Covered California: SHOP (Small Business Health Options Program)

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Thanks for stopping by today, we’re glad that you here. Today we’re going to talk about the Covered California SHOP program, otherwise known as the Small Business Health Options Program.

As you know, Covered California is the new state health insurance exchange in the state of California. The new exchanges were a major part of healthcare reform, and were designed to help extend health insurance coverage to eligible individuals and businesses. There are two different programs available at Covered California:

  1. Individual & Family Plans (IFP): these are plans that you enroll in outside of an employer (or group) plan. They are available with APTCs (or subsidies) at the exchange. These subsidies make premiums more affordable.
  2. SHOP (Small Business Health Options Program): these are group health insurance plans through Covered California that are available to qualified businesses. Depending on the size and average income of your business, you may be eligible for tax credits that can help reduce the cost of coverage. 

Many of you are probably familiar with the individual plans that are available through the exchange (option #1 above). A lot of you probably even enrolled — over 1.2 million people in California participated during the exchange’s first open enrollment period that just ended.

Even though you might be familiar with individual health plan enrollment at the exchange, this article is about option #2 above. Covered California can also help small businesses. 

SHOP

If you’re a small business owner (especially in a group with less than 25 FTEs), you may want to take a close look at Covered California’s SHOP. This program is specifically designed to help small businesses offer coverage. Here are some important facts about the SHOP:

  • It’s a new marketplace through the Covered California exchange designed specifically for businesses with 1-50 eligible employees.
  • Employers under 50 FTE are not required to provide health insurance, but this program could be a good option.
  • Important: unlike individual enrollment, Covered California SHOP enrollment is open all year in 2014. So, request information and a quote anytime this year.
  • An eligible full-time employee is an employee that works 30hrs per week or more for the month. An eligible part-time employee is an employee that works 20hrs per week or more for the month.
  • To be eligible for SHOP, an employer must provide a minimum 50% contribution to employee plans.

Question #1: What businesses are eligible for a tax credit?

Answer #1: Businesses that 1) have fewer than 25 FTE for the year, 2) have an annual average wage of less than $50,000 per FTE, and 3) who pay at least 50% of their employees’ premium costs.

Question #2: How much is the tax credit?

Answer #2: Starting in 2014, the maximum tax credit for businesses as a percentage of insurance premium expense is 50% (or up to half of your premium). The maximum tax credit for tax-exempt organizations as a percentage of insurance premium expenses is 35%. These premium subsides are available for two consecutive years.

As a small business owner, it’s a great idea to talk with a Covered California “Certified Agent” about this program. They can run a quote for you. You may be eligible for substantial premium savings. Policy Advantage Insurance Services is certified and can help you with your questions. Feel free to contact us anytime. For more information about SHOP, please visit their official FAQ page here.

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:

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Phrases Made Easy: “Advanced Premium Tax Credits” (APTCs)

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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’re going to talk about “Advanced Premium Tax Credits” (or APTCs). And we’ve got great news for you: this one is really easy.

If you’ve enrolled in a health insurance plan at the new health insurance exchanges, there’s a pretty good chance that you’ve already put “Advanced Premium Tax Credits” to work. We’re going to give you the long version of the definition first. This one comes directly from www.healthcare.gov (*note: skip below the “Easy St” sign if you want to make this easier):

The Affordable Care Act provides a new tax credit to help you afford health coverage purchased through the Marketplace. Advance payments of the tax credit can be used right away to lower your monthly premium costs. If you qualify, you may choose how much advance credit payments to apply to your premiums each month, up to a maximum amount. If the amount of advance credit payments you get for the year is less than the tax credit you’re due, you’ll get the difference as a refundable credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay the excess advance payments with your tax return. Also called premium tax credit.

Easy

OK. That was pretty wordy. Now let’s make this easy. Here’s what you need to know about “Advanced Premium Tax Credits” (or APTCs):

  • APTCs are the health insurance “subsidies” that you hear so much about.
  • They are credits that make your premiums more affordable if you purchase insurance through the new exchange.
  • The APTCs that you may qualify for are based on FPL or “Federal Poverty Level” (we made that phrase easy one time before, go check it out).
  • The more money that you make, the less of a monthly APTC you will get.
  • The less money that you make, the more of a monthly APTC you will get.
  • If you get too much credit for the year (because you under-stated your income), you’ll have to pay it back at tax time.
  • And (you guessed it), if you don’t get enough credit for the year (because you over-stated your income), you’ll get a credit at tax time.

