PolicyAdvantage.com is proud to announce that we’re now offering small group health insurance plans (1-100 employees) from Oscar Health Insurance, as of June 1st, 2018. These plans will be available to small groups in both Los Angeles & Orange County.

This groundbreaking, high-demand, hi-tech health insurance product is “trending” with our current individual & family plan client base. We’ve been offering Oscar Health plans to our individual and family clients since 2015 in select areas of California (available through the state health insurance exchange, Covered California).

Now available for businesses, Oscar Health Insurance offers a variety of “features” within their plans that are unlike many other health insurance companies. Some of these features include:

  • Your personal, dedicated concierge team of four members, which includes a nurse. These members can help you navigate anything from selecting proper healthcare services, to managing billing.
  • A proprietary Oscar App that can help you find the information you need about your health plan.
  • Simplified, smart health insurance that is “policyholder-centric” and easy to understand.
  • High quality, world-class hospital networks in both Los Angeles (UCLA Health, plus others), and Orange County (Hoag, plus others). See our .PDF attachments at the end of this article.
  • An affordable EPO (Exclusive Provider Network), that gives you convenient access to specialists in the Oscar network, without a need for a referral. AFFORDABLE: Oscar is currently one of the more affordable small group health plans available. 

We are now quoting for small businesses as of June 1st, 2018, going forward. This is an exciting, value-added, high quality product that we are very pleased to be offering to our small group clients at PolicyAdvantage.com. 

Small businesses in LA & OC: contact us to improve your current coverage, and possibly save money. Our agents at PolicyAdvantage.com are ready to help. Quotes and info are easy to get. Phone: 1(800) 617-0089, Email: info@policyadvantage.com. Or visit our contact page here: www.PolicyAdvantage.com/Contact

Don’t miss these three very good info-graphics about Oscar Health Insurance, available exclusively to our clients and followers in .PDF format:

About_Oscar_LA_OC

About_Oscar_For_Business

LA_OC_OscarHealth_HospitalList

 

 

Renewal for 2017 individual health insurance plans is just around the corner, and you’ve probably noticed that your rates might be increasing quite substantially next year. For example, in California alone, individual health insurance policies are expected to rise more than 13% in 2017 (that’s 3 times the increase over the past two years).

So… why is this happening? And… what can you do about it? To answer the first question: healthcare reform is a big part of the reason your rates are going up. We’ll explain what you can do about it later in this article.

In case you’re not familiar, changes to the individual health insurance marketplace were at the core of Obamacare. There were a number of different provisions that went into place, but the two big ones were:

  • A) Guaranteed Issue,
  • And B) Essential Health Benefits.

“Guaranteed Issue” is the requirement that if you apply for health coverage, you have to be accepted. In other words, if you have a preexisting condition, you cannot be denied coverage. Since this concept took effect on January 1st of 2014, thousands and thousands of people with existing health conditions have enrolled in individual health insurance plans nationwide. Many of these people have had a substantial need for various treatments: prescription drug coverage, surgeries, hospitalizations, and other kinds of medical services. As a result, costs to the insurance companies have gone up, and those costs are now finally catching-up to the consumer (you) in the form of premium increases.

Additionally, “Essential Health Benefits” are new benefits that are now mandated by Obamacare, and must be included in all individual health insurance policies. Prior to 2014, individual health plans were not required to include these “essential benefits” (examples: things like maternity, mental health benefits, and others). As a result, the addition of these benefits has caused prices to increase because there are more health services that need to be covered.

Given the combination of the two concepts listed above, we’re now starting to see substantial increases in premiums in 2017, in order to conform. In fact, in many cases, the cost of providing healthcare services under healthcare reform has been more than what was originally anticipated. As a result, certain insurance companies throughout the country have decided to exit the health insurance exchanges altogether, because of heavy financial losses.

