| (This information concerns those who enrolled into Individual and Family Health Plans through the Government Exchange – Covered California – and received a Subsidy or APTC. It does NOT concern you if you are either on an Employer-Sponsored Group Health Plan or a Medicare Health Plan. This information pertains only to California and may not apply to other states.)
As a courtesy, we are passing this information onto you. |
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Covered California – Urgent Last Minute Alert
Alert to Individuals who Received Tax Subsidies or APTC to Pay for Covered California Health Plans – Form 1095A
(Note: This alert relates only to Individual and Family health plans. It does not relate to Employers with group health plans, nor to Seniors with Medicare plans.)
Re: IRS Form 1095A and Form 8962
Covered California, the California health insurance exchange, will shortly be sending out a form called the IRS Form 1095A to all individuals and families who received tax subsidies in 2014 to help pay for their Individual/Family health plans. This is required by the federal ACA law (Obamacare) and will be sent out by Jan. 31st.
These forms will show, in detail, by month, the amount of APTC (Advance Premium Tax Credit or Tax Subsidy) that the recipient received in helping pay the premium for their subsidized health plans in 2014.
These individuals will be required to use this Form 1095-A to obtain information needed to complete Form 8962 (Premium Tax Credit (PTC)). They must then complete IRS Form 8962 and file it with their 2014 Tax Return by April 15.
Those who enrolled into Off-Exchange health plans need not be concerned, since they did not receive any tax credit, you will not receive a 1095A. Only those who applied for a health plan through Covered CA AND who received an APTC to reduce the premium paid, will be receiving these 1095A forms.
Those enrolled into Medi-Cal (California Medicaid), those on Medicare, and those enrolled on employer group plans are not affected by the above.
Disclaimer: We are not qualified to give tax advice. If you have any questions concerning either Form 1095A or Form 8962, please contact Covered CA, your tax adviser, the IRS or go to the IRS website links below:
www.irs.gov/uac/About-Form-1095-A
www.irs.gov/uac/About-Form-8962
Philip W Lee, MBA
Lee Health Insurance Services
www.health-insurance.com
800-286-7445
Health Plan Enrollment Deadlines
This is a friendly reminder of several deadlines that are approaching.
Deadlines for INDIVIDUAL & FAMILY HEALTH PLANS (Either On-Exchange Covered CA plans or Off-Exchange plans)
(1) Deadline to enroll or change plans for a Jan. 1st effective date is Monday, Dec. 15th
(2) Open enrollment runs from 11/15/14 to 2/15/15. The deadlines corresponding to each effective date are:
Deadlines for each Effective Date
12/15/14 for 1/1/15
1/15/15 for 2/1/15
2/15/15 for 3/1/15
(3) If you are currently receiving a subsidy, then you must Renew by logging into Covered CA with your User ID and Password in order to re-certify to continue receiving the subsidy. (4) If you are uninsured, you may enroll by Dec. 15th to avoid a penalty in 2015.
Deadlines for EMPLOYERS WITH SMALL GROUP PLANS
(1) Groups on Grandfathered or Grandmothered plans will already have renewed on Dec. 1st.
(2) All groups, whether Grandfathered or Grandmothered will have a chance to change to new ACA plans with another insurance carrier on Jan. 1st.
(3) If you are dissolving an Employer Group plan and allowing employees to buy individual plans, they need to enroll by Dec. 15th for a Jan. 1st start. (Note that Individual health plans have significantly smaller Provider Networks than Group plans, and smaller Drug Formulary lists. Each of your employee will need to research their providers and formularies carefully before making a switch. Not all employees will qualify for subsidies. Employers are not allowed to use pre-tax dollars to pay for employees’ Individual plan premiums.)
Deadlines for SENIORS ON MEDICARE PLANS
(1) The deadline to change from a Medicare Advantage MA-PD plan (HMO or PPO) to another is Dec. 7th.
(2) The deadline to change from a Medicare Prescription Drug PDP Plan to another is Dec. 7th.
(3) For Medicare Supplement (or Medicare Gap) Plans there is no deadline and no renewal is necessary. These plans will continue as long as you continue paying the premium.
