Category Archives: Patient Protection and Affordable Care Act

Kaiser Small Group Insurance Rate Increases Infuriate Employers

Kaiser Small Group Insurance Rate Increases are infuriating San Francisco bay area start-ups and family employers, but one Bay Area Kaiser Specialist has an answer:

“We examined two December Kaiser insurance renewals and discovered rate increases of 38.0% and 31.6%, respectively.  Yet, the Kaiser Permanente “recommended” renewal plan was not the best choice for the employer in each of these two cases.”

The specialist is a 32-year veteran of the bay area health insurance market and helped these employers find less costly Kaiser plans that were not included in the official Kaiser Renewal Package that is shipped to small business employers prior to each plan anniversary.

“Kaiser is available through many channels, including PEOs, public and private exchanges and, of course direct.  If you understand changing markets and where to look, you can often find better value.”

Finding A Solution To Kaiser Small Group Insurance Rate Increases

As the individual marketplace continues to deteriorate, the small group market has gained a firmer footing, including stable PPO networks and easier participation rules with Kaiser and traditional PPO plans.  Is it time to review available small group plans?   Reserve your appointment early for Open Enrollment, which begins this November.  Find local assistance in San Jose, Santa Clara and the San Francisco bay area or via telephone, throughout Northern and Southern California..

 

3 Actions To Keep Affordable Health Coverage- Private Insurance

The previous articles covered Part I and Part II, and this final segment describes the 3rd of 3 Actions To Keep Affordable Health Coverage- Private Insurance. [Small Employers should read about huge penalties beginning August 2015]

  • Going directly to the insurance carrier (Kaiser Permanente, Anthem Blue Cross, Blue Shield of California, Cigna, HealthNet and others) is easier than going through Covered California and the prices are virtually identical under California law.
  • In our opinion, the only reason one would choose the Covered California exchange (Part II of story) over your 3rd option (private insurance) is the likelihood of receiving a subsidy or Advance Premium Tax Credt. Otherwise, CoveredCA is not worth the hassle, due to the burden of providing tax forms, proof of California residency, employment information etc.
  • Deadlines: Regardless of your choice among the 3 Actions To Keep Affordable Health Coverage, the 60 day limit applies.

    Time is of the essence to find or keep affordable health coverage while looking for a new job, and you must take action fast. Read more about Special Events here or request assistance.  

    Need Temporary Health Insurance?   CLICK TO QUOTE

In conclusion of this 3-part article, the easiest part of this process is choosing a plan, and the hardest is getting the triggering loss of coverage form to the carrier (the specific document and method vary by health plan). Don’t risk losing your effective date, use a competent broker who is licensed and certified to help you compare your options under all 3 alternatives above, and will help you submit a properly completed application to the health plan of your choice!

Certified Insurance Agents are a free service to consumers under the ACA and California law. However, the best certified agents will also help you compare your private insurance (PPO, HMO) options vs. your CoveredCA options.  Find a local office of one of these broker-agents, in order to keep affordable health coverage while looking for a job.

Click to return to Part I or Part II of this article.

3 Actions To Keep Affordable Health Coverage- CoveredCA

While Federal or Cal-COBRA is the conservative choice (as discussed in Part I of this article), the negative aspects are “higher costs.”  This is true because Federal COBRA administrators add 2% to the premium and Cal-COBRA administrators add 10%. If finding a low cost health plan is your priority, your 2nd action to keep affordable health coverage- CoveredCA should be requesting information from Covered California [Small Employers should read about huge penalties beginning August 2015]

  • Covered California provides access to most private health plans e.g. Kaiser Permanante, Anthem Blue Cross, Blue Shield of California, HealthNet EPO and PPO plans and some regional providers as well (although availability varies among each of California’s counties- check here for assistance): extra caution is advised, because you must complete and submit your application prior to the desired 1st of the month coverage start date to avoid a gap in coverage, and the 60 Day Limit also applies.

Warning:  failure to enroll within the special event 60-day period will not only incur a possible IRS tax penalty, but will consequently lock you out of the U.S. health insurance market until the following open enrollment period i.e. January 1st!  (This is a lessor known problem with the Affordable Care Act).

Need Temporary Health Insurance?   CLICK TO QUOTE

 

Yet there are other reasons to skip CoveredCA and go directly to a private carrier.  Read more about the 3rd of 3 Actions to keep affordable health coverage while looking for a job in Part III of this article.

Return to Part I of this article or proceed to Part III or request assistance now.