The moral of the story: APTCs are really what makes individual health insurance “affordable” in the Affordable Care Act. They’re government tax credits that are designed to make health insurance premiums less expensive.

In certain exchanges (like Covered California), when you shop and compare plans (using their “Shop & Compare Tool“), they will apply the APTCs you may eligible for, and give you your total monthly premium estimate. This estimate is based on four factors:

  1. Number of People in the Household
  2. Ages of People in the Household
  3. Yearly Household Income
  4. and Zip Code

Once again, if you want to see an example, look at Covered California’s “Shop & Compare Tool.” Once you input the factors listed above, you’ll be able to see what kind of APTC you may qualify for.

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:

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#Advantage: Working with a Covered California “Certified Agent”

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“Covered California” is the new public health insurance exchange in the state of California. If you live California, you’ve probably heard quite a bit about it over the past 6 months. These exchanges are a new way to buy health insurance and are a major part of healthcare reform.

The California exchange opened back in October of 2013. Since then, hundreds of thousands of Californians have enrolled in individual insurance plans there. Many of these plans have been subsidized by Advance Premium Tax Credits (or APTCs). These APTCs can substantially reduce the monthly cost of health insurance.

If you’ve taken a look at Covered California, you’ll know that there are various ways in which to enroll. Some of them include:

  • Online. You can set up an online account and enroll via the internet. You can also assign a Certified Insurance Agent to your case through your online portal.
  • Over the phone. You can call Covered California’s phone number and enroll with a service agent.
  • In person. You can enroll in person with A) Certified Enrollment Entities, B) Certified Enrollment Counselors, or C) Certified Insurance Agents. 

The purpose of this blog post is to explain some of the advantages of enrolling with a Certified Insurance Agent. 

Advantage

Here are some really good reasons to work with a Covered California “Certified Insurance Agent”:

  • Certified Agents are Licensed Professionals: Any insurance agent that is certified with Covered California is also licensed with the state department of insurance. Many of these agents also have years of experience and know the industry well.
  • A Single Point of Contact: This is one of the biggest advantages. You’ll have a single point of contact if you enroll with a certified agent. You can pick up the phone or send an email to that person anytime. If you need to make changes or have questions in the future, you’ll have someone familiar to work with.  However, if you enroll with a Covered California customer service rep over the phone, or a Certified Enrollment Counselor, you may speak with different people each time.
  • Certified Agents are Appointed Directly with the Insurance Companies: Insurance agents are appointed and have a direct relationship with the insurance companies. This can help with quick, effective, and efficient customer service.
  • Certified Agents Have Passed Rigorous Certification Requirements: These are people that have gone through extensive training and testing to obtain their certified status.
  • No Cost. You can work with a Covered California “Certified Agent” at no cost to you. Compensation is built into every insurance plan, regardless of whether-or-not you decide to work with an agent.

As you can see, there are a number of good reasons to work with a Covered California “Certified Insurance Agent.” Look for this badge when searching for assistance from an agent or agency:

CCCertified

Policy Advantage Insurance Services is certified. Please contact us if you have questions, or need ongoing help at Covered California.

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:

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Policy Advantage Insurance Services: How We Can Help

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Today’s article is about how Policy Advantage Insurance Services can help you with your health benefits planning. As you know, we’ve written a few blog posts about this topic in the past. If you’re new, we’d encourage you to catch up here:

Policy Advantage Insurance Services literally has the ability to help you with your health benefits planning, no matter what your current situation is. This blog post intends to specifically identify where we can help.

WeCanHelp

  • Employers of Any Size: We have the ability to help any size employer, large or small. If you’re a business owner or executive, you probably know that there are some important differences between businesses (especially your number of full time equivalent employees), when it comes to healthcare reform. We can help employers with 2, 20, 80, 500, or even 1000’s of employees. We can help you design an effective, efficient, and budget-conscience health plan that will fit any business.
  • Individual Health Insurance Plans Off of the Exchange: Are you self-employed or not offered a health insurance plan at work? It’s now easier than ever to “shop” and find individual health insurance. If your income is too high to qualify for exchange subsidies, we can help you find a plan off of the exchange. These are plans that are purchased directly through the insurance companies.
  • Individual Health Insurance Plans On the Exchange: If you’d don’t currently have access to an affordable health insurance plan, and your income is between 100% and 400% of FPL, you may qualify for help with your insurance premiums through the new health insurance exchanges in the form of “Advanced Premium Tax Credits” (or APTCs). These credits can significantly reduce the amount of your monthly premiums. Policy Advantage Insurance Services is “Covered California Certified” and can help you select plans on the new exchange.
  • SHOP Plans On the Exchange: The “SHOP” program is the new “Small Business Health Options Program.” This is a new program on the exchange that is specifically designed to help small businesses (under 50 employees) expand health insurance options to their employees. Those businesses that have less than 25 employees may see significant tax-credits to off-set the cost of premiums. The SHOP program is a group health insurance plan.