So what can you do if your individual/family health insurance plan is increasing this year? Here are some ideas:

  1. Shop. Make sure to take a good look at all of the available options within your zip code this year. There may be new (and/or alternative) plans available in your area that can save you money. Find a good health insurance broker who can assist you.
  2. Leverage the Strength of Small Business Plans. If you’re a small business owner (especially a SMALL business owner of like 2-3 employees), consider setting up a small group health insurance plan with your partners so you can exit the individual marketplace. Small group plans are not seeing price increases at nearly the same rate as individual plans. One big reason why, is that small group plans haven’t been affected as much by having to “on-board” so many people with preexisting conditions like the individual marketplace has. You could reduce your costs substantially with this strategy.
  3. Consumer Direct. Consumer directed healthcare is when you participate in a higher deductible plan, and then pair it up with an HSA (Health Savings Account). This can help you lower your premium, and then retain funds in your HSA that would normally go to the insurance companies.
  4. Look into the “Little Guy” Insurance Companies. In California (especially Southern California), there are many smaller regional insurance companies that are participating on the Obamacare health insurance exchange. In many cases, these smaller insurance companies are actually thriving under the conditions created by healthcare reform. You might be pleasantly surprised that the prices, service, and plans are actually pretty good. Check with your broker for local recommendations.
  5. Don’t Panic. 2017 could be the “big year” for price increases, and they may stabilize again next year. Just because there are big increases this year, doesn’t necessarily mean there will be again next year. If your increase this year is manageable (ie: not breaking the bank) and you like your current plan, consider sticking with it for another year. You can always change it next year.

Be sure to contact us at PolicyAdvantage.com if we can assist you with your current individual health plan this year (Phone: 800-617-0089, Email: info@policyadvantage.com). We may have recommendations that can help you improve coverage and save money. 

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.PolicyAdvantage.com

Twitter: http://www.twitter.com/PolicyAdvantage

Facebook: http://www.facebook.com/PolicyAdvantage

YouTube: http://www.youtube.com/PolicyAdvantage

Pinterest: http://www.pinterest.com/PolicyAdvantage

Word Press: http://www.policyadvantage.wordpress.com

 

 

 

RXPrescription drug coverage in health insurance plans can sometimes be confusing. We’ve put together a simple, short guide that outlines the four “tiers” of prescription drug coverage found in most individual health insurance plans, so that you can understand your options better. 

Most individual health insurance plans will have four (4) different tiers of prescription drug coverage. It’s important to understand the difference between these four tiers, and how the deductibles and co-payments work within them. 

We’ll briefly explain the different tiers, and how they function. Keep in mind that this is just a general overview, and if you have questions about your specific plan, contact us. *Remember: most individual health insurance plans will contain these four tiers of coverage. Here are the four tiers:

  1. Tier 1 Prescription Drugs: these are usually what are called “generic” prescription drugs. They typically have the lowest co-payments, and most of the time there is not a deductible involved. 
  2. Tier 2 Prescription Drugs: these are what are called “preferred brand name” prescription drugs. This tier moves out of generic prescription coverage, and into brand name drugs. “Preferred” means that they are preferred by the insurance companies because of their lower cost. Certain generic drugs can also sometimes be included in this tier. Co-payments are usually higher (compared to tier 1 generic drugs), and sometimes there is an additional annual deducible involved (depending on your plan).
  3. Tier 3 Prescription Drugs: these are usually referred to as “NON preferred brand-name” prescription drugs. They are considered higher cost pharmaceuticals, and are therefore “non preferred” by the insurance companies. Many times, your insurer will try to find alternatives in the lower two tiers. Co-payments are usually higher, prior authorizations (doctor approvals) are more prevalent, and sometimes there are additional deductibles involved. Certain specialty drugs (Tier 4 drugs) can also be included in this list. 
  4. Tier 4 Prescription Drugs: these are usually what are called “specialty” prescription drugs. They are considered the highest-cost pharmaceuticals, and are most often highly expensive specialty drugs. Prior authorizations (doctor approvals) are highly prevalent, and cost-sharing is the highest. Typically there is what is called co-insurance at this point, where you pay a percentage of the entire cost of the drug, and the insurance company pays the remainder. 

