Tip Sheet: Exchange Open Enrollment

/in , , /by

The first half of 2013 open enrollment is complete. It’s official: the new state and federal health insurance exchanges have opened up across the country. We’re now in the very beginning of the implementation of healthcare reform’s major provisions.

Over the past two and a half months, a lot has taken place. Some things not so good (you might even say bad). And some things good (in certain cases, really-really good).

For example, maybe you’re one of those people that found very affordable coverage at the exchange, and you’re thrilled. Or… maybe you’re someone who isn’t getting much financial help via the subsidies, and now you’re looking for a way to find coverage for yourself or your family that won’t break the bank. You could also be a person with a preexisting condition that finally got their much-needed coverage. Or… maybe you found out that you can’t keep that health insurance plan you liked.

Every person’s case is different, and we’ve made it through the first-half with you. We’ve helped people enroll in the new exchange. We’ve also helped people navigate plans outside of the exchange.

With the second half of exchange open-enrollment coming up, we’ve put together a tip sheet for you, based on what we’ve seen so far. No politics. No opinions. Just facts. Here’s the latest:

  1. There really are some outstanding options at the new exchange for certain people. For example, if you make between ~$16,000 and ~$28,000 per year individually, there is a good chance you might really like your plan and premium at the exchange. People in this range also qualify for what are called cost-sharing reductions (in addition to premium subsidies). If you’re making between ~$16,000 to ~$28,000 per year, take a good look at the exchange. Additionally, those people making up to ~$44,000 per year may also qualify for subsidies.
  2. It’s true: you can’t be denied coverage for having a preexisting condition. Some people are still having a difficult time coming to terms with this concept. If you have a preexisting condition, apply for a plan inside or outside of the exchange: you cannot be denied at either place.
  3. Dependent coverage is too expensive at my spouse’s employer. Some of you who are needing to get insured are finding out that access to your spouse’s coverage through his/her employer is very expensive. If your spouse has access to what is called “affordable” coverage via their employer (affordable defined here), unfortunately, you and any dependent children are no longer eligible for subsidies at the exchange (even if the coverage in the exchange is considerably more affordable). This has been an area where we have had difficulty helping people find coverage. Our advice: shop for a more affordable plan on the individual market until the employer can make adjustments (they may need to offer a more affordable plan, or not offer employer coverage at all).
  4. My individual (or family) health insurance plan was cancelled. Your health insurance plan may have been cancelled because it did not conform to new healthcare reform standards. The bad news: you may not be able to get that plan back (so the best you can do right now is shop for another plan). The good news: recently, there was a tax penalty exception granted to people who lost their coverage. In other words, if your plan was cancelled, you won’t have to pay the individual tax penalty in 2014.
  5. My premiums got more expensive. Many plans in the individual market have seen premium increases. This is especially true for individuals that do not qualify for health insurance subsidies at the exchange (ie: individuals making more than $44,000 per year). One of the reasons you’re seeing these increases is because of the newly mandated 10 essential health benefits. Our advice: have a broker shop with you for a more affordable plan.
  6. Check your physician and hospital networks. This is especially true if you’re participating in a plan from a public state exchange. If you’re looking for access to a specific doctor or hospital, make sure to check and see what plans they are accepting. Some doctors and hospitals are not accepting plans from the public exchange at all.

The above listed are some of the things we’ve run into while helping people enroll during the first half of exchange open enrollment. If you’ve participated at the exchange, you may be familiar with what we’ve discussed. If you’ve not yet enrolled, our biggest goal with this post is to get you some tips about what to expect.

The entire second half of 2013 open enrollment has just begun. Don’t forget you have until March 31st, 2014 to enroll this year. If you have any questions about enrolling in Covered California, please contact us. Policy Advantage Insurance Services is Covered California Certified.

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: https://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

California Continues Rollout: Won’t Allow Cancelled Policy Reinstatements

/in , , /by

This Fall, hundreds of thousands of non-compliant health insurance plans began to be cancelled throughout the nation. These plans did not comply with the new requirements set forth in the new healthcare reform law, and for that reason, were deemed not “legal.” As a result, these non-compliant plans needed to go. For more information about why, see this blog post.

However… last week, in light of these cancellations, the Obama Administration made the decision to allow insurers to reinstate these cancelled non-compliant plans. This would allow those plans to be continued for at least the remainder of 2014.

