Qualifying Life Events

Now that Open Enrollment has ended, you must have a “Qualifying Event” to make any changes or enroll in a new plan outside of Open Enrollment.  As of today’s regulations (always subject to change), the next Open Enrollment period will begin on Nov. 15th, 2014.

Examples of Qualifying Life Events:

In all state-based, federal and partnership exchanges, individuals may also enroll outside of the open enrollment window if they have a qualifying life event. The consumer and the agent should contact each specific exchange directly for their qualifying life event procedures. For your reference, qualifying life events include:

  • Marriage
  • Having a baby
  • Adopting a child or placing a child for adoption or foster care
  • Moving outside your insurer’s coverage area
  • Losing other health coverage—due to losing job-based coverage, divorce, the end of an individual policy plan year in 2014, COBRA expiration, aging off a parent’s plan, losing eligibility for Medicaid or CHIP and similar circumstances. Important: Voluntarily ending coverage doesn’t qualify you for a special enrollment period. Neither does losing coverage that doesn’t qualify as minimum essential coverage.
  • Gaining citizenship
  • Leaving incarceration
  • Gaining status as member of an Indian tribe. Members of federally recognized Indian tribes can sign up for or change plans once per month throughout the year.
  • For people already enrolled in marketplace coverage: Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions

Apply by Monday 3-31-14, Open Enrollment will be OVER

 
Enrollees Who Want to Beat March 31 Deadline Rush Should Sign Up Now
 
SACRAMENTO, Calif. — Covered California™ today confirmed its March 31 deadline for open enrollment in an exchange health insurance plan and announced its policies for completing an application for health care coverage.
 
With five days left to enroll in a Covered California health insurance plan, the exchange is urging consumers to sign up before the deadline if they want to get affordable health care coverage and avoid a tax penalty.
 
“If you haven’t applied yet, do it now,” said Covered California Executive Director Peter V. Lee. “We are concerned that high numbers of people will come to our doors at the last minute and won’t be able to get enrolled in time. If that happens, consumers face a penalty for not getting insurance, and they may miss out on the peace of mind that comes with coverage.”
 
Covered California also clarified the process for completing applications for health coverage in 2014.
 
“Covered California is not extending its deadline for applying for a health plan,” Lee said. “However, we’re committed to helping all those who started an online application to cross the finish line.”
 
Individuals who start an online application by 11:59 p.m. on March 31, 2014, will have until 11:59 p.m. on April 15, 2014, to complete their application and select a plan. To start an application, the consumer must take at least the following steps:
 
  • Create an online account.
  • Fill out all required information on the “Apply for Benefits” page and click “Continue.” The page contains two required fields (see application screen images online athttp://news.coveredca.com/p/blog-page_26.html).
  • After clicking on “Continue,” individuals will be taken to the “Consent for Verification” page, where they need to click on “Save & Exit” or “Continue.”
  • They must return to their online account no later than April 15 to complete the application and select a plan. 
Covered California reminds consumers that they must make their first premium payment to the health insurance company by the due date to avoid the tax penalty.
 
Paper applications must be postmarked by March 31, 2014, to meet the open-enrollment deadline for 2014 Covered California plans. To guarantee coverage beginning May 1, 2014, however, consumers are encouraged to enroll online.
 
After the end of open enrollment on March 31, consumers may be eligible for Covered California’s special enrollment period, which can be triggered by one of several “qualifying life events,” as defined under the Affordable Care Act. Some of those qualifying events are:
 
  • Getting married.
  • Having a baby or adopting a child.
  • Permanently moving to a new area that has different health plan options.
  •  Losing other health care coverage that is considered minimum essential coverage.
  • A change in income that would affect an enrollee’s eligibility for financial assistance.
 
Low-cost or no-cost coverage through Medi-Cal is also available to consumers year-round, and they can check their eligibility and sign up on the Covered California website, through its Service Center or with the help of assisters.
 
Covered California also operates its Small Business Health Options Program (SHOP) year-round for businesses with 50 employees or fewer.
 
Covered California’s next open enrollment, for 2015 coverage, will begin in fall 2014, likely mid-November.

Deadline 3/31 Fast Approaching!

As another reminder, everyone has until 3-31-14 to complete and submit their application or change their current plan! Based on website glitches and other problems, we do not encourage our clients to wait until the last minute. Call or email us today, or contact your carrier, with any changes or enrollment questions.

