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..

 

Does The September Long Term Care Insurance Deadline Affect Women Unfairly?

An early September 2015 Long Term Care Insurance deadline may affect women unfairly, as the nation’s leading long-term care insurance issuer changes pricing methodology in California, effectively charging higher rates for females.  The old system had used unisex rates.

It should be noted that properly completed long-term care insurance applications submitted during the week of September 8th 2015, if approved by medical underwriters, will be grandfathered into the old pricing system.

Existing policyholders will not be affected by the change, but for Californians contemplating the purchase of long-term care insurance, now may be the time to make a decision whether or not to buy this family protection.

To be referred to an agent who could help you, complete the following form by September 8th or share this post with a friend who may interested.

You can find Educational Resources about long-term care insurance here:  http://www.rureadyca.org/

 

 

 

 

 

Don’t Reimburse Employees For Individual Health Insurance

Thousands of small employers reimburse or “pay a little extra” to reimburse employees who purchase individual health insurance…However, beginning this month huge fines are possible…even for a small family business of 2 employees if you reimburse employees for individual health insurance.

“Illegal reimbursements can also take on more subtle forms e.g. paying a higher wage in exchange for declining health plan coverage. Some of these indirect arrangements are also illegal. If you think this affects your small company, here’s someone you can talk to for free. Time is running out.”

Tax Deductibility Is Not The Main Issue Here

This is true whether or not you take a tax deduction for reimbursing these premiums!  We are referencing the latest IRS bulletin addressing the subject: Basically, the IRS argues such arrangements create the existence of a group health insurance plan…and since individual plans are not compliant with the same ACA regulations that apply to group health insurance, IRS conclusion…you are sponsoring an illegal plan!  The penalties are punitive, to say the least (read further for details).

Expensive Mistake If You Reimburse Employees Improperly

I don’t think we can overstate this:  it’s a mind-blowing change of policy that negatively impacts smaller employers. Recently, MarketWatch did a good job of bringing this subject to mainstream media, in this article:

“Under an employer payment arrangement, the employer reimburses participating employees for premiums paid for their individual health insurance policies or pays the premiums directly on behalf of participating employees….The penalty for running afoul of the market reform restrictions is $100 per-employee per-day, which can amount to $36,500 per employee over the course of a full year. (from MarketWatch:  The full story)

If you think this affects your small company, don’t focus on the problem, focus on the solution: here’s someone you can talk to for free. Time is running out.

Don't Reimburse Employees For Individual Health Insurance

 

View online pricing, free of charge

 

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.

3 Actions To Keep Affordable Health Coverage While Looking For A New Job

Time is of the essence to find or keep affordable health coverage while looking for a new job, and you must take action fast. In this three-part series, here are 3 important steps to find or keep affordable health coverage under the Affordable Care Act:

  1. If all else fails, use CAL-COBRA or Federal COBRA as a backstop, although it may not be the lowest price option: Warning, there is a maximum 60 Day Time Limit To Respond or you could lose your COBRA rights and eligibility;

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 lessor known problem with the Affordable Care Act).  Read more about Special Events here or request assistance.

If you cannot afford the high cost of COBRA premiums, and really want the most affordable health coverage, then CoveredCA, the Covered California health exchange market may work better for you. Read about the pro’s and con’s of CoveredCA in Part II of this series, or proceed to Part III, “Private Insurance” options.

 

 

Proceed to Part II of this article or skip to Part III.

SEP Qualifying Event Rule- How It Works

The Qualifying Event rule is complicated and confusing, moreover, the definition of qualifying event varies between private insurers and Covered California.

The SEP Qualifying Event Rule- How It Works in a 2 Minute Video

Questions About Special Qualifying Events?  Get Local Assistance

Time is of the essence during your qualifying event period (60 days). Yet some situations don’t qualify for special event consideration e.g. missing a COBRA premium payment.  Either way, time is of the essence, consult with a Certified Agent as soon as possible.  The ideal advisor is also an independent agent/broker:

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

Obamacare is Not Easy! ………………… Cake Pop?

An independent Certified Agent is knowledgable about private market health plans and Covered California plans.

An independent Certified Agent is also able to place you with temporary health insurance until the next regular Open Enrollment season begins.

“Special Enrollment” flyer from Covered California

Qualifying Event

List of Covered California Qualifying Life Events

Lost or will soon lose my health insurance
Examples:

  • You lose Medi-Cal coverage.
  • You lose your employer-sponsored coverage.
  • Your COBRA coverage is exhausted. Note: Not paying your COBRA premium is not considered loss of coverage.
  • You are no longer eligible for student health coverage.
  • You turn 26 years old and are no longer eligible for a family plan.
  • You turn 19 years old and are no longer eligible for a child-only plan.

Read the entire list of Qualifying Life Events at Covered California or view Kaiser Permanente’s sample triggering loss of coverage form.  If you have lost your health coverage within the last 60 days, then read this article first.

Find Local Assistance for your Qualifying Event

You can find independent local assistance in San Jose, Santa Clara and the San Francisco bay area or via telephone, throughout Northern and Southern California.

Eventbrite - Shopping For Obamacare And Better Covered California Insurance

 

NoVisionInsurance

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Special Enrollment Qualifying Life Events List

This Instruction on Qualifying Life Events list is rather cumbersome.  The Covered California web source is here, but we suggest you should get free assistance before using this information.  Tip:  If you don’t qualify for one of the following life events, then consider purchasing interim health insurance from HCC:  Click To Quote

Qualifying Life Events

What Qualifying Life Event to Select from the Drop-Down Menu How to Enter the Date of the Event
Lost or will soon lose my health insurance
Examples:

  • You lose Medi-Cal coverage.
  • You lose your employer-sponsored coverage.
  • Your COBRA coverage is exhausted. Note: Not paying your COBRA premium is not considered loss of coverage.
  • You are no longer eligible for student health coverage.
  • You turn 26 years old and are no longer eligible for a family plan.
  • You turn 19 years old and are no longer eligible for a child-only plan.
Enter the date of the loss of coverage
Permanently moved to/within California
Examples:

  • You move to California from out of state.
  • You move within California and gain access to at least one new Covered California health insurance plan.
Enter the date of the permanent move
Had a baby or adopted a child
(If you receive a child in foster care, you will also qualify for a special enrollment period but will need to indicate “adopted a child” in the drop-down menu.)
Examples:

  • A child is born, adopted or received into foster care. The entire family can use the special enrollment period to enroll in coverage.
  • If you place your child for adoption or foster care, you can use a special enrollment period to enroll in coverage.
Enter the date of birth, adoption or foster placement
Got married or entered into domestic partnership
Example:

  • One or both members of the new couple can use the special enrollment period to enroll in coverage.
Enter the date on the marriage or domestic partnership license
Returned from active duty military service
Example:

  • You have lost coverage after leaving active duty, reserve duty, or the California National Guard.
Enter the date you returned from active duty
Gained citizenship/lawful presence
Example:

  • You become a citizen, national, or permanent legal resident.
Enter the date on the immigration document
Federally Recognized American Indian/Alaska Native
Example:

  • If you are a member of a federally recognized American Indian tribe, you can enroll at any time and change plans once per month.
Enter the date you apply for Covered California
Other qualifying life event
Examples:

  • You are already enrolled in a Covered California plan and become newly eligible or ineligible for tax credits or cost-sharing reductions.
  • Misconduct or misinformation occurred during your enrollment, including: An agent, enrollment counselor, Service Center representative or other authorized representative enrolled you in a plan that you did not want to enroll in, failed to enroll you in any plan or failed to calculate premium assistance for which you were eligible.
  • Eligibility for COBRA coverage: If you become eligible for COBRA coverage due to the loss of employer-sponsored insurance, you can choose coverage under COBRA, or you can use a special enrollment period to enroll in a Covered California plan.
  • Misrepresentation or erroneous enrollment, including:Incorrect eligibility determination. This includes if you applied during open enrollment and were initially told you were eligible for Medi-Cal and then later determined not to be eligible forMedi-Cal.The health plan did not receive your information due to technical issues.An error in processing your immigration documents resulted in an incorrect eligibility result.Incorrect plan data were displayed when you selected a plan: Data errors on premiums, benefits or copay/deductibles were displayed; incorrect plans were displayed; or a family could not enroll together in a single plan.
  • Your health plan violated its contract.
  • Exceptional circumstances occurred on or around plan selection deadlines, including natural disasters and medical emergencies.
  • You received a certificate of exemption for hardship from Health and Human Services for a month or months during the coverage year but lost eligibility for the hardship exemption outside of an open enrollment period.
  • You are required by court order to provide health insurance for a child who was been determined ineligible for Medi-Cal and CHIP, even if you are not the party who  expects to claim the child as a tax dependent.
  • You are a member of AmeriCorps/VISTA/National Civilian Community Corps:
  • If you entered AmeriCorps or one of the other organizations listed above outside of open enrollment.
  • If you ended your service with one of the organizations listed above.
  • You have a “grandfathered” health insurance plan outside of Covered California, and you would like to switch to a Covered California health insurance plan instead of renewing your current plan.
  • Your provider left the health plan network while you were receiving care for one of the following conditions:- Pregnancy.
    – Terminal illness.
    – An acute condition.
    – A serious chronic condition.
    – The care of a newborn child between birth and age 36 months.
    – A surgery or other procedure that will occur within 180 days of the termination or start date.
  • You were released from jail or prison.
Enter the date you apply for Covered California
None of the above (Continue to review my application for Medi-Cal/AIM)If none of these qualifying life events apply, you should still apply using “None of the above,” because you may be eligible for Medi-Cal or California’s Access for Infants and Mothers (AIM) program for pregnant women based on your income. Regardless of which life event you select, your application will still be reviewed for coverage through Medi-Cal and AIM. Enter the date you apply for Covered California
Obamacare: Not Easy! ............ Cake Pop, Anyone?

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

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Back to the basic introduction page on Special Events

Questions About Special Events?  Get Local 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.

Everybody’s Happy With Obamacare In California

Need Temporary Health Insurance?   CLICK TO QUOTE

On May 13, 2015, Jamie emailed me late at night to ask what it would cost to change from a Covered California PPO plan and re-enroll directly with the same insurance company, off the exchange. [Check out our latest article for students leaving school]

I asked, “Jamie, it’s the same total premium, either way, but don’t you want to keep your $199 per month subsidy?  “…because you can’t have a subsidy unless you go through Covered California.”

Jamie responded, “My CPA told me we have to re-file my tax return and pay back hundreds of dollars because Covered California sent me a revised 1095-A form on May 1st.”  I offered to help and Jamie completed the Insurance Help Form for 1095-A Questions.

“No problem, I thought.”  I phoned Covered California at the special agent line and was placed in line as number 34.  15 minutes later, Dale answered the phone:  “Dale, your customer received no 1095-A form and was unable to file taxes in early January.  We followed your instructions and filed a 1095-A-Dispute-Form.  As promised, after 60 days (March 31st to be exact), we received the 1095-A form and all the numbers looked correct.”  So Jamie filed her taxes.

“Dale, guess what, on May 1st, CoveredCA issued a “corrected 1095-A form” that is unfortunately incorrect.  In fact, there are zeros in all the boxes.”  The customer is upset, naturally, and is faced with additional tax preparation fees for the amended return.  Dale’s solution:  We need to file a new 1095-A-Dispute-Form and wait two more months.

Being a diligent agent, I pushed back and asked him to look in the system log to see what may have generated a new 1095-A form.  Dale responded with “Medi-Cal has this case under review.”  I asked, “what does that mean? Today is May 14th and the application was enrolled and paid for last December…is there insurance or not?”

Dale suggested he transfer me to another unit in Customer Service who may help further.  So he did…I went back to the end of the line and waited 15 minutes before Valerie picked up.  In the meantime, I phoned the insurance company directly and asked if coverage was in-force.  They said “yes, but Covered California has not yet sent the eligibility information to us…but sometimes they don’t send it if the case renews with no changes.”

I confronted Valerie with this information and she very nicely responded, “our records show the customer has not yet paid the first month (January) premium and that is why we have not sent over the enrollment information.”  (I quickly checked the insurance company’s website and it shows all premiums paid to May 1st).

Valerie was not sure how this could be happening, but also noted Medi-Cal has the case under review since March.  I laughed, “if Medi-Cal has been reviewing this for 1.5 months, then it is going to take them 15 years to get through this season’s new enrollments.”  Valerie responded, “the insured is suppose to contact the local county to help the case worker finish their review.”  “Really, and when did you tell the customer this?”

Valerie said there was an “eligibility determination” in late April and a letter was sent out.  I looked it up on their website and she was right.  It reads,

“Congratulations! You qualify for health insurance through Covered California. You also qualify for up to $199 per month in premium assistance to help pay for your health insurance coverage”

I said (nicely) to Valerie, “let me summarize this.”

  • Covered California never provided a 1095-A form until the customer filed a dispute (which is the only way to get a 1095-A form when it is lost or missing)
  • You issued the correct form in March and the customer filed their taxes
  • In May, you sent a revised 1095-A form for no reason and the client has to pay back the tax credit according to the CPA and pay to re-file the tax return
  • You say there is no person at CovCA who can tell us why this happened, and our only remedy is to file another Dispute form and hope for the best
  • You also say the first premium payment (January) was never paid and therefore you have not sent enrollment data to the insurance company
  • Meanwhile, the insurance company says they are indeed receiving premium payments, but you have never sent them the enrollment data
  • The icing on the cake is you say the case is under review with Medi-Cal for the last six weeks, but nobody has informed the customer to call Medi-Cal to speed it along.  Moreover, the letter you supposedly sent to inform them actually says everything is fine and “congratulations.”

Congratulations!  Everybody is happy with Obamacare in California.

Obamacare Press Releases

U.S. TREASURY DEPARTMENT OFFICE OF PUBLIC AFFAIRS

 

 

Questions About Special Events?  Get Local Assistance Now

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