During his campaign to promote healthcare reform, President Obama reiterated that “If you like your plan, you can keep your plan.” However, in this example (the cancellation of these non-compliant health plans), this did not hold true. For this reason, the administration felt it was responsible for not “honing up” to the promise that it made. As a result, Obama decided that those plans that were cancelled needed to be reinstated for at least an additional year.

However, California was one state that did not agree with the Obama Administration’s decision to reinstate these cancelled policies. The executive board of Covered California (the new state health insurance exchange) unanimously voted to continue to move on with reform implementation, and not reinstate cancelled health insurance policies. This decision was on-par with many state insurance commissioners, and also with certain insurance company executives within the industry.

Here are some of the reasons why some states, insurance commissioners, and insurance executives thought policy reinstatements would be a bad idea:

  • Insurance Companies: Reinstatement of cancelled plans would contribute to the destabilization of an already turbulent insurance market.
  • Covered California (the new state exchange): Covered California was already leading the way with exchange enrollments. Nearly one-third of those enrolled in the first month at both the state & federal exchanges (in other words, nation-wide) were Californians. It made little sense to slow down.
  • Insurance Commissioners: Being this far into the implementation of reform, various insurance commissioners throughout the country also felt that it was inappropriate to reinstate health insurance plans that had been cancelled.

For these reasons (and others), a handful of states made the decision to tell the Obama Administration “thanks, but no thanks” when it came to reinstating policies. Certain states continued to move along with reform implementation as-is, and California was one of those states.

As a result, individuals now have more time to enroll in the state health insurance exchanges. The original open enrollment deadline for a 1/1/2014 plan start was 12/15/2013. This has now been moved back to 12/23/2013. 

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: https://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

Diners & Restaurants: Three Good Reasons to Look at Healthcare Reform

/in , , /by

Today’s blog post is about how healthcare reform can help businesses in the restaurant and dining industries. There are a few really good reasons that these industries should take a close look at what’s going on with regard to reform. In many cases, employees may now be able to access better coverage at much more affordable prices.

In the past, restaurants and diners have had a tendency to be challenging groups to work with when it comes to health benefits for a number of different reasons. Some of those reasons will be addressed in this post. We’ll then offer some solutions about how healthcare reform can help.

 

Here are why restaurants and diners (especially those under 50 employees) should take a close look at healthcare reform:

  1. Many workers are part-time. Part-time workers are usually: A) not eligible for health insurance at work because of their part-time status, or B) not making enough money to want to contribute to health insurance premiums. For these reasons, part-time workers are usually more difficult to help insure. Healthcare reform fits the part-time worker to a T. There is a good chance many part-time workers will be eligible for financial assistance in the form of tax subsidies. 
  2. Many workers are younger. The employees of these groups have a tendency to be younger. Many employees at diners and restaurants hold positions like servers, hostesses/hosts, bar-tenders, waitresses, cooks, etc. Healthcare reform plans can be very affordable for those in the “30 and under” age category (ie: certain plans for younger people who are eligible for subsidies based on income can cost well under $100/month).  
  3. Healthy employees are important in the diner and restaurant industry. If you’re serving people food and drink, you want your employees to be healthy. Employees who have good access to doctors and medical services can be a very valuable asset to business owners in this industry. It can also help with the group’s overall morale.

The above reasons are why healthcare reform can be very important in the restaurant and diner industries. The new healthcare reform law (ie: the state health insurance exchanges) can give these kinds of employees excellent access to good coverage, at very affordable prices. 

Recommended: make a “Covered California Certified” insurance agent available to your employees. Allow he or she to help your employees navigate the new reform laws, and find health plans that make sense both cost and coverage wise. Employees can now make individual decisions on their own at the exchange, without any employer contribution. In other-words, with the proper guidance, they can take care of it themselves. And in many cases, exchange plans can be better than typical small-business employer plans. 

Educate your employees about these new options at no cost to your company. Policy Advantage Insurance Services can help you with healthcare reform, and can help your employees navigate it. If you have further questions about how healthcare reform can fit businesses in the restaurant and diner industry, please contact us any time.

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: https://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

White House: Old Policies Won’t Be Cancelled

/in , /by

Over the past couple of weeks, you may have seen in the news that many individual and family health insurance policies were set to be cancelled across the country as a result of healthcare reform. The reason that these policies were going to be cancelled was because they do not conform to new healthcare reform standards. As a result, insurance plans that do not meet certain criteria set forth in the law can no longer be offered, and those that are currently in place need to be changed. This resulted in the cancellation of millions of policies across the nation.

