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Your Guide: Private Health Insurance Exchanges

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Today we’re going to look at “private health insurance exchanges.” This has been one of the biggest “buzz phrases” in the health insurance industry over the past couple of years for a number of different reasons. The biggest reason though, is healthcare reform. With the implementation of new provisions required in the Affordable Care Act, the way that employers offer health insurance to their employees is changing.

We’ll take a look at the structure of private health insurance exchanges. We’ll also describe the different components that make-up a private health insurance exchange, the types of businesses that should be taking the closest look at these exchanges, how private exchanges work, and why they’re growing in importance.

Private health insurance exchanges are exactly what they say they are: they’re exchanges that are set up privately through an employer. Many private health insurance exchanges utilize two important components:

  1. Technology and software: software programs help facilitate administration of private health insurance exchanges. Technology keeps private exchange administration simple for both the employer and the employee. One example is www.liazon.com. Liazon’s platform allows an employer to define a contribution (much like an allowance), and then employees select their own health benefits. Simply, it’s an employee’s money to spend how he/she wants. The software keeps track of funds spent, shows the employee what kind of health insurance options are available in the private exchange, and allows employees to select the plans they want.
  2. Group health insurance plans: in the past, many employers only offered one group health insurance plan. Administration of multiple plans could be a challenge. So to fix that problem, software companies (like Liazon) have arrangements with insurance companies that allow the employer to more easily offer multiple group health insurance plans, from multiple carriers. The important word here is multiple. With the software and technology that’s available, it’s not nearly as difficult to offer a selection of group health insurance plans anymore. This is important because one of the biggest goals of private health insurance exchanges is to provide choice. By utilizing a private exchange, employees now have choice.

There are additional ways to set up private health insurance exchanges, but businesses with +50 full time equivalent employees will almost always be utilizing the two concepts we’ve described above. And that’s who this article is intended for: businesses that are mandated to provide coverage. However, smaller businesses can also utilize this exact same strategy. If you’re a business that is at 20 employees or above, you’ll want to understand this concept.

Question: Why are private health insurance exchanges becoming more important?

Here’s why:

  • Private health insurance exchanges give employees choices. Instead of being “stuck” in one group health insurance plan, they can more efficiently choose which plans fit them best. Having choices is now more important than ever before, because dependents (spouses and children) need to have affordable access to coverage. In the past, sometimes it was flat-out too expensive for an employee to include their dependents. The private exchange concept helps alleviate that issue.
  • Businesses with +50 full time equivalent employees are mandated to provide coverage. A private exchange is a cost-effective and budgetable way for employers in the “large group” category to provide coverage. You decide on the amount (called a “defined contribution”), and then give that amount to each employee. They pick the plan they want. Simple.
  • Efficiency. If employees are making their own decisions and picking their own plans, the whole system becomes more efficient. Instead of you telling them what they get, they instead pick what they want. When consumers are making their own decisions, they’re more conscience about where money is being spent.

That’s the basic break-down of private health insurance exchanges. Unlike public health insurance exchanges (ie: state & federal exchanges), private exchanges are completely administered within the private workplace.

As mentioned, private exchanges can be an exceptionally important concept for those businesses in the +50 employee range. They accomplish three very important things: budgetability, selection, and flexibility. Those qualities will be very significant to businesses that are mandated to provide coverage. However, this same concept can work very well for smaller businesses too (in the 2-100 employee range).

We work with private health insurance exchanges at Policy Advantage Insurance Services. If you are an employer that fits into the “group-sizes” we’ve described, contact us anytime if you have questions.

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:

Home Page: https://policyadvantage.com

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

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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:

Home Page: https://policyadvantage.com

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

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

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Benefits Chalk Talk: 10 Essential Health Benefits

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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

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Insurance Alphabet: Letter F

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F is for:

“Full Time Equivalent Employee”

Full Time Equivalent Employees (FTE): are employees who do not work full-time (defined as 30 or more hours per week) in your business or organization, but do count towards the full-time equivalent employee count. In other words, YES… part-time employees do count towards your overall employee grand total.

“Full Time Equivalent Employees” is extremely important because it is the sole factor in healthcare reform that determines which employers are mandated to provide health insurance coverage, and which employers are not mandated to provide health insurance coverage. Starting on January 1st, 2015, employers with 50 or more “full time equivalent employees” must provide adequate health insurance coverage to their employees, or face a tax penalty.

For additional detailed information about Full Time Equivalent Employees, please read this blog post.

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

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Department of Labor: Insurance Exchange Notice to Employees

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Today’s blog post is about the insurance exchange notices that need to go out to employees of nearly all employer groups in the United States. The Department of Labor is calling this correspondence the “model notice.” It contains information about the upcoming health insurance marketplaces.

