Category Archives: Uncategorized

Sutter Health Blue Shield Breaking News

Many hearts sank when Sutter Health Blue Shield negotiations failed to produce an agreement on New Years Day. However Sutter Health announced good news this evening (see excerpt below):

 “I am pleased to announce that Sutter Health has come to an agreement with Blue Shield of California on a three-year renewal of our provider contract. We now have all of our health plan agreements in place for 2017.”

 In the rush to publish the good news, they missed a date typo (Jan 4, 2016). Late shoppers appreciate the news anyway.

“For information about products and the networks in which Sutter providers currently participate, please check: http://www.sutterhealth.org/openenrollment/accepted-health-plans.html ”

 

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.

Avoid This Mistake During Open Enrollment Before December 15th

California insurance consumers should avoid this mistake during open enrollment before December 15th, in the event their doctor has been dropped by their health plan (see related story about the thousands of California HealthNet plan members who are forced to take action by December 15th).

For everybody else, there are also lot’s of doctors, coming and going from these networks…some accept group plans and others accept individual plans, but the names are confusing for them, too.  We strongly advise you to hook up with a local Certified Agent (it’s a free service from Coverage California) and make sure you don’t make a big mistake for all of 2015.

Remember, Open Enrollment began November 15th:  Changes are coming to certain PPO & HMO networks.  Read a related article about CoveredCA here.  If you did not use a Certified Agent last year, now is a good time to find one…they are a free service of Coverage California and are here to help.

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?

Open Enrollment Closed March 31, 2014

This article was originally written for the Fall 2013 open enrollment season.  See our related story about Covered California Open Enrollment Notices for the 2015 open enrollment.

Remember, Open Enrollment begins November 15, 2014.  Changes are coming to certain PPO networks.  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.

Original Article

We heard the Website is overwhelmed.  CoveredCA put out a message to agents, today that Paper Applications may be completed and signed and faxed to the following phone numbers, BY March 31, 2014:

FAX NUMBERS FOR COVERED CALIFORNIA PAPER APPLICATIONS:  1-888-329-3700 OR 1-916-636-3400.  Frequently, you get the “all circuits are busy” signal.  Unfortunately, the State of California did not plan adequately.

Paper Application

Customer Service:  1.800.300.1506

Treasury Department Changes “IRS Use It Or Lose It” Rule

We heard rumors the IRS would modify or eliminate it’s Section 125 forfeiture requirement, also known as the “IRS use it or lose it” rule, in Flexible Spending Account (FSA) plans.  Well, the news is out:

October 31, 2013, the Treasury Department issued Notice 2013-71, providing employers more flexibility with medical reimbursement accounts.  Effective with 2014 plans years, plans that do not offer a grace period, may allow up to $500.00 to roll-over.  Currently, left over balances are forfeited to the plan (which often falls under the indirect control of the employer).

The key elements in this IRS Use It Or Lose It notice are 1) the $500 carryover is an alternative to the existing grace period rule, and 2) the plan must be amended in a timely manner.  Talk to your Section 125 administrator or employee benefits broker or attorney, for more details. For a copy of this notice, click here.

For a big picture look at the effect of the Affordable Care Act in California, read our related story.

For additional employer requirements under the Affordable Care Act legislation click here.  For rate comparisons of new group health plans, click here.  For non-group e.g. individual family plans click this link.

Got questions? Request free consumer assistance from Certified Insurance Agents, below:

https://coveragecalifornia.eventbrite.com/

 

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

 

 

 

 

 

 

Coverage California ACA Buyer Guide: Covered California

The Regular Open Enrollment (2015) is Complete, but the 2016 Open Enrollment begins November 1st

By Marc Derendinger  

The purpose of this Coverage California Buyer Guide is to help individuals, families, and early retirees take full advantage of the Affordable Care Act (ACA) Open Enrollment and Special Enrollment seasons, and avoid mistakes that could cost you money and opportunity under Covered California (Obamacare) and the private market.  This is a good reference article, so retain it until you need it.

Remember, Open Enrollment begins November 1st, but you may qualify to enroll sooner under a Qualifying Event Special Enrollment provision of the Affordable Care Act (ACA).  We published an introductory article about Special Enrollments here.

Buyer beware, because changes are coming to certain PPO networks.  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 the good ones can help guide you through the network provider “game of hide & seek” that is being played by California health insurance companies, at the expense of California residents.

Health plans take on a new design structure, with new metallic” plans. (If you already know about metal plans and want to skip ahead to more advanced topics in this series, click here)

Unless you are insulated from all these changes through your participation in a Grandfathered plan, by 2014-2016 you will start to see insurance talk about “metals,” including Kaiser members (for more information on Obamacare vs. Kaiser, Click Here.)   For example, Bronze plans cover an average of 60% of costs, meaning that, on average, you will be responsible for paying 40% of your health care costs.  Also, most services covered by the Bronze plan are subject to a deductible or amount you must pay out-of-pocket before the plan will cover costs.

Download a PDF of the Metallic plans here:  CoveredCA Health Plan Benefits Summary

While the Bronze plan has the cheapest monthly premium, Silver Plans provide a lower risk of out-of-pocket costs, making it a better value for most people. Silver 70 plans cover an average of 70% of costs, meaning that, on average, you will be responsible for 30% of your healthcare costs.  Most common covered services under the Enhanced Silver Plan do not have a deductible.

The higher the metal value, the higher the value of benefits covered under the plan.  Hence, Gold plans expect to cover an average of 80% of the cost of medical services and Platinum, an average of 90%.  Higher benefits also lead to higher premiums, so talk to a certified professional to analyze all your options.  Under California law, only Certified Insurance Agents can compare your options under Medi-Cal vs. Covered California public exchanges vs. private market plans.  There is no added cost when you use these experts.

Insurers Will Battle Within Metal Tiers

If you are looking to benefit from lower prices in a new competitive market, I suggest starting with the Silver Tier, where five insurance companies (in Santa Clara County) compete for your business (see our Obamacare Rate Guide for examples).  Since they offer similar plans within the metal tier, companies are forced to compete on price and provider network.

For additional employer requirements under the Affordable Care Act legislation click here.  For rate comparisons of new group health plans, click here.  For non-group e.g. individual family plans click this link.

Got questions? Frustrated with the Affordable Care Act?  Life’s too short to waste time with all this:  Request free consumer assistance from Certified Insurance Agents, below:

https://coveragecalifornia.eventbrite.com/

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

 

 

 

 

 

CA Employers Contemplate Early Renewal Health Insurance Deadlines

Helping California Employers

Helping California Employers

This Article Focuses On The Pro’s and Con’s Of Early Renewal Health Insurance Options Under ACA:

  • October 4, 2013: Kaiser Permanente California Small Business Plans
  • October 14, 2013:  Blue Shield of California Small Group Plans
  • November 15, 2013:  Anthem Blue Cross California Small Group Plans
  • December 31, 2013:  HealthNet Small Group Plans

 Pro’s and Con’s of advancing your group health plan’s renewal date

Why do it in the first place? (Reasons why a small business employer should consider an Early Advance Renewal Health Insurance amendment)?

  • Your insurance company is offering to extend the rate guarantee period to 12/1/2014, with a nominal rate increase
  • You want to buy more time to let the health insurance market settle down
  • You want to keep your current plan as long as possible and since it is not grandfathered, you have been informed it will be retired from the market in 2014

 

Why your small business should not do an Early Renewal Health Insurance change?

  • You have a grandfathered health plan
  • Your renewal date is already October, November or December
  • ERISA compliance concerns
  • Loss of IRS Small Business Healthcare tax credit
  • You have two insurance carriers and one of them offers grandfathered plans, which would result in two different open enrollment periods

 

Other Upcoming Changes Affecting Family Business Health Plans

  • If you do nothing, you will lose the IRS Small Business Healthcare Tax Credit in 2014
  • 2-Person Husband & Wife Groups to Lose Eligibility Thanks To Obamacare

For additional employer requirements under the Affordable Care Act legislation click here.  For rate comparisons of new group health plans, click here.  For non-group e.g. individual family plans click this link.

Got questions? Beat the October rush and reserve your free 30-minute Q&A session (via Eventbrite invitation below):

https://coveragecalifornia.eventbrite.com/

DOWNLOADABLE FORMS

This story is a follow-up to an original article published here.  If you are an employee checking out Obamacare for yourself, read our Covered California Buyer Guide.