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Showing posts from July, 2013

CA Doctors Could Face Potentially Nasty Surprise

A little-noticed provision in the Affordable Care Act allows exchange participants a 90-day grace period to pay their health insurance premiums.  This was designed to help those who are not used to paying health insurance premiums.

During the first month of grace period when the premium has not been paid, the insurance companies must continue to pay claims incurred by the patient.  During the second month if the patient is still delinquent the insurance company can pend any further claims.  After the third month if the insured has not paid the premium, the insurance company can terminate the coverage.

In the event that the premium is not paid during the grace period and the policy terminates backwards 90 days, doctors  and other healthcare providers in California will have to go after the patient to collect payment for all outstanding claims. 

Essentially this means there can be a 60-day period during which a medical provider who accepts exchange-level health plans is not going to be sur…

Covered California Will Have HSA Plans in Exchange

According to information provided in the last day or so by Michael Lujan at Covered California, the exchange does intend to allow HSA compatible health plans inside both the individual and SHOP exchanges.

Last week sources were told by a spokesperson at Covered California that HSA plans would not be included in the individual exchange.  

As with all things related to the implementation of ObamaCare, information is subject to change at any time and what we know today may well be changed or invalid tomorrow.

If Michael Lujan is correct (and there's no reason to doubt that he is) then the previous blog post is now incorrect.


No HSA Compatible Plans in Covered California Individual Exchange

Update: According to Michael Lujan at Covered California yesterday, the exchange will in fact have HSA plans available in both the Individual and SHOP exchanges.  This information contradicts earlier information from the exchange which was the basis for this blog post.

Word out is that the Covered California Individual & Family Health Exchange will not contain any HSA compatible health plans.

HSA compatible health plans are generally higher-deductible plans with some special design requirements.  HSA compatible health plans do not allow any first dollar benefit coverage (except for preventive care which is covered in full) and the drug benefit of the plan must be part of the medical benefit plan and subject to the medical deductible.  

Compatible health plans allow for the establishment and funding of a Health Savings Account (HSA) with an account provider like a bank, credit union or investment firm.  …

Covered California Agent Certification and Rules

New information provided recently by Michael Lujan of Covered California as it pertains to agent/broker certification to sell exchange plans.

Initial exchange certification training for agents will be sometime in September with an August registration sign-up period.  The initial training will be classroom only training, there will be no online training program available until sometime in November at the earliest.  Agents wishing to certify with Covered California will have to sign up for and attend an 8-hour classroom training and pass an exam at the end of the class.  CE credits are intended to be made available for the class.

Additionally, a second online training segment for the CalHEERS program (helps determine subsidy eligibility and enrollment choices) will need to be completed after the classroom training and will be from 2-4 hours online.

Agents are looking at approximately 12 hours of training to certify with Covered California.

The exchange will provide certified agents with a &…

Covered California No Direct Web Interface for 2014

Covered California Individual Exchange will not provide web-based agencies with a working direct enrollment link to the exchange for the initial open enrollment beginning October 1, 2013. As such, enrollments will require agents to do them "on manual" via a Covered California agent web link either in person or via telephone/e-mail communication.  Only Covered California Certified Agents will be able to access the exchange to assist with enrollment.

I think this is very good news and am sure that there will be many web-based agents/agencies who do not like this decision.  It will take the enrollments in a very complicated environment out of the "click and buy" agencies and put them in the hands of agents willing to work one-on-one with individuals and families to assist with enrollments.  

Agents will be able to assist with enrollments into the exchange via the web using a special link to Covered California that will attach the agent/broker information to the initial …

Anthem Blue Cross Spurns CA SHOP Exchange

Anthem Blue Cross (Blue Cross of California) announced today that the carrier will not participate in the Covered California SHOP (Small Business Health Options Program) Exchange in 2014.  This leaves Blue Shield of California as the lead Blue carrier in the public small business exchange market (same as it was under "PacAdvantage" exchange (HIPC) which collapsed when Blue Shield pulled out some years ago due to inability to meet low premium price points).

Anthem Blue Cross CA will continue to sell health plans to small businesses outside of the SHOP and also will continue to participate in the California Choice (CalChoice) small business private exchange.  

It should be noted that employers purchasing small group coverage plans from CalChoice Exchange will have the ability to offer multiple tiers to employees, whereas the SHOP exchange will require all employees to participate only in a single benefit tier (Platinum, Gold, Silver, Bronze) offered by the employer at the time o…

Beware ObamaCare Scams

As we move closer to the initial open enrollment, it is important to be aware of the current and potential scammers out there who will use ObamaCare to try and obtain your personal information and/or money.

Because it has not yet been clarified with regard to Navigators and Assisters (not Agents) using telemarketing and/or e-mail marketing, you may not really know who is contacting you with regard to new health insurance.  

Licensed agents can be verified both with Covered California (if they are certified) and on the CA Dept of Insurance web site on the "Check License Status" tab at the top.  Navigators and non-agent Assisters will most likely be verifiable through Covered California (at least I would hope so).  

Also, the changes under ObamaCare have little direct impact on Medicare beneficiaries and, as such, anyone calling you about changes to Medicare due to the implementation of ObamaCare may be running a scam.  I can't stress enough how important it is and will be in…

ObamaCare Employer Provision Delayed Until 2015

The provision of the Affordable Care Act (ObamaCare) requiring employers with 50 or more employees to offer health insurance or face a penalty per employee has been pushed back one year.  It will not be implemented until 2015.  

(see CNN Article)

ObamaCare requires employers with 50 or more employees to provide health insurance coverage to all full-time employees.  Should an employer not meet this requirement, the penalty imposed would be $2000 per employee starting with the 30th employee.  Many businesses have claimed difficulty with meeting the reporting and compliance requirements beginning on January 1 and some have begun to reduce hours of employees as well as cease or severely constrict hiring of new employees.

No doubt between now and 2015 we may well see additional changes to this part of Obamacare to encourage hiring and discourage hour reductions.  

At any rate, businesses with 50 or more employees now have an extra year to get ready for whatever the final ObamaCare requirements…

United Health Leaving California Individual Market

Following Aetna's announced withdrawal from the California individual & family market, United Health has announced that it plans to leave the California market on 12/31/13.

(see LA Times article)

Approximately 8,000 members will be effected by this withdrawal and have to purchase new, Obamacare-compliant health coverage from one of the remaining health insurers in 2014.

Unlike Aetna which sold individual & family health plans in California under it's company brand, United Health has not sold branded coverage plans to the California individual & family market. Instead they have sold through two subsidiary carriers--PacifiCare and Golden Rule. 

In any case, both Aetna and United Health cannot re-enter the California individual health market for five years once they withdraw.