But once you cross the border, some plans can be a little coy in whether they will cover any health care services. For both travel in the United States and abroad, you really need to study the health plan’s member agreement also referred to the Evidence of Coverage (EOC). The EOCs are those big documents that tell you have the plan works, what’s included, and what’s excluded. Some EOCs are specific about foreign travel coverage while others that I have studied make no mention of coverage outside the U.S.
Finally, some folks are considering just enrolling in Medi-Cal because they are eligible. They have very little or no income to report on their taxes because they are living off of savings, interest, and dividends. Here again, Medi-Cal would be used as a containment strategy to an unexpected accident or illness. Medi-Cal is typically a HMO plan which requires a Primary Care Physician to make referrals to specialists, order tests, or imaging.
The health plans don’t recognize the invoiced amount of the health care services from out-of-network providers as either accruing toward the deductible or for their cost-sharing of 50% before the maximum out-of-pocket amount is met. The health plans apply a Usual and Customary Rate (UCR) or the Allowable Amount. This limits their responsibility for payment and increases the health plan members costs.
The health plans and Covered California may give lip service to the value of the agent community, but it is not reflected in the compensation we receive. I’m not trying to get rich as an insurance agent. My net revenue listed on my Schedule C for 2016 was $34,000. If the new compensation schedules significantly erode my insurance revenue then I will have to find other income streams. Maybe Covered California will hire me to answer phone calls; I hear they have a great benefits package.
One of my clients received a letter from Covered California notifying her that her monthly premium would jump from $63.64 to $993.45 per month. The letter casually stated that the premium increase was 147.2%. The client is a household of two people one eligible for Covered California and the spouse is on Medicare. When I went through the renewal procedure on the updated Covered California website, I had to re-confirm that the spouse was on Medicare. The final eligibility results were that the Medicare spouse could select a plan at the full premium amount while the primary applicant could select a plan with the monthly subsidies.
A review of health insurance rates in Northern and Southern California shows rates for young adults will increase between 30% to over 40%. Instead of the 6% to 16% increase in rates for adults only, families could experience a 20% increase in health insurance rates in 2018.
What has not been explained was if the increased Silver plan rates were based on existing Silver plan enrollments or projected enrollments. For those individuals and families who receive very little or no APTC the off-exchange Silver 70 plans will be 8.3% to 27% less expensive. People will naturally enroll in off-exchange Silver plans to save money. There will also be people who downgrade their plans from Silver to Bronze to save money, or, enroll in a Gold or Platinum plan for more benefits at an equal or lower cost of a Silver plan through Covered California. Either way, people will exit Covered California Silver plans in 2018. And since only the Covered California Silver plans have the increased rates, will that generate enough money to subsidize those people left in the enhanced Silver plans?
As her 78 year old father ate the breakfast she had prepared for him, she picked up the family shotgun, pointed it at the back of his head, and pulled the trigger. She then poured kerosene in the living room, kitchen, and on some of her clothes tossed on the floor, and set the house ablaze. She later recalled she had every intention of dying in the fire along with her father. Death was the only way out of the dilemma she had created as she saw it.
Another annoying change Covered California made was adding little pop-up windows asking for more information called One More Thing. After submitting a change to the income, Covered California wants to know if anyone is pregnant. The only way to get around this is to select the Edit button and select Nobody from the household member selection.
The Petersen has plans with lower deductible amounts than IHC. Petersen also has an optional hazardous sports or activities rider. Optional Hazardous Sports or Activities Rider – Hazardous Sports or Activities are the following list of activities which are considered to be more than a standard risk. This optional rider will provide up to $250,000 for eligible expenses incurred by participation in the following: