Category Archives: Individual Health Insurance

Important Announcement for Clients with Network Health

If you have Network Health Plan, please read this update.

You may have already read information about Network Health Plan and ThedaCare terming their relationship next July 2016. Our advice is to not worry yet.

  • If you a small group and have Network Health Plan, nothing will change before July 2016

  • If you have a Network Health’s Medicare Advantage Plan, nothing changes before July 2016

  • If you have a pre-ACA individual health plan with Network Health, again, no changes before July 2016

It’s too early to tell what will happen with the negotiations.  Until it’s a firm deal, anything can change in our world of the new Affordable Care Act.  Stay tuned, but relax and know nothing is changing yet.


To view the announcement from Network Health, click here

Healthcare Updates for January 2015: Renewals, Changes, Enrollments

HiResHappy New Year, and what a year it’s been!  Two open enrollments, lots of special enrollments, and a whole lot of “early renewals” to be done within about a 30-day window! I can’t believe that we actually were able to renew every single client from October 15 (open enrollment for our Medicare clients), to December 31.  A special thank you to all of our clients, for your patience during that time! It’s a new world in the health insurance industry. Gone is efficiency. We were overwhelmed with only 30-days to renew all of our individual clients, and now the insurance companies are in the midst of trying to enter (or renew) all of the business!  Please be patient with the carriers as they revise the billings and enrollment changes!

Last week, the Department of Health & Human Services released a report stating that 87% of those who enrolled (or re-enrolled) through were qualified to be eligible for Federal subsidies.  Truth be told the only persons who should be enrolling through the federal website are those who are eligible for the tax credits. Otherwise, it’s a very cumbersome way to buy individual health insurance.  If a client is deemed to be over the 400% of the Federal Poverty Level, we help them enroll directly with the insurance carrier. No need to provide the Federal Government all of your income and household information unless necessary. Overall, there needs to be more consumer awareness of the Federal Poverty guidelines.

Considering the cumbersome tax forms that will now need to be filed (starting this month) if you do receive the Federal tax credits, what was thought of earlier this year as “free money” to help subsidize health insurance premiums, may cost more, because of the required tax filing. I consult with many clients who have been unaware that the tax credits actually are tax refund dollars that you can use today to “buy down” or lower the cost of your monthly health insurance premiums.

I think that this winter will prove a most interesting time, not only in our industry, but also in the tax world.  Remember, the Affordable Care Act was designed as “insurance” and “tax reform”.

Special Enrollment Periods…Just the Tip of the Iceberg!

Copyright: <a href=''>_fla / 123RF Stock Photo</a>The “open enrollment” period to purchase health insurance in Wisconsin, both on and off the exchange, for 2014 ended April 1, 2014. Under the new Federal Law, the only time an individual can purchase health insurance now is with a special enrollment period (SEP). That’s because medical underwriting no longer exists in the commercial market or on the Federal Marketplace/Exchange.

There are several life events that can trigger a special enrollment: a relocation, marriage, divorce, birth, death, adoption of a child (or foster care), loss of minimum essential coverage, or a change in income. These special enrollments are not easy.  I describe the process as confusing, convoluted and complex (the three C’s).

Each special enrollment for health insurance is “special” because every situation is different. There isn’t a standard SEP. Just like human beings and their DNA, I’m finding out that every SEP has its own set of complexities that the Federal Government is not yet equipped to handle. The Marketplace/Exchange website continues to have glitches, especially in cases of income changes and dependent coverage. Many questions do not make sense to the consumer about current and past coverage. In most instances, the system will automatically override your own desires and move dependents (children) from the health plan directly onto BadgerCare, even if you want to cover them privately.

I forewarn my clients that a special enrollment on the Federal Marketplace/Exchange can take anywhere from one to three hours (or longer). Remember, you aren’t considered covered until you pay your premium. You may also owe a fee (penalty) for the months you did not have coverage in 2014.  In addition, you want to try to be as accurate on your income for the Federal subsidies, because when your taxes are reconciled in 2015 (for the 2014 tax year), you may owe money back.

The next open enrollment period for individual health insurance begins on November 15, 2014 (for a January 1, 2015 effective date). If you want to avoid crashing into an “iceberg”, give us a call (920-955-1040)!   We are Federal Marketplace/Exchange certified and licensed agents with over 40 years of combined health insurance experience.

Rules and Regulations More Complex Than ACA Law

ACA and regulations“If you like your plan, you can keep it”…..well sort of!  Since the passage of the Affordable Care Act in 2010, there is one constant to be sure.  Anything can and will probably change, so stay tuned!

The initial law included 2,700 pages of language. Since it’s implementation, the rules and guidelines are at 35,000 pages and growing by the day.

Recent guidelines and mandates that have hit Wisconsin, through the Office of the Commissioner of Insurance (OCI), has been the interpretation of “keep your plan” option. Since March 2014, OCI has issued guidance to the insurance carriers in our region on “how to” actually abide this latest ruling.

Most group clients (and individual clients) chose to “renew” early (last December 2013) to keep their current plan(s) and bypass many of the new 2014 ACA-compliant mandates. There was speculation on what 2014 will bring for renewal options, and although many carriers were still working on the idea that not only could you renew early again 2014, but that you “might” have alternate plan design options (just like the old days) all still outside the ACA mandates. Not so, with the newest information coming out of HHS.  You will be able to renew your plan(s) as is, but not make any adjustments to what you have in place, without rolling into the new ACA-compliant plans.

My personal opinion is that we have to deal with what we know today, and it’s anyone’s best guess what the guidelines will be by this fall. This is a moving target folks. Don’t get worried until you have to (next renewal date).  We will always have options for you to consider. We have close relationships with all the carriers, their representatives, and the OCI.

So, on that note, relax this summer and enjoy all the other aspects of your business and life. The headaches with the ACA (and cold weather) will be here soon enough!

New ACA Fees Now Seen on Insurance Premiums

IncreaseinFeesandTaxesACAHave you noticed additional fees on your insurance premiums?

Federal taxes are being imposed on private health insurance premiums (you the consumer). Estimates for funding needed in 2014 for ACA begin in the $8 Billion range, and increase from there. The allocation to the insurance carriers is based on their market share (the business sold, the more dollars assessed). Insurance predictions last year were that these fees would add about 3% to the rates, but we haven’t even begun to see the trickle down effect of how rates will be impacted moving forward.

The first fee that clients began to see was the PCORI fee (Patient-centered outcomes research institute) in fall 2013, which ranged from $1.00 to $2.00 per member, per year. Add that to the Risk Adjuster fee of less than .10, and it doesn’t seem too bad.

The newest assessed fee (Reinsurance fee) began January 1, 2014, as directed by the HHS (Health & Human Services/Federal Government). This one has more teeth, so to speak, and equates to $5.25 per member (per belly button), per month.

If you haven’t noticed these fees in your premiums, then your carrier has built them into the total premium for each insured or group. One of our major carriers in Northeast Wisconsin (Network Health) made the decision to not include these fees in their premiums, but bill them as a separate line item. Will this be a good or bad decision? It depends on your philosophy of who and how we should all pay for the Affordable Care Act. As it stands today, we are all paying for it, like it or not.

Finally, these fees are being assessed to new groups, new individual plans, renewing (or early renewal) groups/individuals and grandfathered health plans. Regardless of what type of plan you have, you are being assessed new fees/taxes, whether they are easily recognizable or not.