There are a series of newly mandated requirements that all health insurance plans must comply with by January 1st, 2014. If health insurance plans do not adhere to these new requirements, they will no-longer be considered “legal” plans (and will therefore no longer be able to be offered). Here are a couple of the important new mandates that health insurance plans must contain starting on January 1st, 2014:

  1. “10 Essential Health Benefits”: Starting on January 1st, 2014 all plans must contain the “10 Essential Health Benefits,” whether policyholders need them or not.
  2. Minimum Actuarial Value: In addition, on January 1st, 2014, all plans must meet a “minimum actuarial value” of 60%/40% (or Bronze Level Coverage). If plans do not meet this minimum value, they will be considered out of compliance. You can read about the Metallic Levels of Coverage here.

Because of these new mandates, a few things are set to happen:

  • In certain cases, because of new “minimum actuarial value” (#2 listed above)… some current plans’ deductibles, co-payments, and co-insurance are going to go down (ie: there will be less cost-sharing for the policyholder).
  • Secondly, additional benefits will be contained in new health insurance plans (#1 listed above: the “10 Essential Health Benefits) making them “richer” plans, which in most cases, will make premiums more expensive outside of the new marketplaces. Explained another way: plans that are purchased without the help of exchange subsidies (off of the exchange) could be more expensive.
  • Lastly, health insurance plans that do not meet these new requirements need to be “phased out.”

The latter of the above listed is one of the unintentional early consequences of the law. Because these “old” plans don’t contain the new mandates, and need to be phased out, many (if not all) of these “old” plans were set to be cancelled.

However, on November 14th, the Obama Administration announced that these old plans could be kept (and reinstated in certain cases) for an additional year (up until December 31st, 2014.) As a result, many people will now get to keep their “old” health insurance plan for an additional year. 

There may be additional changes to come with regard to this concept. There are currently bills being sponsored in Congress that would not only allow policyholders to keep their old plans for an additional year, but also allow insurance companies to continue selling these “old” plans (in addition to the new plans with the new mandates).

There is also speculation that there may be effects on the individual mandate as a result of the cancellation of these plans, and the other additional “hiccups” (ie: problems with the website) while rolling out the law. Some are wondering if these issues will cause the individual mandate to be delayed for an additional year. Be advised to continue to keep up with this topic over the coming weeks and months. 

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: https://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

Phrases Made Easy: “Cost Sharing Reductions”

/in , , , /by

Welcome back to another edition of “Phrases Made Easy.” This series at our blog aims to help make all of those long, drawn-out insurance phrases easier to understand. One thing we notice when talking about health insurance (and health benefits in general) is that the concepts can be “wordy” and boring. We emphasize fixing that here!

Today we’ve selected the phrase “Cost Sharing Reductions.” The primary reason we’ve selected this phrase, is because it can be a very important concept for certain people in the new Covered California state health insurance exchange. Like many other phrases in our “Phrases Made Easy” series, this one sounds difficult, but it’s really not that bad at all.

If you are shopping in the health insurance exchange, you may start to see the phrase Cost Sharing Reduction (or CSR). Here is what a Cost Sharing Reduction is:

Cost sharing reduction plans are offered through Covered California for consumers whose income is between 133% to 250% of the federal poverty level (FPL). These plans offer lower cost-sharing to reduce your clients’ out-of-pocket costs when accessing medical care. These plans are available only through Covered California.

Quite simply: Cost Sharing Reductions reduce your out-of-pocket expenses. If you purchase what is called an “Enhanced Silver Level Plan” through Covered California, and are eligible for Cost Sharing Reductions, you will get help with your co-payments, deductibles, and other out-of-pocket medical expenses.

————————————————————————————————————

Question: What is the criteria for Cost Sharing Reduction eligibility?

Answer: There are two criteria:

  1. You need to purchase an “Enhanced Silver Level Plan” on the Covered California state health insurance exchange.
  2. Your yearly income must be between 100% and 250% of FPL (or approximately $11,490 per year & $28,725 per year for individuals).

————————————————————————————————————

Here are the three tiers of Silver Level Plans that include Cost Sharing Reductions (or CSRs) in the new state health insurance exchange in California. A standard Silver Level Plan without Cost Sharing Reductions has 70% actuarial value:

  • Enhanced Silver 94: 100% FPL to 150% FPL (94% enhanced actuarial value)
  • Enhanced Silver 87: 150% FPL to 200% FPL (87% enhanced actuarial value)
  • Enhanced Silver 73: 200% FPL to 250% FPL (73% enhanced actuarial value)

Essentially, these are additional benefits that help people who make less, reduce their out of pocket costs. If you have additional questions about “Cost Sharing Reductions” (or CSRs), and how they may apply to you, please contact Policy Advantage Insurance Services. We are “Covered California Certified” and can help you with your questions when navigating the exchange.

