Author Archives: Jeremy Smith

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.

Using the Calculators to Estimate Your Rates

The most important provisions of the Affordability Care Act (ACA) are in regard to coverage changes and consumer protections.  Many more sweeping changes will take effect January 1, 2014. It is imperative to be informed on the changes as they happen.  We at Jordan Financial can help keep you informed and assist you in navigating this ever-changing landscape of health care.

There are calculators designed to help you estimate how much it will cost you to purchase health insurance in 2014 and the amount of your financial assistance. If you already have affordable insurance from your employer or a government program like Medicare or Medi-Cal, you will not be eligible for these cost-saving programs and the calculator will not apply to you. This estimate will give you an idea of how much insurance will cost. Insurance rates for 2014 have not yet been finalized so keep in mind that, once you are ready to purchase a health plan, the actual cost will likely change from this estimate.

To use the calculator, simply enter several pieces of key information.

Enter household size and income for all individuals included on your tax return (yourself, your spouse and dependants, if applicable).

Enter age information only for those household members who need coverage.

The calculator will put all that information together and provide you with the estimated monthly cost for insurance, which appears in the calculator as “Your Estimated Monthly Silver Plan Premium” and takes into account any financial assistance you might receive from the government. The calculator will also indicate whether your income makes you eligible for Medi-Cal. You will also be able to upgrade to more comprehensive coverage with the other metal programs (see Metal Plans Post).

For information regarding your estimated savings call Jeremy at (310) 486-7625.

Metal level plans Available as of January 1

Beginning in 2014, all non-grandfathered Individual and Small Group health plans will be organized in four levels of coverage:

Bronze, Silver, Gold, and Platinum.

The levels are based on actuarial value calculations, and define the split between what the consumer pays and what the health plan pays. As the metal category increases in value, so does the percent of medical expenses that health plans cover.

Guaranteed availability and renewability

Health insurers must accept any individual or business group that applies for coverage.

Percentage of Expenses:

Paid by  health plan    Paid by individual

Platinum      90%                          10%

Gold             80%                          20%

Silver          70%                           30%

Bronze         60%                          40%

Participating Affordable Care Act Providers


Covered California has announced the plans that will be participating in California’s Individual Exchange, as well as rates for 2014 as of June 2013.  All information is subject to change as more providers are negotiated.

Anthem Blue Cross

Blue Shield of California

Alameda Alliance for Health

Chinese Community Health Plan

Contra Costa Health Services

Health Net

Kaiser Permanente

LA Care Health Plan

Molina Health Plan

Sharp Health Plan

Valley Health Plan

Ventura County Health Care Plan

Western Health Advantage

Rates have been submitted and are awaiting approval.

Let us discuss with you whether the Exchange is the most cost effective plan with the options and providers important to your specific needs.

Jeremy Smith

Jordan Financial

(310) 486-7625


How Obamacare May Affect Part-Time Employees

According to an article by Chad Terhune of the LA Times dated May 2, 20013 many part-time workers are facing a number of issues as a result of the initiation of the Affordable Care Act (ACA).   The law requires businesses with more than 50 workers to include insurance coverage for employees working 30 hours per week or more.  Rather than providing healthcare to more workers a number of employers are cutting part-time employee hours instead.  The result is that these workers will not only earn less money but will also not receive heath coverage.

Examples of this phenomenon include:

*The city of Long Beach is limiting most of its 1,600 part-time employees to less than 27 hours/wk on average.  City officials respond that without cutting payroll hours the new health benefits would cost up to $2 million more next year, which could result in layoffs and cutbacks in city services.

*Many large restaurant chains, retailers and movie theaters are cutting part-time employee’s hours.

*Even colleges are cutting courses for part-time professors.

*Last year, in a well-publicized test Darden Restaurants, which owns the Olive Garden and Red Lobster chains began shifting to more part-time workers.  Darden dropped the plan after substantial criticism.

According to research by UC Berkley, an estimated 2.3 million workers nationwide (240,000 in California) are at risk of losing hours as employers struggle to find ways to remain fiscally sound.  Employers cite these cutbacks as a necessity, given that the average annual premium for employee-only coverage last year in California was $6,540.  Family coverage topped $16,000 a year.  These premiums have shot up 170 % in the last decade.

Given these figures, many companies have considered simply dropping employee health coverage and paying the federal penalty of $2000 per worker, but most businesses have rejected that option due to the disruption with existing employees and in order to stay competitive in the market place for talented workers.

Some California lawmakers worry that the Federal penalty is not a sufficient deterrent and will not prevent major employers from restricting hours and placing more workers onto public programs.

One consolation for part-time workers is that they can benefit from the healthcare initiative’s federal premium subsidies or by the expansion of Medicaid (Medi-Cal) beginning in January 2014.

“For people losing a few hours each week, that’s lost income and it has a real impact,” said Ken Jacobs, chairman of the UC Berkeley Center for Labor research and Education.  “But many low-wage, part-time workers will also have some affordable options under the federal law.”

Whether you are an employer searching for answers to remain economically sound, while providing the best health benefits for your valued employees or a part-time worker in need of answers regarding eligibility for discounted premiums or government subsidies, Jordan Financial Services has the expertise to seek out and implement the perfect solution to all your insurance needs.



California Health Insurance Exchange Plan Approved

The State of California has received conditional approval to provide a health care exchange program to residents, according to an article in the LA Daily News, dated January 4, 2013.

According to the article, seven states have now received the “go-ahead” from the US Dept. of Health and Human Services. The goal is to provide a “direct-to-consumer” market and allow residents to compare insurance plans at competitive rates.

This program is slated to begin in October and is available to all residents who meet the criteria for federal citizenship requirements. Actual plan effective dates will begin in January, 2014.

The exchange program will be overseen by Covered California, a state board appointed by Gov. Jerry Brown and state legislators.

Consumers will be able to access this site or contact the exchange to determine whether or not they qualify for federal assistance to offset the costs of their premiums. Additionally, consumers can evaluate other public insurance programs, as well.

Families earning up to $92,000 a year, a government subsidy will be available to help pay for coverage costs.

“Nearly one in three people in L.A. is uninsured,” according to Howard Kahn, president of the LA Care Health Plan, the nation’s largest public health plan. “The exchange will help provide the health care that they so desperately need and deserve. This is a necessary step to cover working uninsured Californians,” said Kahn.

Those who qualify for federal tax subsidies to help pay a portion of their insurance costs include those with incomes between 133% and 400% of the federal poverty level and businesses with under 50 employees.

Please continue to visit this site for more information regarding the ever-changing and exciting developments of “Obamacare,” more formally known as the Affordable Care Act. You can also visit for additional information.


Jeremy Smith (dated, January 10, 2013)

Ca Ins. Lic. #0771110