Category Archives: Health

5 Reasons a Group Health Policy is better

Is a Group Health Insurance policy a better choice for your employees than having them enroll in the Health Insurance Exchange on their own.  Most likely, yes.

5 Reasons a Group Health Insurance policy is better than Individual.

  1. Physician and Hospital networks … Most group health plans provide the “old” networks before the ACA started.  These networks are typically much greater in size and scope than their counterpart, the “Individual / Family” plan.  The difference can be drastic depending on your area in which you live.
  2. Formulary List … A formulary list is a list of the acceptable prescriptions which the company offers.  Or the “Tier” level which the company offers per prescription.  Group plans will usually have a larger formulary list and the prescriptions may be place on a more favorable tier level, meaning the cost of some prescriptions may be lower.
  3. Retaining Talent … As an employer this really does work!  Talented employees have options. Health Insurance / Health Care is expensive, and if it’s between two jobs, one offers health insurance and the other doesn’t, all things being equal, well you know the answer.
  4. Portfolio … The group plan portfolio has many more plan options for the employer/employee to choose from, instead of the one or two Bronze, Silver or Gold plans that come with “Individual plans.”
  5. Out-of-Network benefits … The Out of Network access to doctors along with (OON) coverage will be much stronger with “group plans.”  Today many companies are offering EPO’s instead of PPO’s with their Individual plan, with limits the access to doctors if they are out of the network.  Most Group plans offer traditional PPO (Preferred Provider Network) networks which allows you to see outside doctors and hospitals without any penalty.  Also, Out of network coverage is available when seeking a specialist or outside medical facility.  The new ACA PPO Plans can at times be very tricky when seeking and outside care.

Beginning January 1, 2016 companies with 50 or more full-time employees must provide Group Health insurance to 95% of full-time employees and dependents to age 26.

The employer mandate and employer penalties … Employers subject to the employer mandate are required to offer coverage that provides “minimum value” and is “affordable” to be subject to penalties.

How is “affordable” coverage determined? … A Coverage is considered “affordable” if employee contributions for employee only coverage do not exceed 9.5% of an employee’s household income.  there are three safe harbor methods for determining affordability: 9.5% of an employees W-2 wages (reduced for any salary reductions under a 401 (k) plan or cafeteria plan). 9.5% of an employee’s monthly wages (hour rate x 130 hours per month).  9.5% of the Federal Poverty level for a single individual in applying wellness incentives to the employee contributions used to determine affordability, assume that each employee earns all wellness incentives related to tobacco use but no other wellness incentives.

How will the Federal government know if an employer is complying with the employer mandate?  IRS Code 6056 requires all applicable large employers to file an annual report that ensures compliance with the employer mandate.  The reporting will include information on all employees who were offered and accepted coverage, and the cost of the coverage on a month-by-month basis.

When deciding on a new group plan or to continue with your current group policy, please consider the five points above.

Call anytime with questions.

John Conner
916-682-1117
john@johnconner.com

Group Health Employer Mandate (50 plus employees)

aca logo January 1, 2016 ObamaCare’s “employer mandate” is a requirement that all businesses with 50 or more full-time equivalent employees (FTA) provide health insurance to at least 95% of their full-time employees and dependents up to age 26, or pay a fee.

Is your company part of the “Employer Mandate” … To be subject to the Employer Shared Responsibility provisions for a calendar year, an employer must have employed during the previous calendar year at least 50 full-time employees or a combination of full-time and part-time employees that equals at least 50.  For example, an employer that employs 40 full-time employees (that is, employees employed 30 or more hours per week on average) and 20 employees employed 15 hours per week on average has the equivalent of 50 full-time employees, and would be an applicable large employer.

What’s the fine … If an employer owes the fee because they didn’t cover workers, it’s a flat $2,000 per full-time employee, excluding the first 30 employees.  If only a few end up with unaffordable coverage or if that coverage doesn’t meet minimum value standards, it’s $3,000 per full-time employee who received premium assistance through an exchange.  The fee is always per month, so it’s always 1/12 of those annual totals for each month.

Are all full-time employees counted, even if they are eligible for Medicare or covered under their spouses group health plan … Yes.