Leaving School: 2 Actions To Find Affordable Health Coverage

Time is of the essence in order to maintain or find affordable health insurance when leaving school.   You must take action fast or risk being “locked-out” of the health insurance market for several months, due to a little publicized defect in the Obamacare legislation. We suggest 2 actions to find affordable health coverage when leaving school, which have been made possible under the Affordable Care Act:

Need Temporary Health Insurance?   CLICK TO QUOTE

First, if you have not yet turned Age 26 and have been covered on your parent’s health plan, the Affordable Care Act  allows you to continue on through age of 25.  Is this your best option? Maybe, but there are two reasons to look at other options available through the Affordable Care Act:

  • Your parent’s health plan may have limited medical facilities e.g. Kaiser where you live, or
  • The monthly insurance rate may be lower through Covered California with a subsidy, if you qualify

Second, the following are two new options made available through the Affordable Care Act:

  1. Covered California provides access to most private health plans e.g. Kaiser Permanente, Anthem Blue Cross, Blue Shield of California, HealthNet EPO and PPO plans and some regional providers as well (availability varies according to each of California’s counties- these folks will give you free assistance).

    Extra caution is advised, however:  You must complete and submit your application prior to the desired 1st of the month coverage start date to avoid a gap in coverage, plus a 60-Day time limit applies. Warning: failure to enroll within the special 60-day period will not only incur a possible IRS tax penalty, but will consequently lock you out of the U.S. health insurance market until the following open enrollment period i.e. January 1st! (This is a lesser known problem with the Affordable Care Act) Read more about your special enrollment qualifying event here;

  2. Apply Direct- to the insurance carrier (Kaiser Permanente, Anthem Blue Cross, Blue Shield of California, Cigna, HealthNet and others) is easier than going through Covered California and the prices are virtually identical under California law.

The only reason you would choose the Covered California exchange (above) over this 3rd option is if you were to qualify for a subsidy or Advance Premium Tax Credit. Otherwise, CoveredCA is not worth the hassle of providing personal tax forms, proof of California residency, employment information etc.

  • Deadlines: The same warning applies as above i.e. you must complete and submit your application prior to the desired 1st of the month coverage start date to avoid a gap in coverage; the 60 Day Limit also applies.

The easiest part of this process is choosing a plan, and the hardest is getting the triggering loss of coverage forms to the carrier (the required document and method vary by health plan). Don’t risk losing your effective date on a technicality:  Use a competent broker who is licensed and certified to help you compare all your options, on or off the exchange.  Especially valuable is the broker will help you submit a properly completed application forms to the health plan of your choice!

Certified Insurance Agents who offer educational meetings are a free service to consumers under the ACA and California law. Find a local meeting here.  If you don’t use a certified agent, then you could run into the problems publicized by KPIX 5 (San Francisco):  Watch this news story here.

Covered CA Website Causes Suffering During Open Enrollment

Covered CaliforniaCovered CA website causes suffering during open enrollment this week after being fortified for high utilization.  An interview with a San Jose-based Certified Agent provided the following observation:

Today, I assisted at least 4 different clients on their renewal process and/or to start a new application.  The website directed all of the clients into Medi-Cal, even if their income was well above 140% FPL

Calling Covered California directly is not an option, due to five-hour wait times.  Cases such as these require special handling, which is a free benefit of Certified Agents.  For example:

I had a family of three come in with a total annual household income of $49,666.73 and they were placed on Medi-Cal.

Certified Agents can provide local assistance with such glitches, and often times are willing to meet you in person. Read our related article about avoiding Open Enrollment mistakes.  Open Enrollment is here, changes are coming, and websites are frustrating.  If you did not use a Certified Agent last year, now is a good time to find one…they are a free service of Covered California and are here to help.

Obamacare: Not Easy!   ............  Cake Pop, Anyone?

Obamacare: Not Easy! ………… Cake Pop, Anyone?

Obamacare Penalty Tax

An Obamacare Penalty Guide For All California Residents

The purpose of this article is to help individuals, families, and early retirees avoid the Obamacare penalty under the Affordable Care Act.  Obamacare Penalty

Don’t miss the next Open Enrollment season, and avoid mistakes that could cost you money and opportunity.  This is a good reference article, so retain it until you need it.

 

  • Since January 2014, most people will be required to have public or private health insurance or pay a financial penalty AKA the Obamacare Penalty tax.

Avoid the Obamacare Penalty and use the savings to buy vision care insurance

 

  • As of 2016, the penalty has been increased substantially.
  • Parents with children who are tax dependents will be responsible for making sure their children comply or also face penalties.

