Lee Health Insurance Services

Medicare Open Enrollment Period 2017-18

Phil Lee — Sat, 14 Oct 2017 03:56:23 +0000

(This information concerns Medicare Health Plans. It does not concern you if you are either on an Employer-Sponsored Group Health Plan or an Individual & Family Health Plan. This information pertains only to California and may or may not apply to other states.)

Medicare Enrollment season is once again upon us.

The Medicare Open Enrollment Period for Medicare Advantage Plans (i.e. HMO, Part D PDP Rx plans) runs from Oct. 15 to Dec. 7.

There is no open enrollment period for Medicare Supplement plans which do not need to be renewed. They continue month to month until cancelled.

Here are some common questions that we have been asked:

When is the 2017-18 Medicare Annual Enrollment Period (AEP)? For most people, Medicare AEP runs from Oct. 15th to Dec. 7th. You may do the following during this time: 1. Enroll or change your Medicare Advantage plan (MA-PD). 2. Enroll or change your Medicare Rx (PDP) plan. 3. Enroll in a Medicare Supplement and a PDP plan (the supplement plan is not guarantee-issue unless you have a qualifying event). Technically, AEP only applies to Medicare Advantage plan. These plans include Advantage MA-PD (Medicare Advantage-Prescription Drug, mostly HMO) plans as well as Advantage PDP (Prescription Drug Rx Plan) plans. These Advantage plans are regulated by CMS (the federal Center for Medicare & Medicaid Services, which is part of HHS, the federal Dept. of Health & Human Services). Medicare Supplement plans on the other hand, are regulated by the State’s Dept. of Insurance which does not have AEP’s and go by different rules.

(B) Can I Switch into a Medicare Supplement Plan from a Medicare Advantage HMO Plan during AEP? Supplement plans may be purchased anytime, as long as you have Original Medicare Parts A & B. However, if you have an Advantage MA-PD plan currently, you must either have a qualifying event or be subject to medical underwriting. For those who have a Qualifying Event (QE), e.g. their Advantage plan is terminating or moving out of their area at year end, they have until Dec. 31st to enroll into a Medicare Supplement and PDP plan for a Jan. 1st effective date. I recommend that you enroll no later than Dec. 15 because of the holidays as well as the crushing workload of the insurance carriers. For those without a QE, switching to a Supplement Plan is difficult and filled with pitfalls. This process should be started early in the Enrollment season (Oct. 15th), and handled very carefully with assistance from a knowledgeable Medicare insurance agent. It involves medical underwriting (approval based on health). There is no guarantee of approval by a Supplement carrier. And you must not enroll into a PDP plan before you have received approval from a Medicare Supplement carrier, otherwise your MA-PD plan may be cancelled, leaving you with no coverage except for Part A/B.

(C) Is Medicare Supplement Plan F going away? CMS (Center for Medicare Medicaid Services) has announced that they will ban the sale of Medicare Supplement F, the most popular supplement plan, after Jan. 2020.

Anyone who qualified for Plan F before Jan. 2010 will be grandfathered and permitted to keep the plan or enroll indefinitely. However, unless the enrollment is during the initial coverage enrollment period (ICEP), acceptance is not guaranteed. There may be medical underwriting. Those who will turn 65 or become eligible for Medicare after the year 2020 will unfortunately never be able to experience Plan F.
(D) **Are there any instances where one can enroll into Supplement F after Jan. 2020? We understand that anyone who was initially eligible for Plan F before Jan. 2020 would still be allowed to enroll into Plan F even if they enroll after that date.

(D) Are rates for frozen Supplement Plan F (after 2020) likely to skyrocket? Some concerns were raised that the premium for F plans may skyrocket, after 2020, due to there being no future new entrants into the risk pool. Although this is a distinct possibility, it is unlikely to be a cause for alarm for the following reasons: (1) Unlike under age 65 plans, supplement plans are secondary payers (Medicare is the primary payer) and not subject to the brunt of the risk, (2) In the past when older supplement plans were frozen, such as the Anthem Classic J plan, there were no great increases in rates, (3) After the freezing of Plan F, other plans like G and N will still be available. Although these other plans are not as comprehensive as F, (4) The Birthday rule allows members to switch to like, or downgrade plans, guarantee-issue, every year, on their birthday month, (5) Supplements plans are in a highly competitive marketplace. Currently there are over a dozen carriers in CA offering Plan F. This will likely keep prices competitive. The practical implication is that seniors may keep plan F and take a wait and see attitude. If rates go out of line at some point, then simply downgrade, guarantee-issue, on their next birthday.

