If you are a Small Group subscriber, please take note of the following important deadlines regarding early renewal:
The deadline for submitting the CalChoice Early Renewal Form is OCTOBER 1. We have contacted all of our CalChoice clients personally about early renewal, but if you have questions, call us immediately at (925) 254-6262.
Kaiser Confirmation of Early Renewal Forms are due FRIDAY, OCTOBER 4. We MUST have your forms NOW in order to insure that you are processed for December 1 renewal.
BLUE SHIELD OF CALIFORNIA:
The deadline for submitting the Blue Shield Early Renewal Option Form is OCTOBER 7. Please send us your form no later than FRIDAY, OCTOBER 4 to insure that we can get to Blue Shield on time.
ANTHEM BLUE CROSS:
The deadline for submitting the Anthem Early Renewal Request Form is NOVEMBER 15th. Please send us your form no later than NOVEMBER 13th to insure that we can get to Anthem on time.
Health Net clients eligible for early renewal should have received a packet in the mail indicating that early renewal will take place automatically unless you say otherwise. . You have until the end of the year to let them know your decision. Non-qualifying groups will need to submit an Early Renewal Option and we will assist you in doing so.
Please contact us at (925) 254-6262 with any questions you may have.
Individuals and Small Businesses need to begin preparing for changes to their health insurance NOW!
Here are a few key dates and tips on what you should be doing:
Individuals and Families: Only one month to go before open enrollment begins on Covered California — the state health exchange. Individuals should assess their current and expected insurance needs for 2014. Are you planning a job change ? Expecting a child ? Determine your household income and visit the Covered California website to find out whether you might qualify for assistance with purchasing health coverage on the exhange. Once you have determined what level of assistance (if any) you may receive, explore the levels and types of coverage available. We will be contacting you in September to discuss your options.
Small Business Owners: Your big decision going forward will be: 1) Whether you want to continue offering health coverage to your employees or 2) Whether you prefer your employees seek coverage individually on the exchange or 3) Whether you intend to continue to offer coverage and whether you qualify for tax credits through the Small Business Health Options Program (SHOP). Explore your options by visiting the SHOP webpage. We will be contacting you to discuss your choices.
Individuals and Families: Open enrollment begins on the Covered California exchange and continues through March 31, 2014. Using the research you did in September, you can shop for specific plans through specific carriers. We can help you sort through the offerings to find the best fit and get you enrolled in your plan of choice.
Small Businesses: Beginning in October, small businesses may opt for early renewal if they have Aetna, Anthem Blue Cross, Blue Shield, Health Net or Kaiser plans. Even if you already renewed your plan in 2013, you can still lock in 2013 rates for the coming year. We can help you compare your rates to those offered on the SHOP exchange to determine whether early renewal would be a wise choice for your business.
Medicare Clients: Your open enrollment period for Medicare Part D — prescription drug coverage and for Medicare Advantage plans begins October 15. Use early October to determine your enrollment needs. We’re here to help your enrollment go smoothly, so let us know if you have questions.
Small Business: December 1 is the early renewal deadline. You must have decided whether to opt for early renewal or wait for your established renewal date to change plans.
Medicare Clients: Open enrollment for Medicare Part D and/or Medicare Advantage plans ends. Any changes/additions must be submitted by this date.
Individuals and Families: This is the final day to purchase coverage on the exchange for an effective date of January 1, 2014.
March 31, 2014:
Individuals and Families: This is the final day for open enrollment on the exchange.
Covered California announces the players in the SHOP exchange.
On August 1, the Covered California announced the carriers that would be included in the Small Business Health Options Program (SHOP) for businesses with fewer than 50 full-time equivalent employees. Starting in October, small group employers will be able to shop for plans that will become effective January 1, 2014.