(4) For those of you who received termination notices from Scan Health and Health Net Medicare Advantage plans, you must enroll before Dec. 31st for a Jan. 1st effective date. Since some carriers will be closed during the holidays, you should submit these applications 2 weeks before Dec. 31.
(5) If you are on a Medicare Advantage MAPD plan and wish to switch to a Supplement plan and a PDP plan, you may do so, guarantee issue, only under 13 specific conditions. Otherwise, underwriting approval may be required and the timing of the switch can be tricky. The ideal time to make a change is between Oct. 15 and Dec. 7th, and as early as possible during this window. This should not be done without the assistance of a knowledgeable agent.
Please contact us, Lee Health Insurance Services, at 925-284-2000 if we can be of assistance.
Phil Lee
Open Enrollment and Renewal for 2015 Individual Health Plans
(Please Note: This information pertains only to those of you who are on Individual or Family Health plans. This does not affect either Employer Group plans or Medicare.)
This past year just flew by. But Open Enrollment is upon us again. The Open Enrollment period runs from Nov. 15th through Feb. 15th. (Any plan changes to start on the first of a month must be made by the 15th of the previous month.) All of you should have received letters or emails from either your insurance carrier or from Covered CA, or from both. Many of you may not need to do anything at all for your plans to continue. However all of you who received subsidies through Covered CA will all need to take action. Details on how to do this are at the bottom of this email.
NOTE: If you require assistance, but we are not your agent, you may designate us as your agent in order to receive our assistance.
If you have an ON Exchange Individual Health Plan
(i.e. you obtained your Anthem Blue Cross or Blue Shield or Kaiser or Health Net plan through Covered CA, either with or without our assistance as your agent.)
You must “Renew” your plan if you want to continue receiving your subsidy for the 2015 year. You do this by logging into CoveredCA.com using your User ID and Password. Government regulations require that you so this in order to continue the subsidy. If you don’t do this, the premium for your plan will jump up to the full non-subsidized rate and you will be billed for that. Some may also lose the cost reduction feature on the Silver 70+ AV plans. Details on how to do this are at the end of this email.
If you have an OFF Exchange Individual Health Plan
(i.e. you obtained your Anthem Blue Cross or Blue Shield or Kaiser or Health Net or Cigna health plan, outside of Covered CA. You did not apply for a subsidized plan. You may or may not have used us as your agent.)
Please read the letters from your insurance carrier carefully. Most of your plans will continue and you may not need to do anything to continue. However for some of you, especially those who are on Health Net plans, they have cancelled some plans and changed many from PPO to EPO. You may want to research new carriers or plans.
How to “Renew” Your Covered CA Subsidized Health Plan
Log into your account on Covered CA by going to: www.coveredca.com and once you are on your account page choose Renew (yellow box). Next will appear Household Plan Selection and click Renew Health Plan (yellow box).
On the next page, two boxes will appear: Choose either Keep the Plan you now have or Shop for a different plan.
If you want to keep your current plan click Keep (yellow box) and checkout (yellow box) check all boxes, put in your pin number, sign and click Enroll (yellow box). On the next page you can print out your confirmation page and make sure you click Done (yellow box). Submit your payment to the carrier no later than December 26, 2014 by either calling your carrier or logging into their website to pay online.
If you want to change your plan when you are on the page that says: Keep the plan you now have or Shop for a different plan you will “remove your plan” (yellow box) first and then click on “Shop for a different plan”. Next page you will review all plans and choose a new plan, check out, check all boxes, put in your pin number, sign and click “Enroll” (yellow box). You can print out your confirmation page and click Done (yellow box). Submit your payment to the carrier no later than December 26, 2014 by either calling your carrier or logging into their website to pay online.
Please contact us, Lee Health Insurance Services, at 925-284-2000 if we can be of assistance.
Phil Lee
Covered California Announces Extension of Deadline to April 15th
(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
Tips on Applying to Covered California
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
Obamacare Deadlines – March 15 and March 31
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
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
Applications to Covered CA On and Off Exchange Health Plans. Provider Search Update.
(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
(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
• 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.
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
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