Individual Mandate | Lee Health Insurance Services

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

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

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

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

November 22, 2013 By Phil Lee

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Health Net:
(Online link pending)

Kaiser:
(Online link pending)

Cigna:
(Online link pending)

Getting Paper Applications to Us

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

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

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

Obamacare — What You Should Do Next with your Health Plan

November 14, 2013 By Phil Lee

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

Today, everything has changed once again! In a press conference this morning, President Obama announced that he wants policy cancellations to be delayed for one year.

How and whether this will be implemented will be decided by the HHS (Dept. of Health & Human Services), the California Insurance Commissioner, Dave Jones, and each insurance company. The final information will trickle down to us after these decisions are made. We don’t know yet when that will be.

Our phone has been ringing non-stop since this announcement. I will give you what we know and suggest some next steps.

1. Before you make any move, please follow the instructions on the piece “Choose an On or Off Exchange plan” to figure out if: (a) you qualify for a subsidy, (b) if your providers are on the network of the 2014 plans and (c) if your prescription drugs are on the formulary lists of the 2014 plans.
2. If you are on a grandfathered plan, you do not need to change anything unless you want to. Your plan will continue as is with the same benefits, provider network, and formulary lists.
3. If you are on a plan where you have received a cancellation notice for Dec. 31. This may be delayed until Dec. 2014. We are waiting for information on this.
4. If you have received a notice that your plan will be “mapped” to a new plan Jan. 1st, this also may be delayed until Dec. 2014.
5. If you want to change plans on Dec. 1st, please contact us.
6. If you received a large rate increase and want to consider other carriers and plans on Dec. 1st or Jan. 1st, please contact us.
7. If you qualify for a subsidy and want a Covered CA plan, please contact us for advice, online enrollment instructions and a paper application.

Please contact me know if you would like me to receive the following attachments:
A. “Choose On or Off Exchange plan” helps you to choose a plan inside or outside the Exchange (with screenshots).
B. “Fillable CoveredCA application” is a fillable Covered CA paper application in pdf format.
C. “Application Screenshots CovCA” takes you step by step to start an application, set up a Profile and Designate an Agent with screenshots).
D. “Agent Designation Screenshots” shows you how to designate an Agent (with screenshots).

Phil Lee
www.health-insurance.com
www.healthplantalk.com
800-286-7445

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

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

November 13, 2013 By Phil Lee

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

Please read this before making your decision

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

What you need to consider in your decision:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What is the difference between Covered California On-Exchange, Off-Exchange and Off-Off-Exchange Health Insurance Plans?

October 22, 2013 By Phil Lee

What is the difference between Covered California On-Exchange, Off-Exchange and Off-Off-Exchange Health Plans?
1) On-Exchange plans are offered by the official Covered California Exchange to consumers and small businesses. They have the following characteristics:
• 4 Standardized Metallic Tiers of plans called: Platinum, Gold, Silver and Bronze.
• There also offer a Catastropic level plan to 18 to 30 year olds only.
• Each Metallic Level plan may be offered by several of the carriers in each county, e.g. Anthem Blue Cross, Blue Shield, Kaiser and Health Net.
• On-Exchange Plans may be purchased online, through a licensed and certified Agent or through a CEC (certified enrollment counselor).
• You may apply for a federal Subsidy (or Premium Assistance) at the time that you make you application for enrollment.
• Most On-Exchange plans have reduced or limited networks of providers.

There are 2 kinds of Off Exchange Plans:
2) Off Exchange plans that “mirror” the Metallic Level plans and are identical to them. These plans usually have different names than the metallic plans.• Rates are the same between the On Exchange plans and the Off Exchange “Mirror” plans.
• They offer the same 4 metallic level plans, although under different names.
• Subsidies are not offered on Off Exchange plans.
• Off-Exchange plans may have either full or limited provider networks.

3) Off-Off Exchange Plans that are not standardized and are different from any of the On Exchange or Off-Exchange “Mirror” plans.
• Rates and Benefits are different than On Exchange plans.
• No Subsidies are offered for these Off-Off Exchange plans.
• Off-Off Exchange plans are more likely to offer full provider networks in addition to limited provider network plans.

On Exchange plans (1) are identical to Off Exchange plans (2). The only difference is that one may apply for a subsidy if they purchase an On Exchange plan. No subsidy are available on Off Exchange plans. On the Individual Exchange, one may apply for an individual subsidy based on income. On the SHOP Exchange, small business employers may apply for a tax credit to help pay for premiums on employee plans.

With On Exchange plans, each metallic level may offer a choice of multiple carriers to their employees simultaneously, like Anthem and Kaiser, or Blue Shield and Kaiser. While Off Exchange plans may be purchased only from one carrier at a time.
Off-Off Exchange plans (3) may offer many plan designs not available under the 4 standardized metallic levels.
Off-Off Exchange plans are more likely to offer larger provider networks than On-Exchange plans.

