Category Archive: Affordable Health Care Act

Voluntary Benefits Are Growing

Voluntary benefits (benefits purchased at work) grew 9 percent in 2013.

Voluntary health product sales experienced a 13 percent increase from the prior year. Accident, critical illness and vision products grew by double-digits for the third straight year. Life insurance sales rebounded in the fourth quarter. Total life sales increased 14 percent in the fourth quarter to end the year up 2 percent. A survey of 800 employers revealed the impact of the Affordable Care Act (ACA.) Three out of four employers said they have changed or intend to change their medical plan design in the near future. Cost shifting is the most common strategy among the surveyed employers. Sixty percent said they have already or plan to increase employee contributions to the cost of coverage.

With cost shifting and other plan design changes, voluntary benefits become the best option for employees to maintain their overall insurance coverage. Research has found that more than 60 percent of employees prefer to buy health and life insurance benefits at work. Employees like using payroll deduction.


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California Assembly Bill 1838 lets doctors graduate faster

State of California Governor Brown signed legislation recently that will allow students at accredited medical schools in California to complete their education in three years instead of four. The goal of Assembly Bill 1838 is to meet the high demand for doctors that has been created by federal health care reform. Accelerated educational programs focus on the achievement of individual and academic skills for students who demonstrate a high level of scientific and medical understanding. Currently California faces an extreme shortage of trained medical residents and physicians. The bill takes affect in January 2015. This bill is considered an important step in addressing California’s primary care physician shortage.

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California Medical Insurance Update

Alarm clockIn California, small employers had the choice in 2013 to opt for “early renewal” of their coverage at the end of 2013. This allowed small employers to keep their current, non ACA-compliant plans or policies until late 2014.

On July 7, 2014, Governor Brown signed into law SB 1446. This law permits small group employers with “early renewal” or “grandmothered” plans that were in force as of 12/31/2013, and are still in effect on 7/7/2014, to renew until 1/1/2015 and remain in force until 12/31/2015.

Health plan contracts and insurance policies renewed under SB 1446 are exempt from some ACA provisions such as rating limitations, requirements to provide essential health benefits, and affordable care act mandated limitations on out of pocket expenses & deductibles.

It is important to compare “grandmothered” plan rates and benefits with ACA-compliant plans in order to know the best plan for each small employer’s unique situation.

For information about how options for early renewal may effect you, contact us at 858-361-0735.


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What is a Medical Insurance Exchange?

Shop for Healthcare at Exchange

A Medical Insurance Exchange is an online marketplace where people can compare policies side by side, and buy health insurance.  The public exchanges allow applicants to determine whether they qualify for government subsidies.
For 2014, open enrollment started October 1st, and runs through March 31st.  Coverage begins in January, 2014.

The affordable health care act requires almost all Americans to have health insurance, or pay a penalty to the government.  The penalty starts at $95 in 2014, but increases to at least $695 by 2016.  In the public exchanges, premium subsidies are available for individuals earning up to $46,000 annually, and for families, premium subsidies are available with incomes up to $94,200.

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Agents Help Consumers in Complex Health Insurance Marketplace

KatieandLarryCookPhotoMany insurance agents in California are taking the time to participate in training regarding the public health insurance marketplace.  Agents are continuing to serve clients with expert advice on health insurance plans that will be available in the individual and group marketplace.  Agents will provide assistance and service beyond just enrolling for a health insurance plan.

Consumers benefit from the expertise that brokers and agents provide in servicing the plan throughout the year.  Insurance agents are helping to reduce confusion among consumers in how the Affordable Health Care Act will affect them.  Agents can help small business owners understand the cost and requirements under the law and what plans will be available to their businesses.  Agents need to be involved, or costumer service could be missing in the health care reform effort.  We would like to offer the opportunity to be of service to you.

For more information on how we can assist you in the health insurance marketplace, please contact Larry Cook at, and/or 858-361-0734, or Katie Cook at, and/or 858-361-0735.  Please also feel free to visit the health insurance dedicated website or send an email to

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10 Things Every Business Should Know About Healthcare Reform

Questions about healthcared1     Consult a Knowledgeable Insurance Professional

A licensed health insurance broker, serving as your consultant, can be valuable to you in understanding the facts of health reform.

