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See for Yourself: Real People. Real Results.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

 

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Essentials: The “Need-to-Knows” About the NEW Individual Health Insurance Marketplace

NeedToKnowWith the on-set of healthcare reform, the landscape in the individual health insurance marketplace has changed dramatically. In this article, we’re going to describe what you need to know in order to navigate the new individual segment of the health insurance industry.

Before we head for the good stuff, let’s share with you a very short background on the differences between individual health insurance and group health insurance. Briefly: if you know anything about the health insurance industry at all, you’ll know that these are two completely different ballgames when it comes to plan design. There are different rules. There are different tax incentives. There are different eligibility criteria. The list goes on. That’s a whole different article.

As an individual or business owner, you’ll want to know the ins-and-outs of both the individual and group health insurance marketplaces, but let’s emphasize that we’re looking at the individual segment only here. For certain small business owners, that’ll be most important anyways.

Here are the “essentials” of the new individual health insurance marketplace. This is what you need to know:

Guaranteed Issue Mandate

This is probably the biggest “game-changer” of them all. For years-upon-years, if you were going to apply for an individual health insurance plan, you had to go through a series of health-related questions in order to apply for coverage. There were 50, 60, and sometimes 70 or more questions. If you’ve applied for individual health insurance coverage before 2014, you know what this all about.

Starting in 2014, these health-related questions are all gone. You heard that right: outta’ here. It’s still difficult for many to comprehend. There are no more health-related questions on individual health insurance applications anymore. This is what is called “guaranteed issue” in the insurance world (big insurance word). All “guaranteed issue” means, is that if you apply for coverage, you have got to be accepted.

Q: How does this change the ballgame? A: You don’t need to necessarily have access to a group health insurance plan (employer plan) anymore to apply for coverage. This is huge (especially for those with preexisting conditions).

It can’t be emphasized enough how much this has freed-up individual choice in health insurance plans. You can literally pick any individual insurance plan from any company, and apply for coverage now. And to boot: if you’re eligible for subsides at the new health insurance marketplaces (exchanges), you could see some massive subsidies that will help you pay for your premiums.

This all sounds fine and dandy, right? It is. But there are some important rules that need to be understood, and that leads us into our next important topics.

Open Enrollment Periods

In the past (before 2014), you could apply for an individual health insurance plan at anytime during the year. You could go out, you could pick a plan, you could apply for coverage… but you might be denied. Today (2014 and beyond)… there’s now an “individual plan open enrollment period.”

Q: What’s an open enrollment period? A: It’s a time-frame when you can apply for health insurance coverage. If you’ve ever worked for an employer that has a company health insurance plan, you’ll know that you’ve usually got to apply for coverage (and make changes) during yearly enrollment. This is that same exact concept in the new individual health insurance marketplace. Except it’s a BIG enrollment: it’s the entire United States.

So, that being said, you’ve now got to apply during individual insurance open enrollment each year. This can be very important, because if you miss this enrollment period, you don’t get an opportunity to apply until the next Fall. Need an appendectomy in the middle of the year? It’s too late.

The moral of the story: you want to make sure you know exactly when you can enroll in an individual health insurance plan: and that’s during open enrollment each year. That’s much different. It’s important to note that open enrollment dates are the same for individual health insurance plans both on and off the new exchanges.

Special Enrollment Period

Now that you know what open enrollment is all about, the next thing that needs to be looked at is what is called a “special enrollment period.” A “special enrollment” is a time to enroll in the middle of the year (outside of the regular open enrollment described above), under specific circumstances.

Q: What are these “special enrollment” circumstances? A: They’re described as “life events” that can take place throughout the middle of the year. If you incur one of these “life events,” you’ll then be eligible to enroll in an individual health insurance plan outside of the regular open enrollment period: called a special enrollment.

Here are some examples of these “life events”:

  • You get married.
  • You get divorced.
  • You have a child.
  • You lose your coverage (changing jobs, etc).
  • You move out of the state where you currently get your health insurance.
  • You become a legal citizen or national.
  • … plus others.

You’ll want to make sure that you understand these qualifying “life events” if you ever need to utilize the “special enrollment period.” Additionally important: most events give you 60 days to enroll in a new plan from the time the “life event” takes place. However, a few of these events only give you 30 days. Make sure you know which event applies to you, and how much time you have.