As you can see, Policy Advantage Insurance Services has the capacity to help you in any circumstance. If you are a business, individual, or self-employed, we can help you find a plan that will fit your situation. One of our biggest goals is to help our clients save money and improve coverage. Contact us today, and we’ll help you sort it all out.

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

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Important Outreach: Only 10 Days Left in 2014 Open Enrollment

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If you’ve been following along at our blog, you’ll understand that there are now “open enrollment” dates each year for Individual and Family Plans (IFP). 2014 open enrollment is coming to a close soon. This very important blog post is for everyone: individual clients, group & employer clients, potential clients, friends, co-workers, family, and anyone else.

**Individual and Family Plan (IFP) open enrollment is coming to a close on March 31st, 2014. There are only 10 days left in 2014 to enroll. 

10days

Here are some important notes:

  • Open enrollment applies to all individual insurance plans on and off the new exchange.
  • Those who don’t have a plan by March 31st, 2014 will not be able to enroll after this date until next Fall, unless there is a “qualifying event” (an example: loss of employer coverage).
  • Good reasons to look into enrolling in a plan: health insurance can be very important, you may be able to find a good plan at a good price, and there is also a tax penalty this year for individuals who have not enrolled in a health plan.
  • Policy Advantage Insurance Services has the capacity to help with all plans: on the exchange, off of the exchange, and group/employer plans. Regardless of your situation, we can help.

We’ve helped many people enroll since last Fall (both on and off of the exchange). If you know of anyone: friends, family, co-workers, or anyone uninsured… please contact us (or share our info) and we can help them sort it out online, over the phone, or in-person.

Thanks for stopping by, we hope our information was valuable to you. 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

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Last Leg: Final Two Weeks of IFP Open Enrollment

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We’re about to enter the last leg of 2014 IFP (Individual & Family Plan) open enrollment. As a result of healthcare reform, there are now yearly open enrollment periods for individual and family health insurance plans.

What does this mean? This means that if you plan on participating in a non-group (or non-employer) health insurance plan, then you’ll need to enroll during this new enrollment period.

This year’s IFP enrollment has been extended until March 31st, 2014. The reason for this extension is because we’re in the very first year of enacting healthcare reform’s major provisions. In years after 2014, open enrollment will end sooner. LastLap

Entering the final leg of 2014 IFP open enrollment, here are some important notes:

  • The latest numbers show that nearly 4.2 million Americans have enrolled in health insurance plans through the new exchanges across the country. The Obama Administration says that this will be enough participation to maintain stability within the insurance markets.
  • The last day to enroll in any individual or family health insurance plan (on or off of the new exchanges) is March 31st, 2014.
  • If you have a “qualifying event” after open enrollment ends on March 31st (ie: the loss of an employer health insurance plan), you can enroll mid-year in a special enrollment.
  • If your plan is subsidized through the exchange with an “Advanced Premium Tax Credit” (or APTC), make sure that your income is correctly reported, and that you keep the exchange updated with any income changes throughout the year.
  • There is a tax penalty in 2014 for not carrying a “minimum essential coverage” health insurance plan. This tax penalty is $95 or 1% of household income (whichever is greater).

With that, we’re into the anchor leg of our first healthcare reform open enrollment period. Expect to see some additional late participation in these past few weeks, that will most likely push the total first year enrollment up over 4.2 million Americans.

If you need help enrolling, Policy Advantage Insurance Services is “Covered California Certified” and can assist you with plans on or off of the exchange. Please feel free to contact us with your questions.

Thanks for stopping by, we hope our information was valuable to you. 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

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Voluntary Benefits in the Post Healthcare Reform Environment

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This blog post is about “voluntary benefits” and how they are poised to see significant growth in the post-healthcare reform environment. If you’ve been following along here at our blog, you’ll know that we’ve discussed the definition of voluntary benefits in the past. We’ve referred to these benefits as “supplemental health insurance.”