To repeat, Open Enrollment ends on 3-31-14. For those who successfully submit an application by 3-31-14 and make their first month’s binder payment, their effective date for coverage will be May 1st, 2014.

Enrollment Tips for the Consumer

A summary of an article in Benefits Pro had some excellent suggestions:

There’s still time to shop for coverage before open enrollment closes March 31. But this year — with Obamacare — there’s more to know and understand than ever.

Ehealth released a list of top five health insurance tips for consumers who are shopping for 2014 coverage during the remainder of the open enrollment period.

1. Know your deadlines. PPACA creates specific deadlines that affect you when it comes to enrolling in coverage and avoiding a tax penalty at the end of the year. Carriers might have their own enrollment deadlines and rules to determine the date on which your coverage becomes effective.

•March 31 — This is the last day of the nationwide open enrollment period for 2014. You need to enroll in health insurance coverage by this date in order to avoid possibly having to pay a tax penalty on your 2014 federal tax return.

You should know that enrolling in coverage in the second half of the month generally means coverage likely will take effect on the first day of the month, two months in the future. So, for example, enrolling by Feb. 15 means that your coverage may start as early as March 1, but enrolling on Feb. 16 means that your coverage won’t begin until April 1.

2.  Shop outside of public exchanges to explore all your coverage options. Government exchange websites are designed to provide subsidy-eligible consumers with access to plans specially qualified for purchase with a subsidy. Not all plans are. Some major carriers have opted not to sell plans through the exchanges. Consumers who want to choose from the broadest selection of plans and find the best match for their needs and budget also should consider plans available off the exchange through licensed agents. These plans will still meet the coverage requirements of the law and keep you from having to pay a tax penalty, so long as you maintain your coverage during the year without a gap of more than three consecutive months.

3. Understand the true cost of any health plan you’re considering. The true cost of any health insurance plan is about more than your monthly premiums. It’s also about how costs are shared when you actually receive medical care. Look at your annual deductible, copayments, and coinsurance — and your annual out-of-pocket maximum. Understand how different forms of cost-sharing may apply to different kinds of medical care. Read the fine print, and talk to a licensed agent for personal help understanding your coverage details.

4. Make sure that government subsidies will work for you. PPACA allows some people earning less than 400 percent of the federal poverty level (about $46,000 per year for a single person or $94,000 for a family of four) to receive subsidies to help with their monthly premiums, depending on the cost of coverage for the benchmark plans in their area. Be aware that your eligibility is based on your projected earnings for 2014 rather than your past earnings, and only the government can make the final determination on your subsidy eligibility. If your income fluctuates or changes during the year, your eligibility for a subsidy may also change. If you earn more than expected in 2014, you may have to repay all or a part of any subsidy you received when you complete your 2014 federal tax return.

5. Pay attention to doctor and hospital networks. People who already had self-purchased coverage in 2013 might find that their list of network providers is different in 2014. Just because your favorite doctor accepts a specific insurance company doesn’t mean that he or she is a preferred provider for all plans sold by that insurer. Provider networks may have changed on January 1, and some plans limit your access to providers to help keep costs in check. Make sure that the doctors or hospitals you like best — or the ones close to your home—are preferred providers under your new health plan in 2014.

PRESS RELEASE: San Diego County Enrollment Figures Released By Covered California

Dear Colleagues and Interested Parties:

FOR IMMEDIATE RELEASE
Dec. 16, 2013

 

SAN DIEGO COUNTY ENROLLMENT FIGURES 

RELEASED BY COVERED CALIFORNIA

SACRAMENTO, Calif. — Covered California™ and the California Department of Health Care Services (DHCS) announced today that from Oct. 1 to Nov. 30, as a benefit of the Patient Protection and Affordable Care Act, an estimated 20,301 individuals* in San Diego County started applications for Covered California health insurance plans. 

Cumulatively, 10,231 individuals in San Diego County have enrolled in subsidized or non-subsidized Covered California health insurance plans, which reflects about 9 percent of the statewide enrollment (the county makes up 8 percent of those eligible for subsidies statewide). San Diego County encompasses Covered California pricing region 19.

“San Diego County is critically important to our success,” Covered California Executive Director Peter V. Lee said. “While it is good news that so many who live in this county have signed up, Californians all have one more week — until Dec. 23 — to enroll for coverage taking effect Jan. 1.”