Now that we know all about guaranteed issue, open enrollment, and special open enrollment… we want to take a brief last look at a few of the basic important concepts of the new individual health insurance marketplace. They are:

  1. Shared Responsibility
  2. Minimum Essential Coverage
  3. Essential Health Benefits

Shared Responsibility

Shared responsibility” is a technical term that has been coined in the healthcare reform law. All it means is that everybody has got to be “in” in order to make these new reforms work: the federal government, state governments, employers, and individuals. The “shared responsibility” provision applies to all individuals of all ages, including children. Everybody has got to have a health insurance plan from somewhere.

Minimum Essential Coverage

Minimum essential coverage” is the type of coverage that you have got to have in place in order to satisfy the requirements of the Affordable Care Act (healthcare reform). In other words, there is a standard of coverage that has to be met in order to meet responsibilities required under the Act. If you don’t want to pay the tax penalties, you’ve got to have this “minimum essential coverage.” There are health plans that are called “limited benefit plans” that do not meet the criteria of “minimum essential coverage.” In an instance where you only have a “limited benefit plan” in place, you’d be paying premiums for this plan that doesn’t conform, and then would also end up having to pay the tax penalty.

Additionally, if you’re one of those people that saw your rates go up in your individual health insurance plan over the past year (or even saw it cancelled), this is one of the reasons why. They’ve “raised the bar” on the required benefits in health plans (for additional info, read about the “metallic levels of coverage“). For this reason, rates have gone up. If you’re a higher earner that is not receiving a subsidy at a health insurance exchange, this can be burdensome.

Essential Health Benefits

These are certain new benefits “essential health benefits” that are mandated in the new “minimum essential coverage” plans described above. There’s a series of them 10 of them. Count ‘em:

  1. Outpatient Care.
  2. Trips to the emergency room.
  3. Treatment for inpatient care in a hospital.
  4. Care before and after your baby is born.
  5. Mental health and substance abuse services.
  6. Prescription drug coverage.
  7. Services to help you recover if you’re injured or disabled: physical therapy, etc.
  8. Lab testing.
  9. Preventive services like counseling, vaccines, and screenings.
  10. Pediatric services which includes dental care.

Even though you may or may-not need some of these services, these benefits are now still required in all plans. This is another reason that individual insurance premiums have gotten more expensive, and in certain cases, cancelled altogether. If you’re not getting any help with subsidies at the exchange, this can again be a “problem area.”

That’s it. Those are the basics of the new individual insurance marketplace. These are all of the “need-to-knows” so that you can begin to navigate this segment of the health insurance industry.

Additionally, you can coordinate various strategies within the new individual marketplace, so that you can put together a health benefits program for your small business that is affordable, and that your employees will appreciate.

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

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

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

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

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

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

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

 

International, Travel, & Expat Health Insurance

When you’re living or travelling abroad health insurance is not usually the first thing on your mind, but it can be a very important. If you ever need medical services while you’re in another country, you may end up paying for these services out-of-pocket if you’re not insured. That’s where a global international, travel, and expat health insurance plan can come in handy.

Policy Advantage Insurance Services partners with some of the best companies in the industry like Cigna Global and Anthem GeoBlue. With these companies you will:

  • Attain peace-of-mind when insuring with some of the world’s biggest international insurers.
  • Have access to global networks of over 1 million quality hospitals, physicians, clinics, and health specialists.
  • Custom-tailor the plan that fits you or your family best.
  • Get top-quality 24/7 customer service while you’re abroad.

Q: What is international, travel, and expat health insurance?

A: It’s health insurance when you’re traveling, working, or living abroad. It’s designed to give you and your family peace-of-mind and access to high-quality healthcare wherever you are in the world.

Q: Why would I need international health insurance?

A: In most cases, if you’re a foreign national in another country, there is a pretty good chance that you and your family won’t have access to the national health program where you’re currently residing. Additionally, healthcare services vary widely across the globe, so the standard of care that you are accustomed to receiving at home may be significantly different than what you are used to.

Q: How does coverage work when it comes to international health insurance? 

A: International, travel, and expat health insurance plans are flexible to your needs. A plan can be designed to fit your coverage necessities and budget. Core benefits include things like: inpatient hospitalizations, surgeries, and other hospital or physician services. Additional benefit options can be added like: doctor visits, prescription drugs, and even cancer treatments.

Cigna Global and Anthem GeoBlue are two of the most reputable international, travel, and expat health insurers in today’s market. Both have global hospital/physician networks and strong customer reviews; these companies can add peace of mind to your stay abroad.

Policy Advantage Insurance Services partners with both companies. If you’re planning a trip overseas (long-term or short), or are going to be working/studying abroad, contact us today for a quote. Prices can vary based where you’ll be in the world, but we’ll be sure to help you find the plan that fits you best, at the best price.