As we move forward with this concept, keep in mind that you may see this specific category of benefit worded in three ways:

  1. Voluntary Benefits (the verbiage we’re using in this blog post).
  2. Supplemental Health Insurance (verbiage we’ve used in the past).
  3. Ancillary Benefits (or: benefits that support existing benefits).

The above listed could all be considered “voluntary benefits.” Each are composed of a variety of different important products when designing employer health programs.

The big question: What are voluntary benefits? 

Answer: voluntary benefits are exactly what they say they are. They are products that employees voluntarily participate in at work. In other words, employees typically pay for voluntary plans with their own money. The employer usually does not make a contribution.

The next big question: What types of plans are available voluntarily? 

Answer: there are a number of different plans that are available on a voluntary basis. Listed below are a few of them.

  • Supplemental Health Insurance: Accident Plans, Cancer Plans, Hospital Plans
  • Ancillary Benefits: Vision, Dental, Life Insurance, Disability Insurance
  • Specialty Benefits: Pet Insurance, Legal Counsel, Law/Litigation Insurance

The last big question: Why are these types of plans poised to grow significantly?

Answer: there are two big reasons why voluntary benefits are poised to grow significantly in the post-healthcare reform environment.

  1. It’s expected that there will continue to be increased exposure to “out of pocket expenses” and “cost sharing.” In other words, deductibles, co-payments, and coinsurance will all continue to be common. And most likely, these types of out of pocket expenses will continue to increase over time. Voluntary benefits can help reduce exposure to these kinds of expenses. Read more here.
  2. Government money is now helping to pay for a considerable number of new health insurance plans. This is especially true for small businesses (under 50 employees). With the integration of the new health insurance exchanges into the insurance marketplace, the federal government is now helping millions of new people pay their premiums in the form of tax subsides. What does this do? It frees up money for products like voluntary benefits.

As you can see, voluntary benefits will be a very important component in the post-healthcare reform environment. According to a recent study by Met Life, 51% of employees are willing to bear more of their benefits costs in order to have better choices, and 58% of employers say providing voluntary benefits will be significant to their benefits strategy in the coming years.

Policy Advantage Insurance Services provides a broad range of voluntary and ancillary products. If you have questions, please contact us, and we can evaluate your situation (as a business or individual) to see exactly where these benefits can fit it, and how they can help. Continue to look for additional posts on this topic.

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:

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Extended Delay: Insurance Mandate for Medium-Size Employers (50 to 99 employees)

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Yesterday (on 2/10/14) the Obama Administration announced an additional delay to the healthcare reform law’s “employer mandate.” This new announcement stated that medium-sized businesses (those from 50-99 employees) will now have additional time to cover their employees with a health insurance plan.

This is the second announcement of a delay with regard to the employer mandate. Back in July of 2013, the entire mandate (for those employers with 50 or more full time equivalent employees) was postponed until 2015. Now, the “medium sized” employers in that group (those with 50 to 99 workers) will be given an additional year (until 2016) to provide “minimum essential coverage” or face tax penalties.

With this new announcement, comes an additional “grace period” for employers that are at or above 100 employees. The employers in this group will still have to cover their workers. However, originally they only needed to cover 95% of their total full-time employees. Now, with the grace period, they will only need to cover 70% of their full-time employees in 2015. In 2016, they will need to cover 95% of their employees.

The main idea behind this recent delay: to provide a “dual phase-in” period for the employer mandate, and lighten the burden on those  employers in the 50 to 99 employee range that have not provided health insurance in the past.

Thanks for stopping by, we hope our information was valuable to you. 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:

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Business Owners: Give Your Employees More Choices

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Believe it or not, it can save you money. One of the most important concepts in the post-healthcare reform environment will be giving employees choice when it comes to their health benefits selection. This blog post will explain why this is so important. A future blog post will explain the ways this can be accomplished. Your employees have questions right now… have good answers for them.

If you’re an employer that is offering health benefits, you’ll want to understand that it’s now easier and more important than ever to give your employees a healthy selection of health plans at work. This is especially true for businesses that are in the “+50 Full-Time Equivalent Employee” category.