2    Public and Private Health “Exchanges” Come Online

Open enrollment is scheduled to begin in October of 2013 for Health Insurance Exchanges, with coverage effective January 2014.  Private health insurance exchanges are also expanding to offer businesses and employees more choices for coverage at an affordable rate.

3    Health Plans Will Be Classified in “Metal” Categories

Health insurance plans will receive a metal rating- Platinum, Gold, Silver or Bronze- based on “actuarial value” calculations.  For example, Platinum plans will provide coverage for 90 percent of costs while policyholders pay 10 percent.  Bronze plans would offer 60 percent coverage while policyholders would pay the remaining 40 percent of medical costs out-of-pocket.

4    Tax Credits for Small Employers

Employers with fewer than 25 employees and average annual wages of less than $50,000 may claim a tax credit for the cost of providing insurance beginning with 2011 tax returns.  Beginning in 2014 this tax credit is only available to eligible small employers who purchase coverage through the Exchange.

5    W-2 Reporting

Businesses that issued 250 or more W-2’s in 2011 must begin to report on 2012 W-2’s (issued Jan. 2013) the aggregate value of health benefits provided to each employee including medical, dental, and vision coverage.

6    “Essential Health Benefits” Defined

Beginning in 2014, health plans must provide coverage for a minimum set of products and services in the following 10 categories: outpatient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse disorder services, prescription drugs, rehabilitative services and devices, laboratory services, preventive and chronic disease services and pediatric services including oral and vision care.

7    Requirement to Inform Employees

Beginning in 2013, employers must provide each employee with written information on the employer health plan, health exchanges, available subsidies for insurance and guidelines on how to purchase insurance.  Further guidance is scheduled for release in late summer, early Fall of 2013, postponed from the original March 2013 deadline.

8    Automatic Enrollment

Employers with more than 200 employees must automatically enroll employees in employer-sponsored plans; however, the IRS has said that rules for this requirement will not be issued until 2014.

9    Limits on Flexible Spending Accounts (FSAs)

Beginning January 1, 2013, FSAs, which allow employees to save tax-free dollars that can be used to pay medical expenses not covered by insurance plans, will have a plan year limit of $2,500 in 2013 (indexed for cost of living adjustments after 2013).

10  Employer Play or Pay

Beginning in 2015, employers with 50 or more full-time equivalent employees will pay a penalty fee if they do not offer health coverage or if they offer coverage which is not affordable or doesn’t have minimum value (60%) and at least one full-time employee receives a premium subsidy.

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Health Law Offers Some Consumers Help Paying Deductibles and Co-Pays

Health Care Law Offers HelpThe Affordable Health Care Act will provide financial assistance for some people who buy plans on the market places known as “exchanges” for plans effective January 1, 2014.

Cost sharing subsidies can substantially reduce the deductibles, co-payments, co-insurance, and total out of pocket spending limits for people with incomes up to two hundred fifty percent of the poverty level ($58,875 for a family of four in two thousand thirteen).  These reductions can be an important consideration for lower income consumers when choosing their coverage.

Cost sharing reductions will be applied automatically for consumers based on their income if they buy a Silver Level plan.  Silver plans are one of four plans that will be sold on the exchanges.  A Silver Plan will generally pay seventy percent of covered medical expenses.  In California, a standard Silver Plan will have a $2,000 deductible, and have a $6,400 maximum out of pocket limit.  In addition, people with incomes up to two hundred fifty percent of the poverty level will qualify for premium subsidies as well, based on that income level.

Consumers should remember, the cost sharing subsidies apply to in-network expenses only.

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Affordable Care Act: What You Should Know Today

Businesswoman shrugging, isolated on white backgroundMost of the law will be in effect January 1, 2014.

What happens to the uninsured?

There will be a Medicaid expansion for those individuals making less than $16,000 per year.

For individual higher earners, there will be tax credits available on the online exchanges.

Businesses with more than 50 employees won’t be required to cover their full time employees until 2015.

There will be more preventative services and wellness incentives.

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