Last week Covered California and DHCS released statewide figures showing that applications were started for an estimated 777,000 individuals between Oct. 1 and Nov. 30.

For the two-month period statewide, 109,296 individuals enrolled in Covered California health insurance plans. For the same period, 179,000 were determined to be likely eligible for Medi-Cal.

Other facts about San Diego County enrollment figures:

  • Approximately 90 percent of consumers chose one of the four health insurance carriers that have traditionally been the largest in the individual market: Blue Shield of California, Anthem Blue Cross of California, Kaiser Permanente and Health Net.
  • For the individuals who were eligible for subsidies, the great majority (66 percent) selected the “Silver” level of benefits, which is the level at which the federal premium assistance is targeted. Those who are not eligible for subsidies were more likely to buy across the spectrum of levels of coverage.

(Additional data, including details about the levels of benefits and carriers selected, can be found in charts released alongside this announcement.)

Dec. 23 is the deadline for consumers to enroll for health insurance coverage taking effect Jan. 1, 2014, but Lee pointed out that consumers can continue enrolling in Covered California plans through March 31, 2014. Medi-Cal enrollment is continuous throughout the year.

Lee also reminded consumers of the many paths they can take to enroll in Covered California health insurance plans and in Medi-Cal, including meeting in person with thousands of trained Certified Insurance Agents, Certified Enrollment Counselors and county eligibility workers, who can provide assistance with completing applications. Consumers can find the nearest in-person help on CoveredCA.com. Additionally, self-enrollment is available online, and enrollment can be completed over the phone by calling Covered California’s Service Center at (800) 300-1506.

The estimated total of individuals is based on an average of 1.8 individuals per application.

About Covered California

Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, was charged with creating a new health insurance marketplace in which individuals and small businesses can get access to affordable health insurance plans. With coverage starting in 2014, Covered California helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.

Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the Governor and the Legislature. For more information on Covered California, please visit www.CoveredCA.com 

About the Department of Health Care Services

The Department of Health Care Services (DHCS) works to preserve and improve the physical and mental health of all Californians. DHCS provides health care services for more than 8.5 million Californians through Medi-Cal, including medical, dental, mental health, substance use treatment services and long-term services and supports. This is accomplished through an investment of approximately $70 billion annually in public funds for the care of low-income families, children, pregnant women, seniors and persons with disabilities. DHCS focuses on delivering quality, effective services primarily through the more coordinated systems of care provided by 21 Medi-Cal managed care plans located in all of California’s 58 counties. For more information about DHCS, please visit www.dhcs.ca.gov

Special Notice for those applying for Covered CA

For those who have started to apply or applied on CoveredCA.com (Obamacare) and designated us as your brokers, please be advised that their website is definitely slow at certain times of the day.  They are very overwhelmed with traffic right now.  You can call their Customer Service line with any special subsidy questions #800-300-1506.  And for those who received cancellation notices from your current carrier and are applying on Covered CA, they have a hotline for consumers with complicated questions #855-857-0445.  And as always, with any coverage questions or otherwise (including outside of Covered CA), we are here to help!

Good Quote on the Value of an Agent for Small Businesses

Janet Trautwein, CEO of the National Association of Health Underwriters, made the following statement:

“By going through an agent, small business owners have the advantage of the experience and advocacy of a professionally licensed health insurance advisor. Not only are agents able to help small business owners find a plan that fits the healthcare needs of their employees and the financial needs of their business, but agents also offer a litany of consumer protections to their clients. Agents are required to complete continuing education courses through their state department of insurance in order to keep their license, and they go through additional certification training to be able to sell exchange policies. Long after a policy is sold, agents continue to administer plans by working directly with carriers to resolve any billing and coverage issues that might arise. They also have professional liability insurance, have been proven to decrease insurance fraud, and improve claims processing efficiency and coverage stability.”

The Role of the Agent with Covered California

CERTIFIED INSURANCE AGENT:

A Certified Insurance Agent is a licensed health insurance agent who has passed Covered California’s intensive training and certification program. You have the option of working with a Certified Insurance Agent at no cost to you.