[Note: If you are a small business or employer representative researching your obligations under the new law, click here.  The remainder of this article is intended for California individuals and families.]

 What Is The Obamacare Penalty For Not Having Health Insurance?

  • In 2014, individual penalty was the greater of 1% of the family income above the tax filing threshold or $95 per adult and $47.50 per child (max $265 per family).
  • By 2016, the maximum penalty grows to the greater of 2.5% and $2,085 per family. 
  • Do you qualify for lower rates with a Premium Assistance Subsidy?  Find out here.
  • CoveredCA-ComparisonChart and Paper Application

How will mandatory health insurance and the Obamacare penalty tax be enforced?

The IRS will administer such penalties on personal tax returns.  Besides the Obamacare penalty aspect, there is also some positives, deserving mention:  Follow the actual experience of an Agent’s first week of Obamacare on this Prezi:  My First Week of Obamacare Open Enrollment

In summary, avoid mistakes that can cost you money and opportunity. Tax issues should be reviewed with your tax advisor.  Here is a resource from the IRS: IRS Affordable Care Act Tax Provisions.

 You can find local assistance.

 

Obamacare California: The Big Picture For Coverage In California

California Marketplace

What is really happening in the Obamacare California Marketplace?

By Marc Derendinger

Let me start by framing this up in a big picture:  The changes to the California health insurance industry can be characterized as a restructuring of the existing market, not a destruction.  Under the new structure (Obamacare) California private insurers continue to operate and will offer services through the following channels:

  • Existing distribution network
  • Private healthcare exchanges
  • Public healthcare exchanges (individual & small business)

It’s news to many, but there is truly no “government Obamacare plan” in California. In some respects, this is a private market solution to public needs:  For example, private health plan insurers who participate in the public exchanges are serving three markets needs:

  1. Applicants who earn over 400% of the Federal Poverty Level (FPL)
  2. Applicants who earn between 139%- 400% of FPL
  3. Medi-Cal (up to 138% of FPL) 

In the new Obamacare California health plan structure, the healthcare exchange serves the function of “a starting point” for all 3 markets, and can be useful later in moving families off Medi-Cal and transitioning them back to the “premium-paying” world. It does not replace the private market, rather it complements it. Under the current system, it is a costly leap for Medi-Cal recipients to enter the private pay insurance world.  Time will tell if the new structure helps reduce costs or is negated by the cost of new subsidies.

Do you qualify for lower rates with a Premium Assistance Subsidy?  Find out here.

There are additional details covered by the Obamacare Rate Guide and California Buyer Guide, but you should also seek out your local Certified Insurance Agent. There is no additional cost and the benefit to you is access to professional guidance, as you use your new plan or in the event you wish to change plans later.   Compare the new health plans here:  CoveredCA-ComparisonChart and Paper Application.

Editor’s Note:  Marc Derendinger has 30-years experience in the California health insurance marketplace and serves on the agent advisory group for the State of California Department of Healthcare Services California Partnership for Long-term Care.  His insurance brokerage is located in San Jose and advises many well-known organizations e.g. San Jose Police Officers’ Association, City of Campbell, City of Santa Clara, plus individuals and family businesses throughout Northern California.California License No. 0563986

 

 

 

 

 

 

Small Biz Employers With Kaiser Plans Have 5pm, August 30, 2013 Deadline

This is an important reminder that Employers with 1 to 50 employees who sponsor a California Kaiser Permanente Group Health Plan have until 5:00pm PST Friday August 30, 2013 to file the Kaiser-Early-Renewal-Intent-Form.

 What Is The Kaiser Intention To Renew Early Form?

Simply stated, this form (Kaiser Small Business Form No. 60141913 (August 2013) informs Kaiser that you want 35 more days to think about their offer to change your anniversary date.   There is no commitment on your part.  We recommend you submit the form, as it changes nothing in your current arrangement with Kaiser, but it does buy you until October 4, 2013 to think about their offer.

 Which Employers Should Consider An Early Renewal?

  • Employers with a Non-Grandfathered Kaiser small group plan
  • And contract renewal dates in the first half of the year
  • And who have not made a prior renewal date change in 2013.

 I have Submitted The Form Already, What Happens Next?

Over the next few days (until October 4th), you have the opportunity to decide if you want to go through with a contract anniversary date change.  If you wish to proceed, then you must file an additional form by October 4, 2013, titled the Kaiser-Early-Renewal-Confirmation-Form, which confirms your intent to renew early for December 1, 2013.