Those offering plans through SHOP are:
- Blue Shield of California
- Health Net
- Kaiser Permanente
- Chinese Community Health Plan (regional)
- Sharp Health Plan
- Western Health Advantage
Rates will vary by region, but will be comparable to 2013 small group market rates and will be competitively priced. As with Individual and Family Plan (IFP) offerings on the exchange, SHOP plans will also be categorized into Bronze, Silver, Gold and Platinum pricing tiers, with benefits and coverage increasing in value commensurate with the value of the metal/amount paid. The amount an employer will pay depends upon 3 factors:
- The level of coverage (bronze, silver, gold or platinum) the business owner wants to offer
- The amount the emploer wants to contribute toward employee plans
- Whether or not the employer wants to contribute to family or dependent care
Business owners may be eligible for tax credits to assist with the cost of providing health coverage for their employees if they have fewer than 25 full-time equivalent employees who receive salaries less than $50,000 per year and if they (the employer) contribute 50 percent toward the employees’ premium cost. Employers with 10 or fewer full-time equivalent employees who make less than $25,000 per year may be eligible for the maximum tax credit. In 2014, the maximum tax credit will be 50 percent of the employer’s premium expenses — so long as coverage is purchased on the SHOP exchange. In the fall, Covered California will provide resources to small businesses to help them determine whether they qualify for tax credits and how much.
Once an employer decides on what they want to offer their employees, Covered California will handle enrollment, premium collection, plan payments and all adminstrative tasks associated with overseeing implementation of coverage. For more information, see the Covered California Plans and Rates booklet.
Small business owners can lock in 2013 rates
Aetna, Anthem Blue Cross, Blue Shield, and Health Net have announced that they will allow small businesses to renew their health plans before year-end in an effort to shield their clients from the expected volatity in pricing that may occur in 2014 with the full implementation of the Affordable Care Act. Renewals will need to take place by December 1 for a January 1 effective date (Note: Blue Shield requires a commitment for early renewal by October 7).
Early renewals allow small groups — even those that have renewed already in 2013 — an opportunity to reset their renewal date and at the same time lock in their 2013 rates for 12 months following the renewal. Employees can elect to keep their current plan(s) and/or make changes as they might normally during open enrollment. Medical and pharmancy deductibles would also be reset starting January 1, 2014.
With rates on group health plans expected to rise 15-30 percent next year, this could be a way for employers to stave off significant increases in their health care costs. We encourage you to give us a call if early renewal is something in which you might be interested.
Aetna and UnitedHealth are opting out of the individual health coverage market in California: The two major carriers announced that they will no longer be selling Individual and Family Plans (IFPs) in California and that those with their IFPs would need to find insurance through other carriers by December 31 for coverage in 2014.
Aetna said it will continue selling health insurance in California to employers and Medicare beneficiaries, as well as dental and life-insurance products. The insurer said it is “fully committed to serving the needs of our 1.5 million members in the state.” UnitedHealth will likewise continue its offerings of AARP Medicare supplement and prescription plans, along with its large employer offerings.
Aetna said it currently has about 49,000 individual policyholders in California. In 2011, it was the fourth-biggest player in the state’s consumer market with about 5.2% of the plans sold that year. UnitedHealth said it had notified state regulators that it, too, would leave the state’s individual market at year-end, forcing about 8,000 of its customers to find new coverage. United’s focus has long been the large to mid-size employer market, so its departure from selling individual coverage is not likely to create too many repercussions. Aetna and United combined cover fewer than 60,000 people in California’s two-million-strong individual market.
Aetna said it had begun notifying customers that they would have to find new health coverage, and it stopped taking applications for individual policies after July 15. It estimates that up to 30% of its IFP customers will seek other insurance through Covered California, the state-run health exchange that opens in October.
People who currently have Aetna or UnitedHealth individual health coverage will have to find plans with other carriers by year-end, but it may be easier now that federal health law’s prohibit exclusion of coverage for pre-existing conditions. They could find that premiums are also more competitive – especially on the state health exchange with 13 different carriers in 19 pricing regions offering a multitude of plans.
According to regulators, UnitedHealth and Aetna cannot reenter California’s individual market for five years after they leave,.
Are you playing the right insurance odds ?
The odds of having a residential fire are less than 1%. You probably have fire insurance. The odds of having police reported car accident are about 2%. You probably have car insurance. The odds of being admitted to a critical care are a little more than 2%. You may have health insurance. The odds of needing long-term care are 70%. Do you have long-term care insurance?
We often hear people rationalize not having coverage for long-term care saying, “It’s too expensive” or “What if I pay premiums and don’t use the coverage?” or “I’ll self-insure.” There are two ways to get long-term care benefits that address the first two objections. These are a hybrid life / long-term-care product and life insurance with a critical illness rider.