There are provisions in the healthcare reform bill that were designed to expand coverage and access beginning in 2014. Some of these provisions included the establishment of what are called state health insurance exchanges (or marketplaces). With these exchanges, premium tax-credits may assist qualified individuals or families in the payment of their health insurance premiums. As such, employers need to distribute notices to their employees about the coverage options available through the new marketplaces.

On January 1st, 2014 individuals and employees of small businesses will have access to a new individual private competitive health insurance market – the Health Insurance Marketplace. This marketplace will provide a “one stop shop” to find and compare private health insurance options. Open enrollment for the new health insurance exchanges begins on October 1st, 2013.

Section 1512 of the Affordable Care Act creates a new Fair Labor Standards Act (FLSA) section 18B requiring a notice to employees of coverage options available through the Marketplace. You can find copies of the approved “model notices” here:

  1. Department of Labor “model notice” for employers that are currently offering health insurance coverage.
  2. Department of Labor “model notice” for employers that are not currently offering health insurance coverage.

Which employers must provide notice?

The FLSA section 18B requirement to provide a notice to employees of coverage options applies to employers to which the FLSA applies. In general, the FLSA applies to employers that employ one or more employees who are engaged in, or produce goods for, interstate commerce. For most firms, a test of not less than $500,000 in annual dollar volume of business applies. The FLSA also specifically covers the following entities: hospitals; institutions primarily engaged in the care of the sick, the aged, mentally ill, or disabled who reside on the premises; schools for children who are mentally or physically disabled or gifted; preschools, elementary and secondary schools, and institutions of higher education; and federal, state and local government agencies.

Which employees do I provide notice to?

Employers must provide a notice of coverage options to each employee, regardless of plan enrollment status (if applicable) or of part-time or full-time status. Employers are not required to provide a separate notice to dependents or other individuals who are or may become eligible for coverage under the plan but who are not employees.

When does the notice need to go out to employees?

With respect to employees who are current employees before October 1, 2013, employers are required to provide the notice no later than October 1, 2013. The notice is required to be provided automatically, free of charge. Employers are required to provide the notice to each new employee at the time of hiring beginning October 1, 2013. For 2014, the Department of Labor will consider a notice to be provided at the time of hiring, if the notice is provided within 14 days of an employee’s start date.

Again, you can find copies of the approved “model notices” here. There are two of them. One is for employers that are currently offering health insurance coverage, and one is for employers that are not currently providing health insurance coverage:

  1. Department of Labor “model notice” for employers that are currently offering health insurance coverage.
  2. Department of Labor “model notice” for employers that are not currently offering health insurance coverage.

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

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Delayed: Employer Mandate (+50 FTE)

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Today’s blog post is about a change/delay in the healthcare reform law (Obamacare, ACA, the Affordable Care Act, or whatever you would like to call it). Last week, the White House announced that the “employer mandate” (ie: employers with 50 or more full time equivalent employees having to provide coverage) would be delayed until 2015.

The reason that this happened, is because many businesses had informed the Obama administration that they were greatly unprepared for this change to be implemented (citing administrative burdens, difficulties with technology, additional expenses, etc). As a result, the White House rolled-out a decision that the “employer mandate” would be delayed until 2015.

What does this mean?

  • Employers with +50 Full Time Equivalent Employees: You will not have to provide minimum essential coverage to employees by January 1st, 2014. This decision allows you to postpone your decision making (ie: pay or play) until January 1st, 2015 (one full year). If you are not currently providing health insurance coverage, you may have faced additional tax penalties. With this decision, you will have additional time to make your decisions about employee health benefits.
  • Employers with Less Than +50 Full Time Equivalent Employees: This recent determination has not changed your health benefits planning in any way. If you are currently providing health insurance to your employees, you can continue to do-so. If you are not currently providing health insurance to your employees, keep in mind that (as of now) the individual mandate is still in place, and your employees will need to find a way to find affordable health coverage (or face a tax penalty).

The Fallout:

  • Democrat/Liberal Interpretation: many employers with +50 FTE across the county are already currently offering health insurance coverage. Because the overwhelming majority of employers with 50 or more FTE are already offering health insurance, this is not much of a change, and will not affect the broad scope of healthcare reform overall. This is simply a means to allow those employers with 50 or more FTE to continue to make their necessary adjustments, with an extra year of time.
  • Republican/Conservative Interpretation: this is the beginning of many of the major “issues” for the healthcare reform bill (Obamacare). Many will argue that there is much potential for this bill to begin to “unravel,” and that the “train wreck” is yet to arrive. Additionally, be prepared to anticipate major changes as this bill is implemented (ie: will the individual mandate still hold up?).
  • Policy Advantage Insurance Services Interpretation: This decision gives employers with +50 FTE’s more time to make their decisions about whether-or-not to offer health insurance coverage. The healthcare reform bill was large and far-reaching legislation, and changes were anticipated. Be prepared for additional delays and changes along the way. There is no-doubt that this bill will continue to take shape as implementation moves forward. We will continue to stay up-to-date with changes… stay tuned, and keep informed.