Are Companies with employees working outside the U.S. subject to the Employer Shared Responsibility provisions?  For purposes of determining whether an employer is an applicable large employer, an employer generally takes into account only work performed in the United States.  For example, if an employer has employees who are permanently living and working outside the U.S., they would not be counted towards the Employer Shared Responsibility.

Advice for Employees with Unaffordable Options .. If employer-sponsored coverage is unaffordable (costs more than 9.5% of employee-only income) or doesn’t provide minimum value, you may be eligible for marketplace subsides. If employer-sponsored health insurance (for self-only coverage for you or a family member) costs more than 8% of your household Modified Adjusted Gross Income, you may be exempt from the fee as well. You are not required to take the coverage that your employer offers.

  • The employer mandate is based on full-time equivalent employees, not just full-time employees.
  • Employers have to offer coverage to 95% of their full-time employees.
  • Coverage must be offered to dependents up to age 26.
  • Spouses do not count as dependents; coverage does not have to be offered to spouses.
  • Coverage to employees must be considered affordable and can’t cost more than 9.5% of employee household income.
  • Employers who don’t provide coverage the fee is; $2,000 per full-time employee or $3,000 per full-time employee who is receiving a subsidy through an exchange.
  • Employers must offer at least a 30 day “Special Enrollment Period” for employees or qualifying employee family members losing coverage from another source.

The employer mandate is starting for all employers with more than 50 full-time employees on January 1, 2016.  Employers that employ fewer than 50 full-time employees (including full-time equivalents) in their businesses are not subject to the Employer Shared Responsibility provisions. The vast majority of businesses fall below this threshold.

What the Employer Reports to the IRS … All large group employers (ALE – Applicable Large Employer) must file a “Form 1095-C. Employer Provided Health Insurance Offer and Coverage, and Form 1094-C, the transmittal form. The ALE must also furnish a similar statement to each of its full-time employees.

Be sure you have all the appropriate info before January 1.  Some groups may be able to keep their current plan for the 2016 plan year.  If you have questions or would like more information, please contact me anytime.

John Conner
916-682-1117
john@johnconner.com

 

Health Insurance

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Individual & Family Health insurance …

Everyone in the U.S. is eligible for an individual and family health insurance policy of their choice regardless of health status.

If your income falls between certain guidelines you will qualify for a subsidy, below are the income ranges to qualify for a premium subsidy.

ACA subsidy levels 2015

Enroll Today … Choose one of the companies; Anthem and Blue Shield.  Find the plan of your choice and simply enroll online.  It as simple as that!  Your new ID and policy will be mailed within a couple weeks and you can start using your policy right away.

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Group Health ..

Is your company ready for the Employer Mandate which starts January 1, 2016?  Click Here.

No matter what size business, we offer a full range of health insurance options for small group employers that provide affordability for you and flexibility for your employees.  Learn about our coverage options, we’ll match your business needs with high quality plans that are comprehensive and budget minded.

Aetna   –   Anthem   –   Blue Shield   –   Health Net   –   Kaiser

 

Ready for simple and affordable?

Sit back and relax .. and let our solutions work for you.  As part of the largest health benefits company in the country, we have the experience, strength and stability to create and stand by solutions that work for you and your employees.  We’re proud to work with you now and as your business grows, helping you keep it simple and affordable every step of the way.  In times like this, isn’t it good to know we are working hard to help your company and your employees save money on health care costs.

  • Is Group Health a better choice than Individual Health?  Click Here

Your employees will also appreciate the personalized programs that help manage and coordinate care for more than 40 chronic conditions. 360° Health can help your employees at all stages of their lives, and wherever they are along the health spectrum.

Call for a custom group health quote today … 916-682-1117

Free Service … Our advice and services are free of charge, and the premium you pay should you buy a policy through us will never be higher than going direct to the insurer.

Questions?

John Conner
916-682-1117
john@johnconner.com

2015 Covered California Health Insurance Plans

New 2015 Individual & Family Health Insurance Plans (Affordable Care Act – ObamaCare) health plans and rates for Individuals, families and children.  Health Insurance is now offered on a guaranteed-issue basis, meaning you can enroll in any company health insurance plan regardless of your current or previous health status.

