Keeping You Current
 March 2014 Monthly Newsletter
Hi ,

Time flies when you're busy, and that's definitely been the case here with health care reform. Last week featured the seventh installment of our Master the Maze of Health Care Reform webinar series in which we discussed exchanges, "skinny" plans, and much more. If you'd like a copy of the slides from the presentation please let us know and we'll be happy to provide you with one. The series addresses both groups with under 50 full-time equivalent employees (FTEs) and groups with 50 or more FTEs.

Wellness continues to be a topic of interest when the cost of health care is discussed. On Friday, February 28th, Gayle and I attended the annual Health Care Leadership Summit moderated by the Sacramento Business Journal. The need for a commitment to wellness and transparency in the health care system were emphasized during the discussion among other aspects of the Affordable Care Act. You can read my thoughts on the discussion here.

On Tuesday, we were proud to sponsor the Positive Coaching Alliance's first annual Leadership Luncheon featuring former Major League Baseball player and manager Dusty Baker. The event was a pleasure to attend; Mr. Baker was refreshingly positive and inspired attendees with the story of the obstacles he overcame in his lifetime. Gayle blogged about the luncheon and shared her impression of the event and Mr. Baker's story; it's definitely worth a read.

As always, it is a pleasure and a privilege to work with you, and you can count on us to keep you current.


Best regards,


Laurie Rood, CEO
Help employees evaluate their options      

Historically, when an employee was terminated from your employment, they had three choices: elect COBRA (an extension of current coverage through the employer), apply for individual coverage, or go uninsured. With the changes set forth by the Affordable Care Act (ACA), the employee is better off seeking coverage through Covered California and possible being eligible for a subsidy if they are not transitioning to another job.

The information you provide a terminated employee may have greater impact on their coverage and finances than years past. Some key considerations:
  • COBRA - If COBRA is elected, the opportunity to enroll in individual coverage and/or apply for premium assistance through the state exchange (Covered California) is lost until the open enrollment period from October 15 through December 7. If the participant elects to make a change from COBRA to an individual plan through Covered California during the open enrollment period, coverage won't go into effect until January 1st.  
  • Individual Coverage - Qualifying for individual coverage is easier than ever. Individuals can no longer be declined or rated up based on medical history. The big decision when faced with a loss of coverage and whether to enroll in COBRA or individual coverage now comes down to affordability and physician availability.  
  • Going Uninsured - Being uninsured has never been an option we have endorsed. Now, with the "Individual Mandate," which requires that everyone have insurance or pay a penalty, being uninsured is no longer an option. The annual penalty for not having coverage in 2014 is the greater of $95 per adult and $47.50 per child or 1% of the family's gross income. The penalties will increase to the greater of $325 per adult and $162.50 per child or 2% of the family's gross income in 2015 and $695 per adult/$347.50 per child or 2.5% of the family's gross income in 2016.
If your employees need an individual insurance quote please have them contact us or visit this link.
Carrier Eligibility and Claims Processing Update     
Claims processing has normalized, but eligibility updates still delayed

The unprecedented renewal activity at the end of 2013 proved to be a strain on the system across the board. While we have seen claim processing time frames back on track, eligibility updates are still running much slower than usual. The reality is some carriers are still playing catch-up on processing eligibility and contract changes and are having difficulty keeping up with the volume of calls resulting in very long hold times when calling to follow up.


For tips on how to make the claims process go as smoothly as possible, check out our recent blog. The information will assist employees in avoiding delays and reduce confusion during the claims process. Click here to take a look!   

Pediatric Dental Coverage  
What you need to know
One of the many facets of the Affordable Care Act is the requirement that all small group (under 50 full-time equivalent employees) benefit plans include coverage for "Essential Health Benefits." When you renew your benefit package in 2014 the plans you choose must include all the essential health benefits unless your current plan is grandfathered. One of the essential health benefits as defined under the ACA is pediatric dental coverage.

If your group is on a "small group medical contract" when you renew in 2014, employees enrolled with dependent children under the age of 19 will automatically receive pediatric dental benefits as part of their medical benefit plan. These employees will receive correspondence and ID cards at their home addresses informing them of the pediatric dental coverage approximately 90 days before the effective date of your renewal.

This will likely be an unexpected correspondence to your employee and may create confusion. We recommend you give your employees a heads-up regarding the pediatric dental benefit and correspondence so as to avoid any unnecessary confusion and reduce the number of inquiries coming your way.

Benefits Done Right Insurance Agency, Inc.
601 University Avenue, Suite 250 / Sacramento, CA  95825
800 482 1817 / 916 568 2345 / fax: 916 564 9228

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