Monthly Archives: October 2013

What to look out for!

Some employers may want a simple list of what major items to look out for when looking for new plans or coverage-

Here’s what (non-grandfathered) large group insured plans (more than 50 employees) should be looking for:-

    Eligibility waiting period maximum of 90 days
    Pre-ex not permitted on anyone
    Annual dollar limits prohibited on essential health benefits
    Protections for those in clinical trials
    Out of pocket may not exceed $6,350/$12,700
    Guarantee issue and renewal apply
    Revised wellness program rules

If you have a (non-grandfathered) small group (50 or fewer employees) insured plan, keep a watch on the following requirements that apply BOTH inside and outside the SHOP exchange:

    Modified community rating applies
    Essential health benefits (EHBs) must be offered
    Deductible generally may not exceed $2,000/$4,000
    Out of pocket may not exceed $6,350/$12,700
    Must meet metal levels (60%, 70%, 80%, 90%)
    Guarantee issue and renewal apply (subject to participation)
    Single risk pool
    Revised wellness program rules
    Eligibility waiting period maximum of 90 days
    Pre-ex not permitted on anyone
    Annual dollar limits prohibited on essential health benefits
    Protections for those in clinical trials

If you are a small OR large self-funded plan, watch out for the following:-

    Eligibility waiting period maximum of 90 days
    Pre-ex not permitted on anyone
    Annual dollar limits prohibited on essential health benefits
    Protections for those in clinical trials
    Out of pocket may not exceed $6,350/$12,700
    Revised wellness program rules
    Transitional reinsurance fee, including reporting

PPACA to date!

Ever since the new marketplaces/exchanges opened for the new PPACA health insurance plans that begin 1st Jan 2014, we have been deluged with business.

It’s as if suddenly everyone realised that PPACA was here to stay and maybe they should do something about it!
Both group and individual- business has been phenomenal!

The most surprising part has been the number of prospects who have told us how their own insurance agent/brokers have let them down so badly! Agents just walking away and leaving the clients to fend for themselves. Typical was the prospect who told us that their agent told them that they were NOT going to deal with the PPACA Plans and the clients would have to deal with them themselves!!

However, most of the business is not even PPACA business as they want to get their quotes and enrollment done now BEFORE 1/1/14 when PPACA comes into play.

Sometimes, their problems are quite complicated but nothing specifically yet we cannot sort out and produce a satisfactory result of health insurance coverage for the owners and their employees. Very few problems are intractable and a clear understanding of the problem(s) can lead to the correct solutions.There has been so much misinformation supplied that many people are very confused about the whole process.

The marketplaces/exchanges,when one can get through, are a not easy to navigate or user friendly – both Individual/family and SHOP. BUT try and get through first.

Worse, when we put in our Identity Number and NPN number as agents or the client puts it in themselves when they try and apply, the marketplace never recognises them- what is going on? Plus it is reported that the telephone call line (presumably Navigators) is telling applicants that they cannot use agents/brokers ID numbers and NPN numbers when applying by phone!!

Our ID- EWALTERS37 and NPN number- 8594684

Eric

Cell: 602-616-1660/ Office: 480-657-8595/Fax: 888-739-0796

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SHOP marketplace-enrollment delayed

In most states, small businesses planning to purchase group coverage through the Small Business Health Options (SHOP) marketplaces will have to wait until November 1 to enroll online. SHOP marketplaces were planned to open for enrollment on October 1. It was announced that the federally-run SHOP marketplace is delaying online enrollment until November 1.

Eric’s insurance web site

Marketplaces are open- but who knows anything about PPACA?

Very busy these last few days as many groups and individuals want to know about the new marketplaces and what
all the fuss is about!

I always believed that PPACA would be good for brokers and agents and nothing to be scared of!

Our only problem is the time its taking to take each client to the web sites, create accounts and then get the tax info and plan info together!! There has to be a better way.

Eric
Cell: 602-616-1660

Eric’s Insurance web site