Monthly Archives: July 2013

New Affordable Care Act Sparks Scam Worry

The need to work with a reputable insurance agent or broker was spotlighted in an article in the LA Times (July 21, 2013.) According to Anna Gorman of the Times, the National Health Reform Law has the potential for scams leading to identity theft and fraud. The National Health Reform Law (Obamacare) will make more than 2.6 million people eligible for subsidized coverage and an additional 1.4 million low-income residents eligible for expanded Medi-Cal programs in California. The Federal Trade Commission said dozens of consumers have reported fraud since the law has taken effect. One scam involves a caller promising to send a healthcare card if the person reveals personal and financial information. False enrollment websites have sprung up and even one company promising huge savings for consumers and then swindling them with fake insurance.
The other major issue of concern is the 20,000 plus counselors that will be hired to process information through the health exchange. Although training, background and fingerprint checks and secret shoppers have been instituted to ensure compliance, fraud is inevitable.
The California Department of Insurance has warned that there is still not enough protection for consumers. “If someone is just careless with a consumer’s identity, that could cause all kinds of problems,” said Nancy Kincaid, spokeswoman for the insurance department. Insurance agents and brokers undergo a much more rigorous vetting process than will be required of the new staff counselors.
Working with a licensed agent or broker for all your insurance needs is still the best protection that your best interests, as well as your privacy are of utmost importance. For more information call Jeremy at Jordan Financial Network Insurance Services, your licensed broker – (310) 486-7625

Grandfathered Plans Part II – Health Net

What types of changes can a plan make without losing grandfathered status?
Health Net Clients be advised of these changes in regard to employer Health Plans. Contact Jeremy for information about other carrier plan changes.

Grandfathered health plans (policies in effect prior to March 23, 2010) will be able to make routine changes to their policies and maintain their status. These changes include making cost adjustments to keep pace with medical inflation, adding new benefits, making modest adjustments to existing benefits, voluntarily adopting new consumer protections under the new law, or making changes to comply with state or other federal laws.

Grandfathered plans:

• Cannot significantly cut or reduce benefits.
• Cannot raise coinsurance charges.
• Cannot significantly raise copayment charges.
• Cannot significantly raise deductibles.
• Cannot significantly lower employer contributions.
• Cannot add or tighten an annual limit on what the insurer pays
• Cannot restructure the company
• Cannot move employees to a plan with lesser benefits.

Among the changes that will not result in the loss of grandfathered status are the following:
• Changes in premiums
• Addition of family members of an individual who is enrolled in a grandfathered plan
• Addition of new employees (whether newly hired or newly enrolled) in a grandfathered plan
• Disenrollment of one or more individuals enrolled on March 23, 2010, (provided that the plan or coverage has continuously covered at least one person since March 23, 2010)
• Changes required to conform to federal and state laws and regulations
• Voluntary adoption of consumer protections as articulated in the new reform laws or increases in benefits
• Changes in a third-party administrator (TPA)

More From Health Net – Essential Health Benefits

As of January 2014 all plans must cover essential benefits. Open enrollment begins in October. Be prepared with the information relevant to you with Jordan Financial.

2014 Essential Health Benefits
All health plans offered in the individual and small group markets must provide a comprehensive package of items and services that are called Essential Health Benefits, which fit in 10 categories:
• Ambulatory patient services
• Emergency Services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services, and chronic disease management
• Pediatric services, including dental and vision care

The benefits generally will be based on those provided now in the small group market with some variation from state to state.
Wellness programs Permits employers to offer employees rewards of up to 30%, potentially increasing to 50%, of the cost of coverage for participating in a wellness program and meeting certain health-related standards.
If certain conditions are met, health plans may provide a discount or rebate when an individual satisfies a standard related to a health factor.

Affordable Care Protection In Place Today – Health Net

The Protections in place today according to Health Net include change that:

*Prohibits individual and group health plans from placing lifetime dollar limits on coverage.
*Restricts annual dollar limits on coverage for Essential Health Benefits.

Non-grandfathered plans must cover, without cost-sharing, a variety of preventive services as determined by organizations such as the U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention.

Group and individual market health plans providing coverage for dependent children must continue to make coverage available for an adult child until the child turns 26 years of age.