The hybrid life / long-term care policy usually involves redirecting savings (i.e. savings you might set aside to self-insure) to purchase a single premium payment life insurance policy. For example with this type of policy, a healthy 60 year-old woman could be eligible for long-term care benefits equal to 5 times the total premium. In this scenario, she makes a single premium payment of $100,000 and has immediate access to $500,000 worth of long-term care benefits. It is also possible to set up a payment plan that stretches premium payments out over as much as ten years. The benefits in a hybrid plan are similar to what one would have in a conventional long-term care insurance plan, with the addition of providing life insurance of more than 150% of the premium. Another plus is that the entire premium is available should the owner decide to cancel the policy prior to taking benefits. This allows the owner to maintain control of their savings while insuring against long-term care costs.
Another approach is to add a long-term care rider to a “permanent” life insurance policy. The Hartford has a unique, patented rider that will pay 2% of the face value per month for over four years once someone has been certified by a medical professional to be eligible for long-term care. The unusual feature of this particular policy is that the benefits are paid on an “indemnity” basis to the insured. That is, the benefit is not a reimbursement for long-term care expenses. The beneficiary can use the money for any purpose whatsoever. If, for example, someone has a $300,000 life insurance policy, they could receive 50 monthly checks of $6,000. This type of plan is an excellent way to provide funds to pay a family member who is the primary caregiver to an elderly relative.
If you are interested in exploring some of these alternative ways of providing for long-term care without getting a long-term care insurance policy, contact Jim at (925) 254-6262 x2.
In May, Covered California announced the Who, What, Where and When of health insurers and plans that will comprise the state health exchange. Out of 32 hopefuls, 13 carriers were selected to sell coverage in 19 separate pricing regions and, as previously announced, plans will be classified into four distinct tiers: bronze, silver, gold and platinum.
The thirteen health insurance companies include major carriers, as well as smaller regional firms. They are:
Each of these insurers met the federal and state plan requirements, as well as additional criteria imposed by Covered California:
- Affordability for the consumer in terms of premiums and at point of service
- Accessibility to quality care for a range of health statuses and conditions
- Facilitation of information to help consumers make knowledgeable choices
- Promotion of wellness and prevention
- Reduction of health disparities and advancement of health equity
- Innovation on the delivery of health care
- Efficient and focused use of resources
The selected carriers include for-profit and non-profit plans, and regional and statewide doctor and hospital networks. Some will offer plans throughout the state and others will offer plans regionally. Plans run the gamut from health maintenance organizations (HMOs) to preferred provider organizations (PPOs) to exclusive provider organizations (EPOs).
As mentioned in previous newsletters, the new plans offered through the Covered California are classified as bronze, silver, gold and platinum, with benefits increasing from tier to tier as shown:
Within each tier, pricing of coverage is further categorized by income as in the example shown below:
Coverage and pricing of plans offered through Covered California are organized into 19 separate regions blanketing the state. Here we show the counties we cover in Northern California, the carriers and types of plans that will be offered through the exchange:
Here’s a summer salad that’s perfect for those hot August nights:
Nonstick cooking spray
5 slices bacon, chopped
1 shallot, finely chopped
1 teaspoon Dijon mustard
¼ C. balsamic vinegar
1 tsp. sugar
Kosher salt and freshly ground black pepper
3 firm, ripe large peaches, pitted and halved
Extra-virgin olive oil
5 ounces baby spinach
½ C. chopped pecans
½ C. crumbled feta cheese
½ red onion, thinly sliced
Preheat the grill to medium-high heat and spray with nonstick spray.
Cook the bacon in a skillet over medium heat until crisp. Remove to a paper towel lined plate to drain.
Add the shallots to the skillet and saute until tender. Stir in the mustard, vinegar and sugar and season with salt and pepper, to taste. Remove from heat and reserve for dressing.
Brush the peaches with olive oil and season with salt and pepper. Grill until peaches are golden and have grill char marks, about 1 to 2 minutes on each side.
Mix the spinach, the sliced red onion, pecans and the feta in a large serving bowl. Add the peaches, the vinaigrette and the chopped bacon. Toss and serve.