There are a number of different reasons why it’s now important to offer more selection. Here are a few of them:

  • “One size fits all” benefits plans are no-longer efficient. In the past, employers would typically offer their employees a single group health insurance plan. Imagine this… buying identical pairs of jeans for each person in the company. All the same size, all the same price. There’s going to be a good chance that pair of jeans you picked won’t fit everyone, and might be too expensive too. The same thing can happen with a health insurance plan. Which leads us into our next important reason it’s important to offer additional choices…
  • In most cases you (the employer) are the one choosing the plan for the group. So, not only are the “jeans too expensive and not fitting everyone right,” but YOU are the one who picked them out for your group. By offering a better selection of plans, people begin to make their own decisions. And when people are thinking about what they’re purchasing, they’ll become a better consumer. When people become a better consumer… it saves money all around. There’s a real concept that describes this phenomenon, and it’s called “Consumer Directed Healthcare.”
  • Dependent coverage can now be difficult to navigate. Now that everyone needs to carry health insurance, the way the dependents of your employees find their coverage is much more important. This is one of the “biggees” in the post-reform environment. For example, you may be offering the best plan to your employees, but their dependents may not be able to afford it (especially if you’re not making a contribution to health insurance for dependents, and it’s an expensive plan). You “mean well”… but this scenario can be big a problem, especially when it comes to eligibility for subsidies at the new health insurance exchanges. By having a better selection at work, dependents of employees can more easily (and affordably) navigate their options.
  • Individual health insurance plans and “defined contribution” health planning are two strategies that are growing in popularity. Why? Because they both allow employers to offer great benefits at maximum flexibility to employees and their dependents. An additional bonus: setting (or defining) a budget for health benefits has never been so easy.

Keep that last bullet-point in mind, because we’re going to get into both of those in more detail in a later blog post. That future blog post will help answer two important questions: “How can I offer more choices and flexible benefits to my employees?” and “How can it save me money?”

The good news is, it’s easier now that ever before. We can’t wait to tell you more. Continue to tune-in to our blog, and we’ll continue to share great information.

Thanks for stopping by, we hope our information was valuable to you. 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

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Health Insurance Exchanges: “Under 35” Crowd, Jump On-Board

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The first-half of open enrollment at the new state health insurance exchanges is long past… and the participation from the younger crowd? It wasn’t very good.

Recently, the October 1st through December 31st enrollment numbers have been announced by the exchanges. Only about one quarter (or 25%) of those who enrolled were between the ages of 18 and 34. This fell far short of the 40% that certain experts had originally forecast.

There are a number of different reasons this younger group (ages 18-34) is so important. Here are a few of them:

  • It’s presumed they are healthier and less-costly to insurers.
  • If insurers end up with a more expensive group of policyholders, rates could go up.

In the weeks to come, be prepared to see advertising geared towards those in this younger demographic. Many of the exchanges are beginning to reach-out to this portion of the population, to help them find and enroll in affordable coverage.

Here are some good reasons to take a good look at health insurance right now if you’re in the age 18-34 category:

  1. The affordable subsidized rates could amaze you. If you qualify for a subsidy at the exchange (ie: if you make between about $16,000 to $44,000 per year individually) you may see some outstanding premiums. We’re talking under $100 per month in certain cases for a good plan (contact us and ask about details).
  2. In general, plans are usually less expensive for the 18-34 crowd. You may be surprised by the cost of a health insurance policy if you’re younger. If you’ve never “shopped” for health insurance, take a good look at what’s available to you.
  3. Accidents can happen. Ages 18-34 are active years. Many of you are biking, hiking, working out, surfing, skiing, jogging, playing sports, travelling, etc. With all of this activity, accidents can happen. Make sure that you have coverage in place that can help you avoid costly hospital bills.
  4. Women: these are child-bearing years. Maternity coverage is now mandated in all health insurance plans. Look for a policy that will cover you in the event that you need it.
  5. Avoid the tax penalty. Even if you are younger, you will still have to pay the tax penalty if you decide not to get health insurance. This penalty is $95 or 1% of income the first year (whichever is greater). Read more about the tax penalties here.

So, even though health insurance may not have always been at the “front of your plate”… as you can see, there are some important reasons for those in the 18-34 category to get covered.

If you have any questions, or need any help sorting it all out… contact us at Policy Advantage Insurance Services any time. We are Covered California Certified, and can help you with plans on (or off) the exchange. Take a look at all of your options, and find a plan that fits your individual needs.

Thanks for stopping by, we hope our information was valuable to you. 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

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