Plans are prohibited from excluding from coverage children with pre-existing conditions who are under 19 years of age.

Plans covering emergency services must meet standards such as not requiring prior authorization, covering services from nonparticipating providers and not allowing out-of-network cost-sharing to exceed in-network rates.

Insurers and group health plans may not rescind an enrollee’s coverage unless the individual has performed an act that constitutes fraud against the plan or has intentionally misrepresented a material fact to the plan.
More On Grandfathered plans to come.

Patient Protection and Affordability Care Act (ACA) 2014 – Health Net

Health Net recently released a number of changes in coverage effective as of January 2014 as the result of the Affordability Care Act.  Here are some of the changes that may affect you.

Guaranteed availability of insurance.

Requires guarantee issue and renewability of health insurance for individuals and business groups.  Prohibits annual dollar limits on coverage for Essential Health Benefits.

Allows rating variation in the individual and small group market and Health

Insurance Exchanges based only on:

•  Age – limited to a 3:1 ratio. This means that the rate for a 64-year-old can’t be more than three times (i.e., 300 percent) the rate for a 21-year-old.

•  Geographic area.

•  Family composition – with member-level rating applied. Instead of composite rating, each family member will be rated individually. Carriers can charge only for the three oldest children in the family who are under 21. For example, in a family of six, the rate would be the subscriber rate + spouse rate + the 0–21 rate x 3.

•  tobacco use (limited to 1.5:1 ratio).

Note: Health Net will not be factoring tobacco use into our rates.

Group health plans and health insurers may not apply a waiting period that exceeds 90 days. California law limits the waiting period to 60 days.

The annual cost-sharing incurred must not exceed the maximum out-of-pocket amounts of $6,350 / $12,700 for self-only and family coverage.

The annual deductible for small group plans may generally not exceed $2,000 for self-only coverage or $4,000 for family coverage (certain exceptions apply).

Plans may not impose any pre-existing condition exclusions.

Call Jeremy with questions – (310) 486-7625

Open Enrollment Dates – Affordable Care Act Exchange

The open enrollment periods for the Affordable Care Act Exchange have been announced.

HCR  Annual  Open Enrollment period, AOE

October 1st  2013       till       March 31 2014

October 15th  2014       till       December 7th 2014

October 15th  2015       till       December 7th 2015

October 15th  2016       till       December 7th 2016

Contact Jeremy to ensure that You are prepared for the enrollment dates. (310) 486-7625

Area Plan announced for Affordable Care Act

At a recent seminar regarding the Affordable Care Act hosted by Anthem Blue Cross, the following plans were announced as participating in the exchange.  All information is open to change as more negotiations are underway.

As of June, the plans selected, in alphabetical order, are:

1. Alameda Alliance for Health   HMO     Hospitals: 12    Physicians: 3,100

2. Anthem Blue Cross of California   *EPO  HMO   Hospitals: 300    Physicians: 30,000

3. Blue Shield of California   PPO       Hospitals: 223    Physicians: 22,048

4. Chinese Community Health Plan  HMO  Hospitals: 9        Physicians: 315

5. Contra Costa Health Plan  HMO        Hospitals: 10      Physicians: 5,000

6. Health Net  PPO  HMO       Hospitals: 204    Physicians: 44,000

7. Kaiser Permanente  PPO        Hospitals: 35      Physicians: 14,219

8. L.A. Care Health Plan  HMO         Hospitals: 35      Physicians: 1,005

9. Molina Healthcare  HMO         Hospitals: 29      Physicians: 4,568

10. Sharp Health Plan  HMO  SAN DIEGO ONLY  Hospitals: 7 Physicians: 2,600

11. Valley Health Plan  HMO  SANTA CLARA ONLY    Hospitals: 4        Physicians: 993

12. Ventura County Health Care Plan HMO  VENTURA    Hospitals: 6        Physicians: 176

13. Western Health   HMO  8 NORTH COUNTIES   Hospitals: 1  Physicians: 3,000

*An EPO is a plan wherein you may choose your providers as long as they are in that network.

Contact Jeremy at (310) 486-7625 for more information on the plan that works the best for you.