Kevin Knauss: Health, History, Travel, Insurance
Posts related to health insurance for individuals, families, small groups, enrollment, eligibility in California, plans, coverage, benefits.
UnitedHealthcare has alerted their appointed health insurance agents that they will not pay any commissions for individual and family plans sold after January 1, 2016. The abrupt cancellation of commissions applies to Marketplace state based exchange plans and health plans sold off-exchange directly through United Healthcare. Commissions on enrollments prior to December 31, 2015, will be honored.
The formula for determining how much premium assistance, also known as the Affordable Care Act premium tax credits (PTC), to lower your monthly health bill is complicated. At its core the formula uses the inputs of your age, MAGI, a special contribution percentage and the annual cost of the Second Lowest Cost Silver Plan. Plugged into the formula, these inputs determine if any Advance Premium Tax Credits (APTC) will be awarded to reduce your health insurance premium. Some people are surprised to learn they don’t qualify for any APTC even though their MAGI is below 400% of the federal poverty level.
At some point you get tired of dealing with idiots. At some point you need to complain with the full understanding that nothing changes because government bureaucracies and private corporation sucking off a government contract never change. As my phone showed I had been on hold for over four hours with Covered California’s agent support Pinnacle Management, I was able to finish writing the following complaint forms to Covered California.
Covered California has awarded quality star ratings to health plans based on just two questions from a questionnaire surveying consumer’s experience in 2014. In addition, the quality ratings were based on a completed sample size of approximately 100 respondents out of 1,000 surveys sent out.
In yet another sign of the erosion of health insurance commissions for agents, Cigna has informed their appointed agents that they will not pay commissions on most of their California health plans in 2016. Cigna has stripped away any agent compensation for their 2016 Silver, Gold, and, Platinum plans sold during open enrollment. In addition, there will be no commissions paid on any health plan that an agent helps a client enroll into during a Special Enrollment Period in 2016.
Individual and family plans offered through Covered California in 2016 will include new pharmacy prescription drug benefits. The benefit, also mirrored in many off-exchange health plans, caps the amount a consumer must pay every month for a particular prescription. While that sounds straight forward, the rules surrounding any pharmacy deductible and tiered drug formulary can be complicated and confusing.
Covered California has locked Certified Insurance Agents into representing all exchange plans to consumers and forbids agents from steering consumers to health plans with the best commission structures. Unfortunately, Covered California has no regulations that address any minimum compensation levels that the health plans or health insurance companies must pay agents for their efforts. Covered California announced over the summer that compensation for Medi-Cal enrollments would end for agents. Most recently Western Health Advantage (WHA) announced a split commission structure where Certified Agent enrolments would receive less compensation for Covered California plans than WHA’s off-exchange plans.
The Department of Health and Human Services has proposed health insurance rules that would prohibit the discrimination of health care services based a person’s gender identity. The proposed non-discrimination rule would apply nationwide to all health insurance offered through ACA Health Insurance Marketplaces. If the rule is adopted, transgender health related services could not be denied even in states that have not specifically enacted non-discrimination legislation.
Covered California has released a series of marketing videos to develop interest and drive sales to their small employer group plans. Formerly known as SHOP (Small business Health insurance Options Program), the small employer group offerings, authorized as part of the Affordable Care Act, has been re-branded as Covered California for Small Business. The small employer group marketplace exchange initially flopped as it was beset with an online application process that failed and subsequent management problems that resulted in billing nightmares for many clients. Fortunately, they seem to have righted the foundering small group boat at Covered California.
Whenever a health insurance company or health plan wants to change their health insurance rates in California they must submit a justification for the rate change in the monthly premium amounts to the Department of Managed Health Care or Department of Insurance. Regardless of which agency they must submit their rates to, the agencies just […]