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: https://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

Benefits Chalk Talk: 10 Essential Health Benefits

/in , , , /by

Welcome back to another edition of “Benefits Chalk Talk.” In this series at our blog, we provide you with valuable, up-to-date, relevant information about health benefits planning so that you can put the things in place that make the most sense for yourself or your company. At Policy Advantage Insurance Services, we feel that informed consumers can make a really big difference in our industry.

The topic today is about the “10 essential health benefits” that must be included in all insurance plans starting on January 1st, 2014. The Affordable Care Act (or ACA/Obamacare), required that certain new “essential benefits” be included in all health insurance plans.

Additionally, you may have heard recently in the news that many people across the country are going to be unable to continue their current health insurance plans. The “10 Essential Health Benefits” provision is one of the reasons why. Many of today’s plans on the individual market do not conform to these minimum standards set forth in the law.

As such, any plans that were not “grandfathered in” (ie: in place before March 23rd, 2010, with certain exceptions) can no longer be offered. As a result, people in these plans will need to find a new one starting on January 1st. In many cases, because of the additional added benefits, premiums will also be more expensive.

Here is an overview of the “10 Essential Health Benefits (source: www.healthcare.gov):

  1. Ambulatory Patient Services: “Outpatient care” – the kind you get without being admitted to a hospital
  2. Emergency Care: Trips to the emergency room
  3. Hospitalization: Treatment in the hospital for inpatient care
  4. Maternity & Newborn Care: Care before and after your baby is born
  5. Mental Health Services: Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
  6. Prescription Drugs: Your prescription drugs
  7. Rehabilitative & Habilitative Services: Services and devices to help you recover if you are injured or have a disability or chronic condition. This includes physical and occupational therapy, speech language pathology, psychiatric rehabilitation, and more
  8. Laboratory Services: Your lab tests
  9. Preventive & Wellness Services: Preventive services including counseling, screening, and vaccines to keep you healthy and care for managing a chronic disease
  10. Pediatric Care: Pediatric services – this includes dental care and vision care for kids

The above listed are the “10 Essential Health Benefits” that must be included in all insurance plans starting on January 1st, 2014. Keep in mind that there may be minor benefits differences between states, but for the most part, all of the above must be included in new insurance policies.

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: https://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

Covered California: “Certified Insurance Agent”

/in , , /by

Today’s blog post is about Covered California’s “Certified Insurance Agents.” As you know, the new state health insurance marketplaces recently opened up for enrollment on October 1st, 2013. The marketplace in California is called Covered California.

With the opening of these marketplaces, a number of new ways to enroll in an individual health insurance plan emerged. One of those ways is finding the help of one of Covered California’s “Certified Insurance Agents.”

The “Certified Insurance Agent” training program allows licensed insurance agents in the state of California to assist the public in enrolling in the new state marketplace programs. Effectively, a “Certified Insurance Agent” becomes a guide for you. They can help you navigate the nation’s largest new insurance marketplace. Here is the official Covered California Certified Insurance Agent marketing badge. You will see it begin to appear on insurance brokerage websites, business cards, letterhead, etc:

CCCertified

If an agent in California is a “Certified Insurance Agent,” they have accomplished the following:

  • Obtained an insurance license to do business in California.
  • Are in good standing with the California Department of Insurance.
  • Have been through an in-person 8 hour Covered California training seminar.
  • Have completed 4 hours of Covered California self-study.
  • Have passed the “Covered California Certification Exam” with a score of 80% or better.
  • Registered and completed the agreement with Covered California to be a “Certified Insurance Agent.”

After completing each of the above requirements, a Covered California “Certified Insurance Agent” is then able to help the public navigate one of two programs at the exchange:

  1. The individual health insurance marketplace.
  2. SHOP (Small Business Health Options Program), for small business.

A Covered California “Certified Insurance Agent” can be a valuable asset for you in navigating the current healthcare reform conditions. They can also help you navigate the new insurance marketplace website, apply for coverage, and provide suggestions about which programs may fit best. Policy Advantage Insurance Services is a Certified Insurance Agent for Covered California. Please contact us with your questions today.

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: https://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

Benefits Chalk Talk: Metallic Levels of Coverage

/in , , , /by

Welcome back to another edition of “Benefits Chalk Talk.” In this series at our blog, we provide you with valuable, up-to-date, relevant information about health benefits planning so that you can put the things in place that make the most sense for yourself or your company. At Policy Advantage Insurance Services, we feel that informed consumers can make a really big difference in our industry.

Today we’re going to tell you a little bit more about the new “Metallic Levels of Coverage” and how they work with regard to healthcare reform and individual health insurance policies. You’re going to want to familiarize yourself with these distinctive types of coverage, because you’ll begin to see them quite often.

These “Metallic Levels of Coverage” will be used both inside and outside of the new state health insurance exchanges. Their primary purpose is to explain (in simple terms) the amount of coverage that health insurance plans provide. The amount of coverage is based on actuarial value. Actuarial value is the percentage of health costs that would be covered by the health plan for an average population. Here are the four standardized “metallic levels of coverage”:

MetallicLevels

  • Bronze = 60% Insurance Company Pays, 40% Policyholder Pays
  • Silver = 70% Insurance Company Pays, 30% Policyholder Pays
  • Gold = 80% Insurance Company Pays, 20% Policyholder Pays
  • Platinum = 90% Insurance Company Pays, 10% Policyholder Pays

Insurance companies must offer the minimum “Bronze Level” plan as their lowest level of coverage starting on January 1st, 2014. This will be consistent with plans both inside and outside of the exchange. A couple of important additional items to understand:

  1. There is also a plan level called “Catastrophic Coverage.” This catastrophic plan is available only to people under 30 years of age. This plan is a high deductible health plan intended for those who are not utilizing services (younger people), in order to keep premiums lower.
  2. The “Platinum Level” (90%/10%) plan is not available in certain state health insurance exchanges. Be sure to check to see if you’ll be able to participate in a Platinum Level plan in the state where you reside.

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: https://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

Health Insurance Marketplaces: Enrollment Begins October 1st

/in , , /by

On October 1st, 2013, the new health insurance marketplaces will open for enrollment across the country for the first time. These new marketplaces (or exchanges) were a major component of the Affordable Care Act (also known as Healthcare Reform, Obamacare, etc). The main objective of these exchanges is to extend coverage to those who cannot afford (or cannot obtain) health insurance. 

If you’ve been following along, in past blog posts we’ve described some of the characteristics of these new exchanges. We’ve discussed the general nature of these marketplaces (specifically the California state marketplace called “Covered California“). We’ve also talked a little bit about eligibility (ie: Federal Poverty Level), and the individual tax penalties involved if someone decides not to purchase health insurance.

That all being mentioned, we won’t go back into those types of topics in this blog post. Instead, this post is intended to be more of a “checklist” for you, so you can decide if you’re prepared for the new exchanges to open up.

These are the kinds of questions you should be asking yourself before the new marketplaces open in October:

Do I currently have health insurance? 

  • If the answer is no, it’s most likely for a few different reasons: A) It’s not affordable. You just flat-out can’t pay the expensive premiums. B) It’s not easily accessible. You want health insurance, but you can’t get it. You could be self-employed, between jobs, unemployed, or you may have a preexisting condition. C) You really don’t care. You can afford some kind of health insurance plan (and you have access to one), but you don’t want to spend your money on health insurance premiums. If these examples sound like you, you’ll want to take a very close look at the new health insurance exchanges.  

If the answer is “yes I do have health insurance,” you want to ask: Where am I currently getting my health insurance?

  • This is an important question. You’ll want to know if you’re buying your own plan, or if you’re getting it through an employer. Regardless of which one it is, you may want to take a look at the health insurance marketplaces because your premiums might be cheaper if you are eligible to receive premium subsidies (which will be many, many people… so make sure to take a look). However, if your employer currently has affordable health insurance coverage in place for you at work, or if your spouse has access to an employer plan, you may not be eligible for subsidies in the exchange.

Does it make more sense for me to buy a health insurance plan…?… or pay a tax penalty.

  • By January 1st, 2014 it’s got to be one or the other. You’ve either got to buy a minimum essential coverage health insurance plan, or you’ve got to pay a tax penalty. You’ll want to decide which one will make more sense in your situation (in certain cases, it may make more sense to pay the tax penalty, especially the first year).

Are the health insurance plans inside of the marketplaces the same as the ones outside of them?