(Courtesy The Neeleys, foodnetwork.com)
Consumer knowledge about sunscreens will now be more than skin deep – thanks to new FDA mandates that require sunscreen packaging to be up front about active ingredients and just how much protection one can get from products, including lip balms, makeup with sunscreen, wipes, body washes – even shampoos and powders.
One caveat, though: The majority of sunscreen products on the market should comply with the new testing and labeling requirements, but there could be a few outdated labels that were on retail shelves before the regulations took effect. Also, small indie brands have until December 2013 to update their packaging.
When it comes to ancillary products (like shampoos and wipes) the government is also evaluating their effectiveness. Do these SPF gimmicks deliver enough sunscreen onto the skin (or hair) to back up their sun-protection claims? Sprays, which people love for the convenience in application, are also in the FDA’s sights for the same dosage-based reasons, so this may be the last summer you can buy sunscreen in an aerosol can.
Bottom line: products have to state how much protection they will give you and be scientifically tested to back up those claims.
1. Broad Spectrum. This is the most important factor in buying sun protection. If “Broad Spectrum” is on the label, it means the product has been tested and proven to protect against both UVA and UVB radiation. Sunscreens used to only include an SPF number, which reflects a product’s protection from UVB — the shorter wavelengths that cause sunburn on the surface of the skin. Labels that specify only the SPF (even if it’s a high number) but don’t include a “broad spectrum” designation are not going to screen your skin from the longer UVA wavelengths – and UVA rays are the ones that penetrate deeper – giving you that beautiful tan, along with skin cancer, brown spots, wrinkling.
2. Drug Facts. The percentage of active ingredients — such zinc oxide, titanium dioxide or chemicals such as avobenzone or octinoxate — must now be listed under “Drug Facts” on the container, along with their potency.
3. The SPF number.The SPF (Sun Protection Factor) measures protection from UVB rays – but it doesn’t have anything to do with the amount of time you can spend in the sun. SPF is determined by an FDA test that gauges how much UV radiation it takes to burn skin with sunscreen versus the amount it takes to burn skin without sunscreen. (A rating of SPF 30 means that it would take 30 times the amount of UVB radiation to cause sunburn with this sunscreen on.)
The FDA is evaluating whether to cap SPF’s at 50-plus because any rating over 50 doesn’t give you that much more protection – a flaw in the rating scale because the math doesn’t add up. For example, an SPF 15 screens up to 95 percent of UVB rays, while a rating of SPF 30 filters 97 percent. For now, the higher numbers – like SPF 70 – will stay on the label, but you should know that most people don’t put on nearly the same thick coating of sunscreen that’s used in the testing to determine the SPF. Recommendation: Your daily sunscreen should be somewhere between SPF 30 and 50.
4. Sun protection warnings. The FDA now requires labels to also include a statement about the danger of sun exposure and to offer additional protection recommendations. Here’s what it says:
“Spending time in the sun increases your risk of skin cancer and early skin aging. To decrease this risk, regularly use a sunscreen with a broad spectrum SPF 15 or higher and other sun protection measures including:
- Limit time in the sun, especially from 10 a.m.–2 p.m.
- Wear long-sleeve shirts, pants, hats and sunglasses.
- Children under 6 months: Ask a doctor.”
Tanning products that are not proven to be broad spectrum, or that have an SPF lower than 15, now have to include caution sticker – much like cigarette packages — on the label:
“Skin Cancer/Skin Aging Alert: Spending time in the sun increases your risk of skin cancer and early skin aging. This product has been shown only to help prevent sunburn, not skin cancer or early skin aging.”
Consumers should get the message that those products are not good choices for sun protection.
5. No more “-Block” or “-Proof.” The words “sunblock,” “waterproof,” or “sweat-proof” will no longer be seen on sunscreen labels. Why? Because there is no way to truly block the sun – unless you live in a cave — and sunscreens aren’t proven to be totally waterproof. All of them eventually wear or rinse off. Products labeled as “water-resistant” must clearly designate how long the SPF protection (from sunburn) lasts in the water — either up to 40 or 80 minutes based on standardized testing. So the new labels will look something like this: “Broad spectrum SPF 30 water resistant (40 minutes).”
Be prepared when you are spending time in the sun, read the label, and choose the right sunscreen protection!