WHAT A CERTIFIED INSURANCE AGENT CAN DO FOR YOU:

A Certified Insurance Agent can be your partner in every step of your path to get covered and stay covered including, but not limited to:

  • Assist you with completing the single streamlined application;
  • Track your progress through the enrollment process;
  • Help you evaluate your health care needs and budget considerations to recommend a plan that works best for your family; and
  • Provide additional help after you enroll in a plan on an ongoing basis.

HOW TO FIND AN AGENT:

You may use Covered California’s agent search tool to locate a Certified Insurance Agent close to you or find one that you already know. Using this tool, you will also be able to find out more about a Certified Insurance Agent’s areas of expertise and designate a Certified Insurance Agent to act on your behalf.

Small Business plans and Covered CA (aka Obamacare)

CAHU States the Important Role of Agents at Press Launch of SHOP Today

California Association of Health Underwriters was well represented by President Sam Smith at the press conference held today at the Los Angeles Chamber of Commerce to announce the launch of Covered California’s small business health insurance enrollment exchange, also known as SHOP.

Among the priorities articulated by Smith, a featured speaker at the press event, is that 86% of small businesses prefer to work with their agent when selecting their health insurance according to a recent poll conducted on behalf of Covered California,  and that more than 7,700 agents are now certified to enroll individuals and businesses through the exchange.

Perhaps one of the biggest myths Smith sought to overcome during one-on-one interviews he had following the press event with both ABC and NBC local affiliates is to dispel public belief that by using an agent the cost of their health insurance premiums would increase. This fact is often misunderstood and was well received by reporters covering the event.

Smith was also quick to point out that agents can, and, do offer an array of ACA compliant policies including many good policies that are not offered through the exchange but are fully compliant with new federal guidelines. This point was supported by Peter Lee, Director of the Covered California Exchange.

The press release distributed by Covered California follows below.

COVERED CALIFORNIA LAUNCHES SELF-SERVICE WEBSITE FOR THE SMALL BUSINESS HEALTH OPTIONS PROGRAM

Small Businesses Can Enroll for Coverage That Begins As Soon AsJanuary 1st

December 2, 2013 LOS ANGELES, Calif. – Covered California™ today officially launched the full self-enrollment function of the Small Business Health Options (SHOP) online marketplace.  This significant new function on the Covered California website will enable small businesses to fully enroll for coverage that may begin as early as Jan. 1, 2014.

“Small businesses now have new options to provide more choice for their employees and new affordable options for their business,” said Covered California Executive Director Peter V Lee.  “Covered California has created the Small Business Health Options Program (SHOP) to help the small business owners to get the best value for themselves and their employees.  Since October more than 1,500 small business owners have begun the process of exploring whether the SHOP program is right for them.”

Small-business owners with one to 50 eligible employees may now enroll in Covered California’s Small Business Health Options Program (SHOP) plans for coverage effective Jan. 1, 2014.  Like the health insurance plans in Covered California’s individual market, Covered California’s SHOP plans were negotiated to bring a standardized set of benefits, a robust provider network, and a broad choice of health insurance plans with competitive pricing to employers and their employees.

Previously, small business employers have been able to register online, check their eligibility and work with a Certified Insurance Agent to obtain a quote.  The new system enhancements now allow online enrollment functionality for SHOP, including online quoting, the ability to submit an online application at www.coveredca.com in real-time, and the ability for employers to initiate electronic open enrollment for their employees.

Many Small-business owners qualify for a federal tax credit to help offset contributions toward employee premiums. Beginning in 2014, the only way for small-business owners to access the tax credits is to purchase insurance through Covered California’s SHOP. Small businesses are eligible for a federal health care tax credit if they have fewer than 25 full-time-equivalent employees for the tax year, pay employees an average of less than $50,000 per year and contribute at least 50 percent of their employees’ premium cost. Employers with 10 or fewer full-time-equivalent employees with wages averaging $25,000 or less per year are eligible for the maximum amount of tax credits.

“The tax credits available to small business through Covered California make quality coverage more affordable,” said Lee. “For example, a beauty shop with 10 full-time employees and total wages of $250,000 that purchases insurance through Covered California’s SHOP may be eligible for a $35,000 tax credit in 2014. We know that the tax credit is meaningful for a lot of small business that have been struggling to obtain quality, affordable coverage for their employees.”

