Exchange, coveredca.com, Family Health Insurance, Family Health Plans, Group Health Insurance, Group Health Plans, Health Care Reform, Health Care Reform Act, Health care subsidy, health insurance, Health Insurance California, Health Net, Health Plans California, health subsidy calculator, Individual Health Insurance, Individual Mandate, Individual Subsidy, Obamacare, Patient Protection and Affordability Act, pre-existing conditions, repeal of health care reform, tax subsidy

Covered California is not extending its deadline past March 31, 2014 for applying for a health plan

March 27, 2014 By Phil Lee

(This information pertains to Individual and Family health plans. Please ignore this email if you are on an Employer group plan, on Medicare or otherwise covered.)

Covered California is not extending its deadline past March 31, 2014 for applying for a health plan
Despite what you may have heard in the news about deadline extensions, these do not apply to California. There is no extension in California.
Based on our experience with past deadlines, Covered CA and possibly the insurance company websites may crash or be inaccessible on the last days. I highly urge you to apply before the end of Friday March 28th. If you miss the 3/31 deadline, you will have to wait until the end of the year to apply, and probably pay a penalty.
However, if you start an online application by 11:59 p.m. on March 31, 2014, you will have until 11:59 p.m. on April 15, 2014, to complete this application and to select a plan. To start an application, you must take at least the following steps:
• Create an online account.
• Fill out all required information on the “Apply for Benefits” page and click “Continue.” The page contains two required fields (see application screen images online at http://news.coveredca.com/p/blog-page_26.html).
• After clicking on “Continue,” you will be taken to the “Consent for Verification” page, where you need to click on “Save& Exit” or “Continue.”
• You must return to your online account no later than April 15 to complete the application and select a plan.
You also must make your first premium payment to the health insurance company by the due date in order to avoid the tax penalty.
How To Apply Online:
https://www.dropbox.com/s/hqbjyqdxcecrs1j/How%20to%20Apply%20to%20CovCA%20or%20Outside2.docx

Paper applications must be postmarked by March 31, 2014, to meet the open-enrollment deadline for 2014 Covered California plans.
Paper Covered CA Application: https://www.dropbox.com/s/olamsrnb43cv2xl/Fillable%20CovCA%20Application%20P%20Lee%20Agent.pdf
The mailing address for Covered CA is:
Covered California
P.O. Box 989725
West Sacramento, CA 95798-9725
We offer one stop shopping and can help you with all of these plans. Please call us at 925-284-2000 if you encounter any problems in this application process. We are prepared to help you.

Thank you for reading.
Phil Lee
www.health-insurance.com
925-284-2000

Tips on Applying to Covered California

March 27, 2014 By Phil Lee

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Filed Under: Covered California, Health Care Reform, Individual/Family Plans Tagged With: ACA, Affordable Care Act, Anthem Blue Cross, Blue Shield, California Health Exchange, California Health Insurance, Covered California, Covered California Health Exchange, coveredca.com, Family Health Insurance, Family Health Plans, 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 Mandate, Individual Subsidy, Obamacare, Patient Protection and Affordability Act, PPACA, tax subsidy

Obamacare Deadlines – March 15 and March 31

March 27, 2014 By Phil Lee

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

1. Obamacare Deadlines – March 15 and March 31

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

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

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

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

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

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

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

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

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

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

Update of Obamacare Deadlines

March 27, 2014 By Phil Lee

Originally Posted 1/15/2014

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

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

Filed Under: Covered California, Health Care Reform, Individual/Family Plans Tagged With: ACA, Affordable Care Act, Anthem Blue Cross, Blue Shield, California Exchange, California Exchange Health Plans, California Health Insurance, california metallic health plans, Covered California, Covered California Health Exchange, coveredca.com, Family Health Insurance, Family Health Plans, Grandfathered Health Plans, 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, Individual Health Plans, Individual Mandate, Individual Subsidy, Kaiser, Obamacare, Obamacare deadline, Off Exchange, On Exchange, PPACA, tax subsidy

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

December 15, 2013 By Phil Lee

(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

Filed Under: Covered California, 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 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 subsidy calculator, Individual Health Insurance, Individual Health Plans, Individual Mandate, Individual Subsidy, Obamacare, Patient Protection and Affordability Act, Patient Protection and Affordable Care Act, tax subsidy

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

Filed Under: Covered California, Health Care Reform, Individual/Family Plans Tagged With: ACA, Affordable Care Act, Anthem Blue Cross, Blue Shield, California Health Exchange, California Health Insurance, children health insurance, Cigna, 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, Health Care Plans, Health Care Reform, Health Care Reform Act, Health care subsidy, health insurance, Health Insurance Marketplace, Health Net, Health Plans California, Health Savings Account, health subsidy calculator, Individual Health Insurance, Individual Subsidy, Kaiser, Obamacare, Patient Protection and Affordability Act, Patient Protection and Affordable Care Act

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

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

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