(The above is meant to be informational. This information has not been approved by CMS. It is not to be used in sales. And should not be relied upon to make purchase decisions. We recommend that you consult a knowledgeable insurance agent before making any decisions.)

Phil Lee

Lee Health Insurance Services

925-284-2000

www.Health-Insurance.com

[email protected]

Employee Benefits & Health Insurance

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

Phil Lee — Wed, 09 Aug 2017 07:27:15 +0000

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

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

Anthem Announcement

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

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

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

Phil Lee

Lee Health Insurance Services (BLIS Corporation)

925-284-2000

https://health-insurance.com

www.linkedin.com/in/philwlee

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

Phil Lee — Tue, 27 Oct 2015 00:58:35 +0000

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

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

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

These are the issues you must consider:

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

Phil Lee

Lee Health Insurance Services
800-286-7445

www.linkedIn.com/in/philwlee

www.Health-Insurance.com

Last Chance to Enroll into a Health Plan in 2015

Phil Lee — Tue, 28 Apr 2015 04:28:03 +0000

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

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

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

At Lee Health Insurance Services we would be happy to serve as your agent. As always, there are no costs, no fees for our services. The premium rates you pay are the same approved and regulated rates whomever you get them from. If you qualify, you will receive the tax subsidies that you are eligible for based on your household income.
Phil Lee
Lee Health Insurance Services
800-286-7445
www.health-insurance.com

Avoid Penalty – Deadline Feb. 15th to Enroll into Individual Health Plan

Phil Lee — Fri, 06 Feb 2015 01:55:23 +0000

Avoid Penalty – Deadline Feb. 15th to Enroll into Individual Health Plan

To avoid a penalty, the deadline to enroll into an individual health plan is Feb. 15th, 10 days from today. If you submit an online application by that date, you will be able to secure an Effective Date of March 1st. If you miss this deadline, you may not enroll again until the end of 2015.
This deadline does not apply to you if you experience a qualifying event during the year, such as a loss of Employer group coverage, a change in family status such as a marriage, divorce or newborn, a move out of the area, etc.
If you are uninsured, or insured only with a temporary or non-creditable health plan, you may face an IRS-assessed penalty for 2015 of up to 2% of your household income. (This is up from 1% in the 2014 tax year.)
If your estimated 2015 household (MAGI or Modified Adjusted Gross Income) is between 138% and 400% of the Federal Poverty Line (FPL, equivalent to roughly between $16,106 and $46,680 annual income for a single person household), you may apply to Covered California for an APTC (Advance Premium Tax Credit or Tax Subsidy) to help pay the monthly premium on a creditable health plan. If not, you may apply for an Off-Exchange health plan at the same price without a subsidy. We can help you with both. If you income is below 138% FPL (or your children below 200% FPL), then you may qualify for Medi-Cal (California’s Medicaid).
Please call us at 800-286-7445 if you need help.

Philip W Lee
Lee Health Insurance Services
Employee Benefits and Health Insurance
[email protected]
www.Health-Insurance.com

Update on Enrollment Deadlines: Extensions for OFF Exchange Plans

Phil Lee — Fri, 19 Dec 2014 07:45:26 +0000

(Note: This alert relates only to Individual and Family health plans. It does not relate to Employers with group health plans, nor to Seniors with Medicare plans.)

ON Exchange (Covered CA) plans:

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

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

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

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

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

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

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

If you need help, please call us at 925-284-2000 or email [email protected].

Phil Lee

www.health-insurance.com

800-286-7445

Covered California Announces Extension of Deadline to April 15th

Phil Lee — Wed, 02 Apr 2014 20:59:05 +0000

(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

Update of Obamacare Deadlines

Phil Lee — Fri, 28 Mar 2014 04:03:08 +0000

Originally Posted 1/15/2014

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

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

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

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

Phil Lee — Wed, 04 Dec 2013 08:42:48 +0000

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