 What Is The Advantage To Changing My Renewal Date?

First, employers with Grandfathered plan status probably should not change their anniversary date, unless your advisor/broker has recommended it.  All other eligible employers would consider the following factors:

  • Is your existing RAF (risk adjustment factor) 1.1 or .90?
  • Is it important to delay your renewal to keep costs down?
  • Is it not worth the hassle to delay the inevitable?

Remember, there are additional important issues to consider, and Kaiser warns that a group will bear all responsibility for its decision to accept the offer for early renewal including but not limited to the group’s compliance with the ACA and ERISA (see related story)..

Talk with your broker for answers, or leave us a comment at the end of the article.

Employers Dilemma- Early Renewal or Not?

A follow-up to this story was published in October can be be read here. Many insurance brokers (and insurers) are suggesting that Employers re-date the plan anniversary (aka “Early Renewal”) to delay certain aspects of Obamacare Affordable Care Act rules and possible penalties (see our related story). Is this a good idea?  Are there pros and cons to using a “plan anniversary date change” strategy?

At Coverage California, we present alternative points of view. The following article came from Benecomplink.com, which argues that merely changing the renewal date of the insurance policy, does not necessarily change the plan anniversary date under ERISA:

“Changing the renewal date on an insurance policy with the plan’s carrier does not change the plan year. Changing a renewal date to December may be allowed by the insurance company, but if the plan sponsor/employer does not change the plan year, their plan year may continue to be a calendar year. From a legal perspective, “plan year” is the year designated in the plan document. Plan years are set by board resolutions and reinforced by plan documents and the filing of 5500 forms.. ” [Full article available at Benecomplink]

 

Employer Plan administrators should seek professional advice from their advisors.  For a limited time, we offer a limited number of free Q&A sessions.  For details, refer to the Eventbrite invitation at this link::  Reserve Q&A time.

 

Public Exchange Notice- Employees Must Be Told

Employers Must Provide The Correct Public Exchange Notice to Employees

Employers must comply by providing the correct public exchange notice of coverage options to each employee, regardless of whether employees are part-time, full-time, enrolled or not enrolled at all.

Public Exchange Notice Disclosure Requirement

President Obama Signs Healthcare Legislation

[Related Story: Huge Penalties for Reimbursing employees for individual health insurance policies]

It is remarkable to note that the DOL public exchange notice disclosure forms read like a sales pitch to join the public exchange. Some industry observers have speculated about the motive behind this notice: Is it to provide neutral information on coverage options, or rather is it an attempt to raid plan participants and shift them to the public exchange?

“When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance:  The Health Insurance Marketplace,” states a required regulatory notice, which all employees must receive from their employers beginning October 2013, as required by the Fair Labor Standards Act.

Regulatory notice OMB No. 1210-0149 goes on to disclose basic information about the new Health Insurance Marketplace, including how to save money on health insurance premiums in the marketplace etc.

As the individual marketplace continues to deteriorate, the small group market has gained a firmer footing, including stable PPO networks and easier participation rules with Kaiser and traditional PPO plans.  Is it time to review available small group plans?   Reserve your appointment early for Open Enrollment, which begins this November.  Find local assistance in San Jose, Santa Clara and the San Francisco bay area or via telephone, throughout Northern and Southern California..

View online pricing, free of charge

Sample Public Exchange Notice From DOL- 

To satisfy the content requirements for FLSA section 18B, employers may refer to the Department of Labor’s website www.dol.gov/ebsa/healthreform.   To save you some time from reading through the DOL website maze, I have included links below.  Note: There is one model for employers who do not offer a health plan and another model for employers who offer a health plan to some or all employees.  Employers may use one of these models, as applicable, or a modified version, provided the notice meets the content requirements described in Regulatory notice OMB No. 1210-0149.

The above public exchange notices are in PDF format. If you prefer an MS Word version for easy Edit & Print, use these versions: FLSAwithoutplans (employers who do not currently offer a plan) or FLSAwithplans (for employers who do have an existing medical plan).

There are additional requirements and upcoming ACA deadlines that affect small employer health plans: Read about them in a related article, 4 Actions Employers Must Complete By October 1st.

For additional employer requirements under the Affordable Care Act legislation click here.

 Finally, some good news…

Announcing the new VSP Individual Plan, great for the self-employed who can often write-off the premiums (but usually not the cost of self-insuring vision care).

Watch the VSP’s new vision care video for Individuals, Families, Retirees, and especially, the self-employed:VSP Video