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

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5 Reasons to “Give Yourself the Advantage”

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There are a lot of great reasons to put a health benefits broker to work for yourself or your company these days. As health insurance planning (and the health benefits industry in general) continues to grow more complex… having an informed, knowledgeable, and up-to-date adviser on your team can be a really big advantage.

Here are 5 great reasons to “give yourself the advantage” today:

  1. Healthcare Reform is Fast Approaching: The major portions of healthcare reform (ObamaCare, ACA, the Affordable Care Act, or whatever you want to call it) are quickly approaching. We can’t emphasize this enough. Although it will take years to implement (and there will no-doubt be changes), you’ll want to make sure that you have a good understanding about what is coming up in 2014 (and beyond). Whether you’re an individual or business, if you “miss the boat,” it could end up costing you a lot of money. Contact us with questions today. **Update 1/1/2014: Healthcare reform is here.
  2. Health Insurance and Health Benefits are Complex: As the health insurance and health benefits “system” continues to grow larger, navigating this landscape can become an increasingly burdensome chore for the typical consumer. We’ve got great news for you: we know this industry well, and can help you navigate it. There’s not a better feeling than having an informed friend on your side, helping you with the ins-and-outs. Just check our growing list of customer testimonials.
  3. Save Money and Improve Coverage: Yes, you heard that right. Individuals and business owners take note: with just a few simple adjustments to your current program, you may be able to improve your coverage, and save money at the same time. How’s that for a home run? Having someone in your corner (who knows the industry well) can help you accomplish this. Consider it a “tune-up” for your health insurance program, free of charge. Example: a minor adjustment with a tax incentive here, then a simple adjustment to a physician network there… and boom. You’ve got better coverage at a cheaper price. Granted, improvement doesn’t happen every single time, but in many cases, it’s possible. Contact us to help you look it over.
  4. Valuable, Up-to-Date, Relevant Information: This is one of our big areas of emphasis at Policy Advantage Insurance Services. We know this industry changes. Sometimes quickly. We stay up-to-date with the information that we provide using a number of different strategies. The two big ones: A) Professional Designations (ie: the RHU®/Registered Health Underwriter® and REBC®/Registered Employee Benefits Consultant are the undisputed professional credentials in our industry). B) Information from our partnerships and affiliations (ie: insurance companies, third party administrators, and educational institutions). Companies like Kaiser Permanente, Cigna, United Healthcare, and others are constantly providing us with fresh information that we get out to our client base and readers. We take great pride in providing you with up-to-date info.
    •  
  1. Insurance Company Choices and Options: With a broker, you don’t just choose from one insurance company, you get to choose from many. A broker is like an “insurance store.” This can be very important for a number of different reasons. Physician and hospital networks vary from insurance company to insurance company. Insurance premiums may also vary. The structure and the way that managed care organizations (or MCOs) operate  can also vary considerably. These are all good reasons why it’s a good idea to give yourself some choices when it comes to health insurance companies.

As you can see above, you can “give yourself the advantage” today. Our number one priority are our clients and customers, and helping you navigate the complex world of health insurance and health benefits.

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

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State Health Insurance Exchange: “Covered California”

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As you know, state health insurance exchanges were a large part of healthcare reform (PPACA). Each individual state was required by the law to set up these new exchanges, and have them ready for enrollment by October 1st, 2013. Some states have elected not to set up an exchange (deferring administration to the federal government). Other states have set up a joint state/federal partnership to operate their exchange.

California has continued along the path to setting up a state-only administered exchange (ie: no help from the federal government, except for funding). The state has taken a more aggressive approach to setting up their exchange, and further information is continuing to roll out. The California state health insurance exchange is called “Covered California.”

coveredcaliflogo

Covered California is anticipated to be the largest insurance exchange in the country. Here are some general questions and answers about the exchange:

Question: How can Covered California help me find affordable insurance?

Answer: Covered California is an online marketplace where you will able to shop for and compare health insurance coverages. If you can’t afford health insurance, and are unable to obtain it through employer, individual or other government programs, the exchange will be something you may want to look at.

Question: How can I participate in the Covered California exchange?

Answer: Eligible individuals will be able to enroll in the exchange plans online, over the phone, or in person.

Question: Can Policy Advantage Insurance Services help me enroll in the exchange?

Answer: Yes. Policy Advantage Insurance Services, and any other “exchange certified” agents/brokers can help you with your questions and enrollment in the Covered California exchange. The exchange has not rolled-out further information about “exchange certification” yet, but we (Policy Advantage Insurance Services) will be getting certified.

Question: How much will my premiums cost at Covered California? 

