Checklist for Coverage Simple Storage Service (S3)
FOR IMMEDIATE RELEASE
For more information, contact: Emmanuel Winston @512-542-9955
TAHU Releases “Checklist for Coverage” to Assist Consumers in Making Health Plan Choices for Year Two of Affordable Care Act Open Enrollment for Year Two Begins on November 15 (AUSTIN, TEXAS – November 12, 2014) - With the enrollment period for year two of the Affordable Care Act set to open in three days, the state’s leading health insurance agent association is releasing its “Checklist for Coverage” to help individuals and employers process the information that should be weighed in making coverage and renewal decisions. Jacqueline St. Hilaire, president of the Texas Association of Health Underwriters (TAHU), said that utilizing the assistance of a professional benefits adviser (health insurance agent) can provide peace of mind and ensure that key factors are considered in making health coverage choices, all at no cost to the individual. “What we saw in year one was that many individuals were a bit overwhelmed with the questions they faced in making the best choices for coverage. Many defaulted to the least expensive plan, which may not be the best choice for coverage or overall cost for the health care that someone needs,” said St. Hilaire. A survey by America’s Health Insurance Plans (AHIP) confirms an increase in coverage through high-deductible plans that offer lower premiums. A report by AHIP indicates the number of individuals covered by high-deductible health plans rose from 13.5 million in 2012 to 17.4 million in 2014. According to the Kaiser Foundation, the average deductible doubled between 2007 and 2014 from $616 to $1,217. Many consumers are initially attracted to the higher-deductible plans because of the lower premiums, only to discover after the fact that the reduced upfront costs result in significantly higher out-of-pocket costs. St. Hilaire added, “There’s really no reason to do this alone, given the importance of this purchase, when you have free support available from insurance experts in your community.” The open enrollment period for year two of the new law will run from November 15, 2014, through February 15, 2015. New and returning customers who take action by December 15, 2014, will have their coverage choices take effect on January 1, 2015. Existing customers who do not take action by December 15 will be automatically re-enrolled with their current coverage, taking
effect on January 1, 2015. Effective dates for coverage selections made after December 15, 2014, will be based on the agreements contained in the health policy they select. Once the open enrollment period ends, consumers will only be allowed to enroll or change coverage if they experience a “qualifying event” such as loss of coverage, marriage, divorce, birth of a child or a move to a new area. Without a qualifying event, an individual will need to wait until the open enrollment process for 2016 begins on October 15, 2015. To aid consumers in making their choices, TAHU has released its three-point checklist used by agents in guiding individuals, families and employers through the enrollment process. The checklist was designed to help ensure that factors including premiums, out-of-pocket costs and limits, covered services, doctor networks, and medications covered are all fully considered in selecting a health plan. The TAHU checklist includes detailed steps that may require some preparation by the consumer. The three steps of “Review, Compare and Select” each involve multiple considerations and analysis that health insurance agents have years of experience in managing. Step One: Review your plan. Consumers are encouraged to evaluate the choice they made in year one in order to assess how it met their health care needs. This process involves reviewing a series of questions on their own or with the assistance of a professional benefits adviser. Those questions include:
Were there any issues with your coverage or the insurance company that you selected in year one? Was your doctor(s) in the plan’s network? Were your medications covered? Are there any procedures that you may be anticipating for which you want to confirm coverage? Are you satisfied with the plan? Should you consider another level (Platinum, Gold, Silver or Bronze)? Does the cost of the plan fit within your budget? Are you comfortable with the out-ofpocket expenses (co-pays, deductible and co-insurance amounts) of the policy? Do you qualify for a subsidy to help pay for your coverage? Are there any additional insurance companies offering plans this year?
Members of TAHU have extensive experience in guiding consumers through these questions and are able to assist them in reviewing and updating information whether they enrolled using the insurance marketplace, an insurer’s website or through an agent. Step Two: Compare your plan to other options. Once a consumer’s satisfaction level with their existing plan is determined, a decision can be made regarding renewal or whether there is a desire to consider other options. Even if an individual is satisfied with their first-year choice, many now have a better understanding of health coverage details and may desire to shop and compare in an attempt to get a better deal. Doing so may 2
result in the cost of a plan playing a significant role in their selection, but this is where a cheaper plan may not be a better choice. Individuals should consider utilizing the services of a professional health insurance adviser to assist in accessing the details of any plans being considered to confirm that doctors, medications and specific procedures are covered. Many consumers either don’t have the time or the insight to ensure these important aspects of their coverage will be in place. Step Three: Select and confirm your coverage for year two. Once a plan for year two is selected, health insurance agents can guide consumers through an online enrollment process or provide instructions on how to complete it. Individuals not making changes to their coverage will automatically be re-enrolled in their current plan beginning January 1, 2015. Individuals purchasing through the federal marketplace will want to update their personal information to ensure they receive the correct subsidy amount, if applicable, as well as timely notifications about changes and updates to their coverage. Individuals/families without health coverage with minimum essential benefits in 2015 will pay fines, including the higher of the following amounts:
2 percent of the yearly household income. (Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.
$325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975.
“Whether an individual or employer is purchasing for the first time or completing their second enrollment process, the cost of purchasing coverage will be the same for someone who uses a health insurance agent as an individual who does not,” stated St. Hilaire. “Agent compensation is already built into the cost of a health plan, so the price of using their services, whether inside or outside the federal marketplace, is the same whether or not an agent is involved.” Individuals and employers interested in locating a professional benefits adviser in their community may go to Find an Agent. ### Texas Association of Health Underwriters (TAHU) is a state trade association representing licensed health insurance agents, brokers, consultants and benefit professionals who serve the health insurance needs of employers seeking health insurance coverage. TAHU is a state chapter of the National Association of Health Underwriters.