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

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

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

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

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

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

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

Categories: General Benefits Info

COBRA: Enrollment Extension

May 31, 2014 1 comment

Recently, Covered California announced an enrollment extension for people that are on COBRA in California. If you’re currently enrolled in COBRA, you may already understand the costs associated with this type of coverage: it can be expensive. This enrollment extension could save you some BIG bucks.

We’re not going to explain COBRA in this post, we’re just going to explain how this recent enrollment extension works. If you’re currently on COBRA, you most likely already know what COBRA is all about.

Below the icon is some important info. If you’re on COBRA, you’ll want to know about all of this. *NOTE: Keeping it simple, if you’re currently on COBRA, talk to us so we can help you sort it out.

Here’s what you need to know:

  • This enrollment extension runs from May 15th, 2014 to July 15th, 2014.
  • If you’re currently on COBRA, you still have the opportunity to enroll in an individual or Covered California (exchange plan), as long as you do it between the above-listed dates.
  • This may save you some BIG MONEY, because COBRA extension coverage from your previous employer is expensive: you pay up to 102% of total premiums (your part + employer part + admin fees).
  • During this time, enrollment is open so you can switch from COBRA to an individual or Covered California exchange plan (either of which may be considerably less expensive than your current COBRA coverage).

If you’re currently on COBRA, here are two important questions you want to ask yourself:

  1. Am I eligible for subsidies on the Covered California exchange? If this is a “Yes” you may really want to look into switching over to an exchange plan from COBRA.
  2. If I’m not eligible for subsidies at Covered California, would switching to a regular individual plan save me money? Even if you’re not eligible for subsides on the exchange, the individual coverage you can find might be considerably more affordable than your current COBRA coverage. 

If you’re on COBRA currently, contact us so we can help evaluate your case. You could save some big money (thousands of dollars a year) by making a simple switch. Here is our CONTACT CARD. And you can call direct here: 424.442.0170.

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

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

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

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

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

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

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

#Advantage: Does healthcare reform make health plans cheaper? (4/24/2014)

We’ve recently created a blog segment called “#Advantage” where we’ll answer the questions that we get at Twitter. Our official Twitter hash-tag is #Advantage, and we’ll explain this in further detail in a future blog post. For now, you can find additional information at www.twitter.com/advantage (or @advantage).

Our 4/24/14 question was from “CA Medicare Assist” (@MedicareInCA) in Santa Rosa, California. The question was this:

Does healthcare reform make health plans cheaper? (see the official Tweet here

“CA Medicare Assist” (@MedicareInCa) mentions that this is the #1 question they’re asked. And… it’s a good one. Check out the answer below the tag.

hash

The answer is: In certain cases, yes it does. Healthcare reform can make health plans “cheaper” for certain policyholders. However, there are some additional important details that should be considered. Here are the questions that are raised:

  • How are these health plans made cheaper? Plans are made cheaper via “Advanced Premium Tax Credits” at public health insurance exchanges like Covered California. APTCs are commonly known as the “subsidies” that you hear so much about. These subsidies are applied to individual health insurance premiums to make them more affordable.
  • Who are these health plans made cheaper for? Health plans are made cheaper for individuals and families that fall between approximately 100% and 400% of FPL (or Federal Poverty Level). For individuals, this is about $11,000 to $45,000 per year in gross income.
  • Are health plans made cheaper for everyone? Nope. In fact, for many of those who fall outside of 100% to 400% of FPL (or individuals making more than about $45,000 per year), health plans can actually get more expensive in a lot of cases.
  • How are the subsidies that make these plans “cheaper” funded? These new subsidies are funded from a variety of different sources, mostly in the form of taxes. Here are a few of them: A) increasing the Medicare tax on high-income households, B) taxing high-cost medical plans, C) penalties for those who don’t get coverage, D) employers paying if they don’t provide coverage, E) new fees on the health industry, and certain others.

Thanks for stopping by at our “#Advantage” blog segment dedicated to questions from our followers and others. We hope you found our information to be valuable.

We’ll continue to roll-out answers as questions come in. Don’t forget to hash “#Advantage” at Twitter, and visit our official tag here: www.twitter.com/advantage.

Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

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

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

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

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

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

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

 

The Policy Advantage Insurance Services Lion: He’s Got a Name

Sometimes instead of talking about insurance and employee benefits, we’ll share some news about what’s going on at PolicyAdvantage.com (ie: some “insider” info about our brokerage). We like to keep you up-to-date about what’s going on within the business too.