Prescription drug coverage is an important concept to understand. Having a good handle on the concepts above can help you improve coverage, save time, and save money.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.PolicyAdvantage.com

Twitter: http://www.twitter.com/PolicyAdvantage

Facebook: http://www.facebook.com/PolicyAdvantage

YouTube: http://www.youtube.com/PolicyAdvantage

Pinterest: http://www.pinterest.com/PolicyAdvantage

Word Press (you are here): http://www.policyadvantage.wordpress.com

EROne of the biggest questions we get at Policy Advantage Insurance Services is:

  • What’s the difference between the Emergency Room (ER) and the Urgent Care Center?

This is an important question for everyone to understand, because there are big differences between the two when it comes to treatments and costs.

Here’s when you should go to the Emergency Room (ER):

If a medical condition is life or limb threatening, and involves severe wounds or amputations.

These are examples of reasons you may need to visit the Emergency Room:

  • Signs of stroke
  • Severe shortness of breath
  • Poisoning
  • Signs of heart attach/chest pain
  • Severe wounds or amputation
  • Coughing up or vomiting blood
  • Suicidal or homicidal feelings

Here’s when you should go to the Urgent Care Center:

If a medical condition is NOT life or limb threatening.

These are examples of reasons you may need to visit the Urgent Care Center:

  • Stomach bugs (flu)
  • Fever
  • Sprains
  • Dislocations
  • Minor cuts (stitches)
  • Minor broken bones

At an Urgent Care Center, you can receive prompt treatment for your minor injury or illness, and the costs (co-payments) are much less expensive than the Emergency Room. 

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.policyadvantage.com

Twitter: http://www.twitter.com/policyadvantage

Facebook: http://www.facebook.com/policyadvantage

YouTube: http://www.youtube.com/policyadvantage

Pinterest: http://www.pinterest.com/policyadvantage

Word Press (you are here): http://www.policyadvantage.wordpress.com

At Policy Advantage Insurance Services, we specialize in helping small businesses when it comes to their health benefits planning. Here’s why:

  • Many times, small businesses don’t have a Human Resources Department to help them sort-out their employee benefits. Therefore, small business owners can end up spending a lot of time and energy researching all the different options and planning strategies. At PolicyAdvantage.com, we can do the “heavy lifting” for you. We’ll put together a custom program tailored to your fit your budget and necessities.
  • With the onset of healthcare reform, there are now many additional options when it comes to health coverage… and many of them are geared towards small businesses. At PolicyAdvantage.com, we know (and understand) how the health insurance industry works. We have broad-based and in-depth knowledge about what programs are available, and how you can put these pieces together to fit your business best.
  • Lastly… we like to help our clients grow and improve. Outside of just health coverage, we know that employee benefits can add a lot of value to an organization. We take great pride in taking good care of your employees, and helping them find the benefits they want or need. We want to help you attract and retain the quality employees that are going to take your business to the next level.

If you’re an employer between 2 to 50 employees, we want to talk with you. There’s often a misinterpretation that brokerages are looking for the “big fish” clients… not-so at PolicyAdvantage.com. We can’t wait to help you improve your small business. For a free consultation, please contact us at our dedicated customer service line: 1(800) 617-0089, or shoot us an email at info@policyadvantage.com.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.policyadvantage.com

Twitter: http://www.twitter.com/policyadvantage

Facebook: http://www.facebook.com/policyadvantage

YouTube: http://www.youtube.com/policyadvantage

Pinterest: http://www.pinterest.com/policyadvantage

Word Press: http://www.policyadvantage.wordpress.com

Today we’re going to provide small businesses with some information about healthcare reform. We’ve put together a checklist, so you can walk through each important item one-by-one.

What does a checklist do? It helps you navigate. If you have a checklist of items, you’ll know exactly what you need and where to get those items. It’s just like running errands. By having a checklist, you won’t forget the important things either. The things that will save you time, money, and help you improve coverage.

Item #1: Determine if you’re a small business.