Answer: Depending on your income bracket (400% of FPL or less), you may received a subsidy from the exchange. Covered California has provided a premium estimation calculator here.

Question: Who will receive subsidies from the Covered California exchange?

Answer: California was one of the states that expanded Medicaid eligibility to 138% of FPL. So, individuals who make between 138% and 400% of the federal poverty level (FPL) should be eligible for subsidies. If you make less that 138% of FPL, you will be eligible for Medicaid in California.

Question: When can I enroll in the Covered California exchange?

Answer: Enrollment is set to begin on October 1st, 2013, and coverage begins on January 1st, 2014.

Question: What types of plans will be available in the Covered California exchange?

Answer: Plans inside of the exchange must contain the same benefits as those outside of the exchange (plans that are being offered within the exchange are private plans that are funded by the federal government). They are essentially identical to those that will be found outside of the exchange. Here are the levels of coverage:

  • Platinum (90% paid by health plan, 10% paid by plan member)
  • Gold (80% paid by health plan, 20% paid by plan member)
  • Silver (70% paid by health plan, 30% paid by plan member)
  • Bronze (60% paid by health plan, 40% paid by plan member)

That’s all for now about the Covered California state health insurance exchange. If you have questions, please feel free to contact us at anytime. As soon as further information is available, we’ll be getting “exchange certified” and helping our clients and potential clients enroll starting on October 1st, 2013. The Covered California website is: www.coveredca.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: 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

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Your Health Benefits Toolbox

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WrenchToday’s blog post is a general overview about all of the “tools” that are available to people to fund their healthcare. We’re also going to talk about the sources of these tools.

One of our biggest goals is to help you understand the programs that are available, and where the access and funding of these programs comes from.

Keeping it simple, there are three major sources that fund benefits programs:

  1. Your employer.
  2. Your contributions (You).
  3. The government.

Below are summaries of the programs that are available to people through the above listed benefits sources. Keep in mind that only healthcare, disability, and life benefits are discussed (retirement benefits are not included):

Government Programs:

  • OASDI (Social Security): Old Age, Survivors, and Disability Insurance. This is a government program that provides benefits for the elderly, survivors/dependents of deceased family members, and the disabled. 
  • Medicare: This is a government program that provides health benefits for the elderly.
  • Medicaid: This is a government program that provides health benefits for the poor.
  • State Disability Income: Five states have state disability programs (California, New York, New Jersey, Hawaii, Rhode Island). Puerto Rico also has a disability program. These programs help the citizens of these states with income protection in the event of disability.
  • State Health Insurance Exchanges (set to begin January 1st, 2014): The new “Health Insurance Marketplaces” of healthcare reform (ACA 2010) will provide a place where people with incomes between 100% and 400% of the Federal Poverty Level (FPL) may receive subsides to purchase individual health insurance policies.
  • Guaranteed Issue Mandate: A provision of ACA 2010 (healthcare reform) that will require insurance companies to accept all applicants who apply for health insurance.

Employer Programs: 

  • Group Health Insurance Plan: Some employers may offer their employees an opportunity to enroll in a group health insurance plan. The employer may pay all (or a portion) of premiums. 
  • Group Dental Insurance Plan: Some employers may offer a group dental plan that is similar in concept to a group health insurance plan.
  • Employer-Paid Vision, Supplemental Health Insurance, and Life: Employers may decide to add additional benefits that are paid for.
  • Health Reimbursement Arrangements (HRAs): These are arrangements that are set up by an employer to reimburse employees tax-free for “qualified medical expenses.”
  • Employer Self Funding: This is an arrangement where an employer pays for the medical expenses of their employees through the general revenue of the company. Typically there is a third party administrator and stop-loss coverage involved.

Individual Programs (programs you pay for individually):

  • Individual Health Insurance Plans: These are insurance plans that people participate in outside of an employer. Starting on January 1st, 2014 all applicants who apply for individual health insurance must be accepted.
  • Voluntary Benefits: These are benefits that are typically offered to the employees of a group at a “group rate” that is usually discounted. Employees typically pay for these benefits through payroll deduction, and premiums can also be paid for tax-free through section 125. Examples of voluntary benefits include supplemental health insurance, vision & dental plans, disability insurance, life insurance, etc.
  • Individual Life, Dental, Vision: There are many individual life insurance, dental, and vision programs available outside of group plans.
  • Health Savings Accounts (HSAs): Health Savings Accounts allow people to save money for medical expenses, and then pay for them tax free.
  • Union, Association, MEWA, etc: Individuals may have accessibility to benefits through these types of organizations. Benefits may be paid for out of pocket, and could be offered at a reduced rate.

The above listed gives you the general overview of the benefits that are available through the government, employers, and individual purchases. This does not include all benefits (as it is a general overview)… but it should give you a broad-based idea about the tools that are available, and where they come from.

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