In addition to purchasing coverage on the Covered California website, Covered California SHOP plans are sold through licensed agents who are trained and certified by Covered California.  Since registration opened in August, more than 22,000 licensed agents have signed up to become certified to sell Covered California products, with more than 7,000 agents currently certified and available to help individual consumers and small employers in the Covered California marketplace.

The increased website functionality also includes a number of new features available for the Certified Insurance Agent community, such as the ability to create an online profile for an individual consumer or small employer; the ability to start and submit an application on behalf of an individual or small employer; and, the ability to process and manage employer online enrollment applications for SHOP.

About the Small Business Health Options Program (SHOP)

The Affordable Care Act includes provisions to encourage small businesses to offer health coverage for their employees by making insurance more affordable and easier to purchase. Covered California has created the Small Business Health Options Program (SHOP) to facilitate the purchase of affordable health insurance for small-business owners.

SHOP is a second marketplace-separate from the one for individuals-and is designed to give employers and their employees more options for health coverage.  Using this marketplace, small-business owners can shop for health insurance in ways that offer convenience and choice, which is comparable to how large companies shop for employee health insurance today.

In 2014, health insurance companies participating in SHOP are: Blue Shield of California, Chinese Community Health Plan, Health Net, Kaiser Permanente, Sharp Health Plan and Western Health Advantage.  These plans will be sold through Certified Licensed Insurance Agents trained and certified by Covered California.

Small businesses are not required to buy insurance for their employees. SHOP is completely voluntary, and small businesses will not be penalized for non-participation. Small businesses can enroll in a SHOP plan year round.

Update on Enrolling for Jan. 1st from COV CA

Dear Colleagues and Interested Parties:

FOR IMMEDIATE RELEASE
Media Line: (916) 205-8403
Nov. 21, 2013
COVERED CALIFORNIA UPHOLDS ORIGINAL DEADLINE FOR ENDING HEALTH PLANS THAT DON’T MEET LAW’S STANDARDS
Strong Enrollment in New Health
Insurance Marketplace a Factor in Decision
SACRAMENTO, Calif. — As consumer enrollment continues to grow, the Covered California™ Board unanimously voted today to uphold its Dec. 31, 2013, deadline for health insurance companies to discontinue plans that don’t meet basic standards. The board cited that extending the deadline offers no benefit to the consumer and may create confusion about accessing affordable health care coverage through Covered California.
The board, consistent with President Barack Obama’s recommendations, also urged Covered California staff to implement helpful tools for consumers currently enrolled in affected plans, to better understand their options.
The decision to maintain the original deadline also confirms the state exchange’s commitment to transitioning Californians into plans that are compliant with the reforms of the Patient Protection and Affordable Care Act, protecting consumers from double deductibles and stabilizing the risk pool to control costs for consumers beginning in 2014.
Additionally, Covered California is implementing five key strategies to sustain, if not increase, its enrollment momentum and help affected consumers:
· Extending the deadline for enrollment for coverage taking effect on Jan. 1, 2014, from Dec. 15, 2013, to Dec. 23, 2013, and extending the deadline for payments due from Dec. 26, 2013, to Jan. 5, 2014.

· Establishing a telephone hotline for consumers to resolve enrollment questions. The hotline, (855) 857-0445, will be available beginning Monday, Nov. 25.

· Sending information directly to nearly 1.13 million affected individuals that provides clear options for coverage. The information will be sent from Covered California and the individual’s current insurance provider.

· Collecting and reporting data, on a regular basis, showing the impacts of conversion for individuals.

· Engaging consumers in their communities through the thousands of Certified Insurance Agents, Certified Enrollment Counselors and Certified Educators now deployed statewide.
“The consumer is front and foremost in Covered California’s policy decision process. These new strategies will provide consumers a better enrollment experience, more flexibility in the selection of a plan and, most importantly, increased knowledge with which to make the best health coverage choice possible,” said Covered California Executive Director Peter V. Lee.
The board and Covered California staff discussed options for maintaining or extending the deadline after President Obama last week gave state insurance exchanges flexibility on when policies that were not grandfathered and are not compliant with the Affordable Care Act could be ended.
About Covered California
Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, was charged with creating a new health insurance marketplace in which individuals and small businesses can get access to affordable health insurance plans. With coverage starting in 2014, Covered California helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.
Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the Governor and the Legislature. For more information on Covered California, please visit http://www.CoveredCA.com.
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