This is number one. You want to establish this right away. Why? Because there are costly tax penalties that may be incurred if you’re actually a “large business” and don’t provide health coverage to your employees. As it stands, “large businesses” are mandated to provide healthcare coverage to their workers. Small businesses are not.

Knowing whether-or-not you’re a small business will also help you determine your plan design strategies. Providing health benefits for yourself or your employees as a small business owner differs greatly compared to those of large businesses.

Question: What is the definition of “small business” with regard to the healthcare reform law? Answer: Small businesses are businesses with less than 50 fulltime equivalent employees for the previous calendar year. You’ll sometimes see “fulltime equivalent employee” abbreviated as “FTE.” This is a very important concept. Also, your FTE count DOES include part-time employees. A part-time employee is defined as working less than 30 hours per week, and there’s a calculation when determining their “full time equivalency.” If you’re anywhere near 50 FTE, you’ll want to make sure to have this all sorted out, because there are costly tax penalties for those employers that are over 50 FTE and don’t provide health coverage.

Item #2: Know the differences between individual health plans and small group health plans.

The second important item is to know the differences between individual coverage and small group health insurance coverage. If you know anything about health insurance, you’ll know that these are two parts of the industry are completely different. They have different characteristics. There are different rules. There are different eligibility criteria. There are different tax incentives.

Depending on your business, your objectives, your budget, and other considerations… you’ll need to determine what kind of health insurance plan you want to work with: A) Individual health insurance plans, or B) A group health insurance plan.

The good news: because of healthcare reform, it’s now easier than ever before to work with individual health insurance plans to provide coverage to your employees. And in certain cases, it might even make more sense. Know how individual health insurance plans and the health insurance exchanges can work for small business.

That being said, group health insurance can still be an important option for small businesses. Group health insurance plans also have the best tax incentives, especially if employees are contributing to the plan. Physician networks are also sometimes better when working with small group health insurance plans.

Additionally, there is now a group health insurance plan called SHOP (the Small Business Health Options Program) that is available through the health insurance marketplaces. SHOP can provide tax-credits to help with premiums for qualified small businesses.

Item #3: Decide if you’re going to provide health coverage for your entire group or just yourself. 

Remember: small businesses (less than 50 FTE) are not required to provide health coverage to their employees. However, if you’re not going to provide coverage, you and your employees will still need to find an individual health insurance plan somewhere on your own. The reason? Everyone has to have health coverage or pay a tax penalty.

Determine if you have a budget for your entire group. There could be strategies that are surprisingly affordable, especially based on the size and average income of your group.

Item #4: Understand the different planning strategies for small business.

There are a variety of different planning strategies that are available to small businesses. These different strategies can utilize individual insurance plans, or group insurance plans.

Health insurance is a very basic benefit that can help you attract and retain quality employees. If you determine that you’d like to help provide coverage for your employees, you’ll want to come up with a program that fits your objectives best. Here are a few of them:

Defined Contribution Strategy: “Defined contribution” is a retirement planning phrase. It’s been around for a long time. You can Google it and read all about it. Health benefits planners are now using “defined contribution” strategies to fund healthcare. And it’s simple. It’s exactly what it says it is: you “define a contribution” (ie: $300) per month, and employees then purchase their own individual health insurance plans. Employees can pick from insurance policies that are both on or off the public health insurance marketplaces (where they may also receive substantial subsidies, based on income). This strategy is budgetable, and gets business owners out of the business of making insurance decisions. Employees make their own decisions and purchase their own plan. Effectively, all it is is an after-tax stipend. A raise.

Consumer Directed Health Planning: This can also be referred to as account based or equity based planning. Small business owners can provide their employees access to a high deductible health plan (usually a group plan), and then pair it up with an HRA (health reimbursement arrangement) or HSA (health savings account). The HRA or HSA becomes an asset that builds equity over time. You retain funds that would normally go to the insurance companies in the form of premiums, and ownership of the account stays with either the employee or business, depending on your strategy.