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

Filed Under: Group Plans, Health Care Reform, Health Savings Accounts, Individual/Family Plans Tagged With: ACA, Affordable Care Act, Anthem Blue Cross, Blue Shield, California Health Exchange, California Health Insurance, Catastrophic Health Plan, Certified Enrollment Counselor, Certified Insurance Agent, children health insurance, Covered CA Exchange, Covered California, Covered California Exchange, Covered California Health Exchange, Family Health Insurance, Family Health Plans, Group Health Insurance, HBEX, Health Benefit Exchange, Health Care Plans, Health Care Reform, Health Care Reform Act, Health care subsidy, Health Exchange, health insurance, Health Insurance Agent, Health Insurance California, Health Insurance Marketplace, Health Plans California, health subsidy calculator, Heatlh Insurance Broker, Individual Health Insurance, Individual Mandate, Individual Subsidy, Insurance Broker, Kaiser, Licensed Insurance Agent, Obamacare, Off Exchange, Off Off Exchange, On Exchange, Patient Protection and Affordability Act, PPACA, tax subsidy

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

October 16, 2013 By Phil Lee

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

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

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

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

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

Covered California Health Benefit Exchanges Open for Business

September 30, 2013 By Phil Lee

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

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

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

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

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

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

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

Filed Under: Group Plans, Health Care Reform, Individual/Family Plans Tagged With: ACA, Affordable Care Act, California Health Insurance, california metallic health plans, children health insurance, Covered California, Family Health Insurance, Family Health Plans, Group Health Insurance, Group 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 California, Health Insurance Marketplace, Health Plan Calculator, Health Plans California, health subsidy calculator, healthcare subsidy, healthcare tax credit, in exchange, Individual Health Insurance, Individual Health Plans, Individual Mandate, Individual Subsidy, inside exchange, metal plans, metallic health plans, metallic plans, Obamacare, Obamacare subsidy, obamacare tax credit, out of exchange, outside exchange, Patient Protection and Affordability Act, Patient Protection and Affordable Care Act, PPACA, Small Business Tax Credit, standardized metallic plans, Subsidy Calculator

Health Care Reform (ACA) Implementation Jan. 1st, 2014 – California Updates

September 24, 2013 By Phil Lee

Latest Updates

Individuals and Families
• Insurance Carriers are expected to release their health plan offerings for 2014 on Oct. 1st.
• The major carriers offering Individual/Family plans in the Bay Area will be Anthem Blue Cross, Blue Shield, Health Net and Kaiser.
• Individual & Family purchase mandates and penalties will go into effect on Jan. 1st. Large Employer Group (50+ Employees) mandates and penalties, however, have been postponed to 1/1/2015.

Small Employer Groups (50 or fewer employees)
• Model Notices — All Employers are required to give “Model Notices” to all their employees by Oct. 1st, and to new hires within 14 days of hire. This is a Dept. of Labor mandated notice, that talks about employees’ and dependents’ options, under ACA, to employer and individual health coverage, Exchanges, subsidies and tax credits.
• Previously, this Model Notice law carried a penalty to Employers of $1,000 per employee for non-compliance. Last week, the Dept. of Labor announced a waiver of the penalty for non-compliance. But they still want employers to send out those notices.
• Anthem Blue Cross will not be offering any Small Group health plans within the Covered California Exchange. But they will be offering a wide selection of non-standardized plans outside of the Exchange.

Large Employer Groups (50+ employees)
• Model Notices — Penalties waived, see above.

Medicare Individuals
If you are on Medicare, you are mostly unaffected by the implementation of ACA on Jan. 1st.

Phil Lee

Filed Under: Group Plans, Health Care Reform, Individual/Family Plans Tagged With: ACA, Affordable Care Act, Anthem, Anthem Blue Cross, Blue Cross, Blue Shield, Blue Shield of California, California Department of Insurance, California Exchange, California Health Exchange, California Health Insurance, children health insurance, Covered CA Health Exchange, Covered California, Covered California Health Exchange, CoveredCA, Employer Health Care Purchase mandate, Family Health Insurance, Family Health Plans, Group Health Insurance, Group Health Plans, HBEX, Health Benefit Exchange, Health Care Plans, Health Care Reform, Health care subsidy, Health Exchange Marketplaces, health insurance, Health Insurance California, Health Insurance Mandate Penalties, Health Insurance Marketplace, Health Net, Health Plans California, Individual & Family health plan mandates, Individual & Family Health Plans, Individual Health Plans, Individual Mandate, Individual Subsidy, Kaiser, Large Employer Groups, Medicare Plans, Model Notice Penalties, Obamacare, Patient Protection and Affordability Act, Patient Protection and Affordable Care Act, PPACA, Small Business Tax Credit, Small Employer Groups