  • The answer to this is yes. The plans inside the exchange will be the same as those outside of it (both are plans from private companies like Kaiser, Health Net, Anthem, etc).

Should I shop in a health insurance exchange?

  • You can always purchase an individual health insurance plan outside of a state health insurance marketplace (and starting on January 1st, 2014 you can’t be denied coverage for preexisting conditions inside or outside of an exchange). This means you don’t have to shop for your plan inside the exchange. However, the big advantage to shopping in the exchanges: you may qualify for substantial subsides that will reduce your monthly premium by quite a bit. The disadvantages: there is some additional administration (tax forms, etc). Also, certain plans and physician networks may not be available through the exchange (ie: not all insurance companies offer plans in the exchanges).

How (and where) can I apply for a plan in the exchange?

  • Eventually, the easiest way to take care of this will be online. You’ll be able to jump online and shop & compare insurance rates right at the state marketplace website. We say “eventually,” because states are still getting online accessibility prepared. Until then, you can apply in person, over the phone, or with a trained “assister/navigator” (these are people that are certified by the state’s Department of Insurance to help you enroll. IE: a Certified Insurance Agent). We can help you, please contact us.

Although these are not all of the questions you should be asking yourself, they are a very good start. They should help you begin to understand and make decisions about participating in a state health insurance marketplace.

Remember: on January 1st, 2014, you need to have a health insurance plan in place, or pay a tax penalty. The state health insurance marketplaces will be a big source of insurance for those who are currently uninsured. Make sure to take a good look at them, especially if you don’t currently have health insurance.

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: https://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

Benefits Chalk Talk: Registered Health Underwriter® (RHU®)

/in , , /by

Welcome back to another edition of “Benefits Chalk Talk.” In this series at our blog, we provide you with valuable, up-to-date, relevant information about health benefits planning so that you can put the things in place that make the most sense for yourself or your company. At Policy Advantage Insurance Services, we feel that informed consumers can make a really big difference in our industry.

Today we’re going to talk a little bit more about the Registered Health Underwriter® (or RHU®) designation. If you’ve been following along here at the blog, we’ve talked a little bit about insurance professional designations in the past. Instead of going back through what we covered in that previous blog post, we’re going to tell you more about the specific knowledge that a Registered Health Underwriter® has acquired in order to help clients.

Remember, as we had mentioned in the past blog post, these are robust designations. The holder of these designations has demonstrated a significant and advanced understanding of the concepts which apply. According to NAHU ( the National Association of Health Underwriters):

The Registered Health Underwriter® designation is the undisputed professional credential for persons involved in the sale and service of disability income and health insurance. Individuals earning the RHU designation demonstrate a high level of knowledge about the principles and practices governing the disability income and health insurance business.

Here is some of the specific knowledge that holders of the Registered Health Underwriter® (or RHU®) designation have obtained:

  • Federal Regulation: Assisting clients with things like COBRA, HIPAA, and ERISA.
  • Individual Health Insurance: Providing health insurance consultation outside of the workplace (ie: individual and family plans).
  • Employer Self-Funding: Advanced knowledge about administration, the TPA environment, and stop-loss coverage.
  • Group Health Benefits: Planning and design of group health insurance programs, benefits structure, tax incentives, Section 125 cafeteria plan administration, etc.
  • Consumer Directed Healthcare: Explaining how Health Savings Accounts (HSAs), Health Reimbursement Arrangements (HRAs), and High Deductible Health Plans (HDHPs) work together to help consumers retain funds.
  • Federal and Social Programs: A knowledge of things like OASDI (Social Security), Medicare, Medicaid, FEHBP (Federal Employees Health Benefits Program), TRICARE, etc.
  • Ancillary Benefits: Vision, dental, and hearing.
  • Voluntary Benefits: Hospital indemnity, accident indemnity, specified health event (critical illness), cancer indemnity, small face value term life (final expenses protection). Supplemental health insurance fits into this category.
  • Managed Care Organizations (MCO’s): PPO’s, HMO’s, POS plans, EPO plans, physician contracting, hospital contracting, accreditation, case management, disease management, managed behavioral health, performance based incentives, integrated health care delivery systems (IDS’s), hospital networks, physician networks, basic compensation of physicians, medical/surgical utilization, quality management.
  • Disability Income Insurance: Short term & long term disability.

As you can see, a Registered Health Underwriter® (RHU®) can be a valuable resource. These individuals have a wide variety of knowledge they can make available to you, to help you make good decisions when it comes to health benefits planning.

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: https://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