Subsidy? … Depending on your household income, When you enroll in a new health insurance plan for yourself or family you may be eligible for a subsidy (discount) which may drastically decrease the monthly premium.  Subsidy eligibility depends on “household income.”  You can see the income chart below.

Open-Enrollment … Every year you will enjoy an “Open-Enrollment” period typically from October 1 through December 15, which allows you to view the health insurance plans and premiums in your area and any changes which may occur for the following year.  This is the time you will make any changes with your current company or enroll in a new plan/company.  for the following year.  Changes can only be made during the open-enrollment period unless there is a “qualifying event” which may allow you to change plans outside the annual open enrollment period.

ACA subsidy levels 2015

4 Levels of Coverage … With all companies you will find 4 levels of coverage.  The plans are categorized into four “metal levels” of coverage based on the percentage of coverage the company’s pay.

  • Platinum:  You pay 10% of health costs, plan covers 90%
  • Gold:  You pay 20% of health costs, plan covers 80%
  • Silver:  You pay 30% of health costs, plan covers 70%
  • Bronze:  You pay 40% of health costs, plan covers 60%

All plans will  offer the “essential health benefits” such as: doctor visits, hospital care, prescription coverage and maternity care, and will include certain preventive care for no charge.

Enroll Online with the company and plan of your choice … Remember, enrollment in a health insurance company is guaranteed, regardless of one’s health history or current health status.  The enrollment process is quick and easy with much less personal information then when insurance companies would medically underwrite.

Do I have to enroll during Open Enrollment?  If you choose not to enroll in an “Affordable Care Act” plan in 2015, you will be fined and the penalty will be the greater of 1% of your taxable income or $95 per adult and $47.50 per child (up to $285 per family).

You can choose to buy insurance from an insurer from your state of residence.  You must keep your plan for the entire year unless you start on an employer health plan or move to an area where your plan is not available.  Also if your income drops to where you are eligible for Medicaid.  Otherwise you must keep your plan or face the fine.

Health Care … Almost everyone gets sick or hurt, or needs some sort of medical help.  To get better you usually need care, like seeing a doctor or staying in a hospital or taking prescription medications.  Health Care includes many different services such as: doctors office visits, hospital stays, emergency room visits, lab and X-ray, prescription drugs, preventive care, well baby visits, well woman visits, immunizations and screenings.

Anthem   –   Blue Shield

Questions?

John Conner
800-700-1246
john@johnconner.com

2015 Anthem Blue Cross Individual Health Insurance

2015 Anthem Blue Cross Individual & Family health plans and rates for Individuals and Families.  Individuals, families and children are now offered health insurance plans on a guaranteed-issue basis, regardless of your current or past health status.

2 Ways to Enroll …

Enroll “On or Off” the Covered California Exchange .. Enrolling Inside the Covered California Exchange is typically for the individual or family who qualify for a subsidy due to their income (see the chart below).  Individuals and families who do not qualify for a state subsidy, will usually enroll outside of Covered California (the plans are the same) although the application process is much quicker because you don’t have to state your income totals.

Anthem of California will offer 4 levels of coverage both inside Covered California and out.  The plans are categorized into four metal levels of coverage based on the percentage of costs covered for an average population:

ACA subsidy levels 2015

  • Platinum:  You pay 10% of health costs, Anthem plan covers 90%
  • Gold:  You pay 20% of health costs, Anthem plan covers 80%
  • Silver:  You pay 30% of health costs, Anthem plan covers 70%
  • Bronze:  you pay 40% of health costs, Anthem plan covers 60%

All plans will offer the “essential health benefits” such as; doctor visits, hospital care, prescription coverage and maternity care, and will include certain preventive care for no charge.

What is a Health Insurance Marketplace?  It’s a website that is set up to allow the government to regulate health insurance plans.  People can buy health insurance from the marketplace (Covered California) with government aid called subsidies.  All Health Insurance Marketplaces like Covered California must be fully certified and running by January 1, 2015, by federal law.  Also known as an “Exchange.”

Do I have to buy from the Health Insurance Marketplace Covered California Exchange?  You can choose to buy insurance from an insurer like Anthem from the state Insurance Marketplace (Covered California).  If you are eligible to get a subsidy and want to use one, you must buy your plan from a Health Insurance Marketplace like Covered California.

What are my Health Care Reform plan choices in 2015?  Under the new health care law, all new plans fit in one of four levels: bronze, silver, gold or platinum.  These levels make it easier to compare costs and benefits so you can choose the right plan for your needs.

Anthem   –   Blue Shield 

Questions?

John Conner
John@JohnConner.com
916-682-1117 – phone
916-258-0296 – fax

2015 Kaiser Permanente Covered California Plans and Rates

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2015 Kaiser Permanente Covered California health insurance plans for individuals and families are now available.

Anyone can get Kaiser coverage as long as you live in a Kaiser service area.  You can no longer be denied coverage because of a medical condition, and you don’t have to pass a medical exam to qualify for a Kaiser health insurance plan.

Qualifying Events – Situations which allow you to enroll in a Kaiser plan “outside” the Open-Enrollment period:

  • Divorce, termination of domestic partnership or civil union.
  • Change in full time employment status.
  • Loss of employer sponsored insurance.
  • Voluntary or involuntary termination of employment.
  • Death of parent or spouse.
  • Change in dependent status – i.e. dependent child turning 26.
  • Existing coverage is being changed to a qualified health plan.
  • Marriage.
  • Domestic Partnership (in states which allow).
  • Birth of child.
  • Adoption of child.
  • Placement for adoption of child.
  • Guardianship or court order dependent.
  • Permanent move to a new state.

Be sure to enroll by December 31 to receive a January 1, 2015 effective date.  After that, the next available effective dates are: February 1st and March 1st.  The only way to enroll in a plan after March 1 is if you have a “qualifying event” such as, you are coming off of an employer health insurance plan, or you move to an area where your current plan is not available or if you are moving on or off of MediCal.  There are a few other situations but typically if you miss the Open Enrollment period you will not be able to enroll for the balance of the year.

ACA subsidy levels 2015

4 Levels of Coverage …  With all companies including Kaiser you will see four levels of coverage; Bronze, Silver, Gold and Platinum.  Each level provides a different level of coverage to meet your needs.  Bronze offering the lowest level, while Platinum is the highest.

All plans will offer the “essential health benefits” which are; doctor visits, hospital care, prescription coverage and maternity care, and will include certain preventive care for no charge.

Enrolling “On and Off the Covered California Exchange .. Enrolling “On” the Covered California Exchange is typically for the individual or family who qualify for a subsidy due to their income level.  Individuals and families who do not qualify for a state subsidy, will usually enroll “Off” Covered California (the plans are the same) although the premium amounts are quite different.

Health Care … Almost everyone gets sick or hurt, or needs some sort of medical help.  To get better you usually need care, like seeing a doctor or staying in a hospital or taking prescription medications.  Health Care includes many different services such as; Doctors office visits, hospital stays, emergency room visits, X-Ray and Lab, prescription drugs, preventive care, well baby visits, well woman visits, immunizations and screenings.

Health Coverage … Health Insurance is a lot like the insurance people get on their car or home.  Some people get their health insurance through their jobs, while others buy it themselves.  Without insurance, high medical bills can wipe out savings and even lead to bankruptcy.  Insurance helps protect you financially, if you have a serious illness or injury that requires extensive care.

How you Benefit … Peace of mind .. You shouldn’t have to worry how you are going to pay if you get sick, injured or pregnant.  Life is unpredictable, but when you have Kaiser, you have more control and you can rest easy knowing you are going to get the care you need.

Care when you need it .. You can see a doctor when you are sick or just need preventive care like a check up or screening.  You don’t need to ignore symptoms, or hope they’ll go away.  You can get treated before they get worse.

Quick Quote …  Anthem   –   Blue Shield   –   Kaiser 

Stay on a Healthy Course .. Preventive care helps you catch minor symptoms before they become problems.  Screenings like mammograms and cholesterol level tests can catch problems early, when they are easier to treat.

Quick Quote     Enroll Online

  • Trip Insurance – Trip cancellation, medical coverage and emergency evacuation while traveling outside the U.S.  Medicare does not provide any coverage outside the U.S.

Need Help or have Questions?  Feel free to call or email anytime.

John Conner
916-682-1117
John@JohnConner.com