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Benefit Agents provides instant access to the Covered California health insurance exchange.  Whenever or wherever you decide to enroll under Covered CA, know that you will be receiving the same standard rate from all licensed brokers.  There are no add-ons, no hidden fees – just quality healthcare .

We provide a simple and straight forward solution to get you insured under a Covered CA health insurance policy immediately.  We specialize in presenting individuals, families, and groups a comparison of different options through Covered CA or the private medical carrier networks.

The Patient Protection and Affordable Care Act, sometimes referred to as “Obamacare” recognizes that most individuals that do not have health insurance are either not offered it through their jobs, cannot afford it, or are denied coverage from a pre-existing medical condition.  Covered CA provides sliding scale financial help so that all Americans can receive essential health benefits at a fair price, where no one can be denied coverage.

If you do not qualify for Covered CA subsidies, you should still evaluate your options on the private marketplace. Everyone is legally required to have health insurance. Given the statewide increase in premiums to accommodate Covered CA subsidies, it’s your job to enroll in something that conforms to your income level and desired level of coverage.  Let one of our agents assist your families needs and obtain the most cost effective combination of benefits.

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Recent News

Grandmothering – What is it? And who does it affect?

Governor Brown has signed into law SB 1446, the ‘grandmothering’ bill.  The bill was unopposed and passed through both Houses in the CA legislature and is in effect immediately.  Below are a few key points that outline what is now allowed under the bill:

  • The bill allows a small employer health care plan in effect on Dec. 31, 2013, and is still in effect as of the date the bill was signed (July 7th, 2014), and that does not qualify as a grandfathered health plan under the Affordable Care Act, to be renewed until Jan. 1st, 2015, and continue to be in force through Dec. 31st, 2015.
  • These plans must be amended to be in compliance with the ACA guidelines as of Jan. 1st, 2016
  • Small employer group policies must still include many ACA and state based mandated benefits such as:
    • Preventative healthcare without co-pays or deductibles
    • No lifetime caps on benefits
    • Maternity care
    • Coverage for autism
    • Elimination of gender discrimination on setting premiums
  • This bill is not a mandate and employers are not required to keep their current plans in place
  • The bill does not address rates, so premiums for these plans may increase

Health Care Costs & How to Spot Errors

Health Care is nearly a $3 trillion industry in the United States, and as many may have already experienced, the billing system can be riddled with errors.  A few statistics that illustrate this are as follows:

  • Medicare overpayments in 2013 totaled $36 billion
  • 42% of evaluation and management bills to Medicare in 2010 contained errors, costing taxpayers $6.7 billion
  • There is an 80% probability that there will be an overcharge on your hospital bill

As consumers, what can we do to protect ourselves?  First and foremost, do not be too quick to pay.  Make sure you are receiving an itemized bill rather than one final amount.  Have your explanation of benefits handy so you can compare charges and benefits.

  • Ensure that your name, address, and social security number are correct
  • Ensure all medications listed on the hospital bill are correct and that you actually took them
  • Ensure all services listed were actually conducted (ie. X-rays or blood tests)
  • After surgery, compare operating room charges which are generally by the minute.
    • If you know how long the surgery took, see if it matches, otherwise compare it to the minutes listed for anesthesia – they should be similar
  • Double check room charges for overnight stays
    • Ensure you weren’t billed for a private room if you actually shared one
  • Review the bill for duplicate charges

If you do happen to find mistakes, you may be able to simply resolve them by reporting it to your hospital and health insurance provider, otherwise setup an appointment with the hospitals billing department after you have reported the mistakes to your insurance carrier.

Blue Shield – Relaxed 25% Participation

Blue Shield has just announced that it will extend it’s relaxed participation promotion through the end of the year.  Blue Shield typically requires a 65% employee participation to enroll in it’s group products, but with groups of five or more enrolled employees they now only require 25% participation.

This limited time offer now allows employers to offer a medical plan from Blue Shield alongside another carrier’s medical plan with more lenient underwriting.  This allows smaller businesses to now competitively offer an HMO from one carrier, and a PPO from another, enhancing their employee benefit program.

You must have at least 25% of the total number of eligible employees to enroll in a Blue Shield healthcare plan with no fewer than five.  Participation in their specialty products has also been reduced to 25%, as long as Blue Shield is the sole carrier offering them in conjunction with medical, or as a standalone product.

For example: If you have 24 employees, yet 4 have a valid waiver (Medicare, Medi-Cal, military, or covered by spouse’s group coverage only) then the total number of eligible employees would be 20.  Of the 20 eligible employees, you must enroll a minimum of 25% (5 employees).