If you’ve been following along at Twitter (@policyadvantage) you’ll know there have been some recent tweets about our lion having a name. It’s TRUE: we’ve found a really good name for him. It fits our theme well. In fact, he’s even got his own .co that we’ll be developing, where you can visit.

So yes… there’s been some buzz. But we have not yet shared his name. There are a couple of reasons for this:

  1. We’re still in the very early stages of his development (logos, website, his three dimensional design, etc). So he’s not even really a cub yet.
  2. We’re still determining exactly what his role will be. We’ve got a really good idea, but we’re still “fine tuning” things.

You’ll find some further information about this undercover project below.

His biggest goals will be to:

  1. Create a fun & interactive consumer engagement environment.
  2. Share important information about the insurance industry.
  3. Promote Policy Advantage Insurance Services to the public as our front-line icon.

Symbolism of the Lion (and White Lion)

He does represent specific qualities. These qualities are important as an insurance brokerage and every day. Many of these qualities were a big part of the basis behind our original image and logo design:

  • Symbolism of the Lion: courage, wisdom, honor, leadership, loyalty, pride, generosity, intuition, confidence, royalty, dignity, strength, assertiveness.
  • Often referred to as the “King of Kings,” white lions are especially rare, and are considered to be divine by many cultures.

Additionally, here are a couple of foundations that he already contributes to:

Question: When will his name be released?

Answer: We’re not sure yet. It could be next week, next month, by the end of 2015, or who knows. Keep checking back. We do know this: our clients will be the first to hear about it.

Thanks for stopping by, we’re glad that you’re here. Please check back for future updates. Here are a few of our other information outlets:

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

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

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

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

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

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

Categories: PAIS Information

Covered California: Special Enrollment Period

April 21, 2014 1 comment

Thanks for stopping by today, we’re glad that you’re here. In this blog post we’ll be talking about Covered California’s “Special Enrollment Period.” To keep it simple, this is a period of time when people will be able to enroll in an individual or family health insurance plan outside of open enrollment if certain “life-changing events” are experienced.

Let’s review before we move on: open enrollment for the new Covered California insurance exchange recently finished up. If you’ve been following along, you’ll know that there are now open enrollment periods for individual and family plans both on and off of the new public exchange. In other words, in order to participate in an individual health insurance plan, you’ll now have to enroll during specific times each year. This is called open enrollment.

However, if you experience a qualifying “life-changing event” you may be eligible for a “Special Enrollment Period” in the middle of the year. In other words, yes: you may be able to enroll outside of open enrollment.

Here are some common examples of those qualifying “life-changing events” we described above:

  • Marriage or domestic partnership.
  • Childbirth, adoption, or placing a child up for adoption or in a foster home.
  • Changing your place of permanent residence, therefore gaining access to Covered California plans (this includes moving from another state).
  • Losing your health insurance (ie: losing or changing jobs, losing MediCAL coverage, or COBRA coverage expiration).
  • Changes in income. If you have an income change in the middle of the year, you may be eligible for more (or less) of a subsidy if you’re currently receiving assistance.
  • Becoming a citizen, national, or someone who is residing here legally. This event would only apply to those who were not previously a citizen, national, or legally residing here.
  • An “exceptional circumstance.” Covered California will determine on a case-by-case basis whether-or-not someone may be eligible to enroll via an “exceptional circumstance.”
  • American Indians or Alaska Natives. You are be eligible to change your plan (or enroll in a new plan) up to once per month even if open enrollment is over.
  • Your enrollment was wrong due to the misconduct or misrepresentation of your health insurance company, Covered California, or a Covered California entity (ie: a Certified Enrollment Counselor).

The above listed are examples of common “life-changing events” that might make someone eligible for a “Special Enrollment Period” outside of open enrollment.

Question: How long do I have to enroll if I experience one of these “life-changing events?”

Answer: You have 30 to 60 days (depending on the event). For example, if you lose your job-based coverage, you have 30 days. However, many of the other events give you 60 days. Make sure you know which event occurred, and how much time you have to enroll. 

If you think you’ve experienced a “life-changing event” and are eligible for the “Special Enrollment Period,” please contact us anytime. As a “Certified Insurance Agent,” Policy Advantage Insurance Services is able to help you find plans both on and off of the Covered California exchange (please note: the “Special Enrollment Period” rules do also apply to plans off of 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: http://www.policyadvantage.com

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

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

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

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

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