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For more information, contact: Emmanuel Winston @512-542-9955
TAHU Releases “Checklist for Coverage” to Assist Consumers in Making Health Plan Choices for Year Two of Affordable Care Act Open Enrollment for Year Two Begins on November 15 (AUSTIN, TEXAS – November 12, 2014) - With the enrollment period for year two of the Affordable Care Act set to open in three days, the state’s leading health insurance agent association is releasing its “Checklist for Coverage” to help individuals and employers process the information that should be weighed in making coverage and renewal decisions. Jacqueline St. Hilaire, president of the Texas Association of Health Underwriters (TAHU), said that utilizing the assistance of a professional benefits adviser (health insurance agent) can provide peace of mind and ensure that key factors are considered in making health coverage choices, all at no cost to the individual. “What we saw in year one was that many individuals were a bit overwhelmed with the questions they faced in making the best choices for coverage. Many defaulted to the least expensive plan, which may not be the best choice for coverage or overall cost for the health care that someone needs,” said St. Hilaire. A survey by America’s Health Insurance Plans (AHIP) confirms an increase in coverage through high-deductible plans that offer lower premiums. A report by AHIP indicates the number of individuals covered by high-deductible health plans rose from 13.5 million in 2012 to 17.4 million in 2014. According to the Kaiser Foundation, the average deductible doubled between 2007 and 2014 from $616 to $1,217. Many consumers are initially attracted to the higher-deductible plans because of the lower premiums, only to discover after the fact that the reduced upfront costs result in significantly higher out-of-pocket costs. St. Hilaire added, “There’s really no reason to do this alone, given the importance of this purchase, when you have free support available from insurance experts in your community.” The open enrollment period for year two of the new law will run from November 15, 2014, through February 15, 2015. New and returning customers who take action by December 15, 2014, will have their coverage choices take effect on January 1, 2015. Existing customers who do not take action by December 15 will be automatically re-enrolled with their current coverage, taking
effect on January 1, 2015. Effective dates for coverage selections made after December 15, 2014, will be based on the agreements contained in the health policy they select. Once the open enrollment period ends, consumers will only be allowed to enroll or change coverage if they experience a “qualifying event” such as loss of coverage, marriage, divorce, birth of a child or a move to a new area. Without a qualifying event, an individual will need to wait until the open enrollment process for 2016 begins on October 15, 2015. To aid consumers in making their choices, TAHU has released its three-point checklist used by agents in guiding individuals, families and employers through the enrollment process. The checklist was designed to help ensure that factors including premiums, out-of-pocket costs and limits, covered services, doctor networks, and medications covered are all fully considered in selecting a health plan. The TAHU checklist includes detailed steps that may require some preparation by the consumer. The three steps of “Review, Compare and Select” each involve multiple considerations and analysis that health insurance agents have years of experience in managing. Step One: Review your plan. Consumers are encouraged to evaluate the choice they made in year one in order to assess how it met their health care needs. This process involves reviewing a series of questions on their own or with the assistance of a professional benefits adviser. Those questions include:
Were there any issues with your coverage or the insurance company that you selected in year one? Was your doctor(s) in the plan’s network? Were your medications covered? Are there any procedures that you may be anticipating for which you want to confirm coverage? Are you satisfied with the plan? Should you consider another level (Platinum, Gold, Silver or Bronze)? Does the cost of the plan fit within your budget? Are you comfortable with the out-ofpocket expenses (co-pays, deductible and co-insurance amounts) of the policy? Do you qualify for a subsidy to help pay for your coverage? Are there any additional insurance companies offering plans this year?
Members of TAHU have extensive experience in guiding consumers through these questions and are able to assist them in reviewing and updating information whether they enrolled using the insurance marketplace, an insurer’s website or through an agent. Step Two: Compare your plan to other options. Once a consumer’s satisfaction level with their existing plan is determined, a decision can be made regarding renewal or whether there is a desire to consider other options. Even if an individual is satisfied with their first-year choice, many now have a better understanding of health coverage details and may desire to shop and compare in an attempt to get a better deal. Doing so may 2
result in the cost of a plan playing a significant role in their selection, but this is where a cheaper plan may not be a better choice. Individuals should consider utilizing the services of a professional health insurance adviser to assist in accessing the details of any plans being considered to confirm that doctors, medications and specific procedures are covered. Many consumers either don’t have the time or the insight to ensure these important aspects of their coverage will be in place. Step Three: Select and confirm your coverage for year two. Once a plan for year two is selected, health insurance agents can guide consumers through an online enrollment process or provide instructions on how to complete it. Individuals not making changes to their coverage will automatically be re-enrolled in their current plan beginning January 1, 2015. Individuals purchasing through the federal marketplace will want to update their personal information to ensure they receive the correct subsidy amount, if applicable, as well as timely notifications about changes and updates to their coverage. Individuals/families without health coverage with minimum essential benefits in 2015 will pay fines, including the higher of the following amounts:
2 percent of the yearly household income. (Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.
$325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975.
“Whether an individual or employer is purchasing for the first time or completing their second enrollment process, the cost of purchasing coverage will be the same for someone who uses a health insurance agent as an individual who does not,” stated St. Hilaire. “Agent compensation is already built into the cost of a health plan, so the price of using their services, whether inside or outside the federal marketplace, is the same whether or not an agent is involved.” Individuals and employers interested in locating a professional benefits adviser in their community may go to Find an Agent. ### Texas Association of Health Underwriters (TAHU) is a state trade association representing licensed health insurance agents, brokers, consultants and benefit professionals who serve the health insurance needs of employers seeking health insurance coverage. TAHU is a state chapter of the National Association of Health Underwriters.
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