Small Business Health Options Program (known as SHOP): This is a new program that has been made available on both the federal and state health insurance exchanges. It was specifically designed to help small businesses (under 50 FTE) provide a group health insurance plan to their employees. Depending on income and size of your group, you may also be eligible for a sizable tax credit (up to 50% of premiums).

Item #5: Know where you have access to products, advice, customer service, and consultation.

This is the last item on the list. Know where you can find help. Find effective advisers that can help you sort everything out. A “one-stop-shop” can help you save time, money, and a lot of hassle by “outsourcing” your small business health benefits planning. It’s like having your own human resources department.

And the good news: brokers are typically compensated by the insurance companies in the form of commissions. So you don’t have to worry about broker fees, etc. Compensation is built into every single health insurance plan regardless of whether-or-not you choose to work with an adviser.

Additionally, a broker will keep you “in the know” about new products, strategies, and reforms. They should offer a broad range of products and services that will make your planning very convenient for you. Here are some of the qualities you should look for in a broker/consultant:

  • Licensed, accredited, ethical. Find consultants that are licensed by the Department of Insurance to do business in your state. Take it a step further and find advisers that have professional designations. People with these designations provide advanced knowledge, and also adhere to strict ethical standards.
  • A strong selection of reputable product choices. Your broker/consultant should offer you a wide variety of choices from reputable insurance companies.
  • Advice and consultation in non-insurance products and services. Your broker/consultant should also be offering products and services that are considered “non-insurance products.” After-all, the goal is to fund healthcare efficiently, and there are important tools that can help accomplish this besides just insurance policies. Things like HRAs (health reimbursement arrangements), HSAs (health savings accounts), COBRA administration, knowledge of tax incentives, etc. Find a well-rounded broker.

And that’s it. That’s your healthcare reform checklist for small business. By understanding the points we’ve made, you’ll be on the right path to drafting a health benefits program that fits you or your business best.

We help individuals and businesses sort everything out at Policy Advantage Insurance Services. We can help you design an effective, efficient program that fits your objectives. Please contact us anytime for a free consultation.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.policyadvantage.com

Twitter: http://www.twitter.com/policyadvantage

Facebook: http://www.facebook.com/policyadvantage

YouTube: http://www.youtube.com/policyadvantage

Pinterest: http://www.pinterest.com/policyadvantage

Word Press (you are here): http://www.policyadvantage.wordpress.com

 

Helping our clients effectively navigate healthcare reform (and the health insurance industry) inspires and motivates us more than anything. Our number one goal is to help individuals and businesses improve coverage and save money. Whenever we can achieve this, it’s very fulfilling.

We go to work on each-and-every case. Whether you’re an individual or business, we’re listening to you. Depending on your current situation, we can provide you with various options so that you have choices when you’re making decisions. Every case is different, and we take great pride in helping you with your health benefits planning.

Here are some of the results. Real people. Right at Twitter.

We helped Heather navigate COBRA and saved her some big money:

Dave was one of the first to enroll at Covered California, even though the website “wasn’t working” at the time:

We helped Meagan enroll after she incurred long wait times online and over the phone at Covered California:

These are just a few of the people that we’ve helped, and we’d like to thank them greatly for their Tweets. There is nothing that motivates us more. We have a growing list of clients that we’re helping each-and-every day.

We don’t sell, we consult with a skill-set. Here are three good reasons to work with a broker:

  1. Selection: select from a “menu” of health insurance plans at the various companies we work with.
  2. “TLC”: receive valuable consultation from the best.
  3. Simplify: health insurance can be complex, let us do the heavy lifting for you.

If you (or your business) need help navigating the health insurance or healthcare reform environment, contact us today. We’re available to help you in-person, online, and over the phone: 1(800) 617-0089.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.policyadvantage.com

Twitter: http://www.twitter.com/policyadvantage

Facebook: http://www.facebook.com/policyadvantage

YouTube: http://www.youtube.com/policyadvantage

Pinterest: http://www.pinterest.com/policyadvantage

Blog: www.PolicyAdvantage.com/Blog