Tag Archives: health care

80/20 Rule

Did you know… about the 80/20 rule?

We realize that many people may have health care but don’t know how the systems work or what their premiums are going to each month. We understand that life is busy and that you may not have all the time in the world to research and learn an argumentatively complex system of health care insurance and providers. So we thought that we would start a new series of posts focused on “Did you know…” With this blog, we will be looking at the 80/20 rule.

 

Did you know… that health insurance companies are required to spend a mandated amount on your healthcare? Insurance Companies are mandated to $.85 of every dollar on your Health Care.

 

This 80/20 rule is also referred to as Medical Loss Provision Ratio in the Affordable Care Act. The rule states for 80% of premiums collected must be spent on health care or on improving actions for the person. The other 20% can go to administrative needs of the medical insurance company such as marketing or other financial needs. These numbers specifically apply to individual and small group markets. If you are part of a large group market, then the numbers change to 85% and 15% of healthcare and administrative needs respectively. The thought process with this rule is to ensure greater transparency within insurance companies so we can truly see where the money is going. If an insurance company does not spend the 80 to 85% of premiums toward healthcare, then they are required to provide a rebate for the portion that was not spent. This rebate looks at the entire corporation and their spending and not just on one individual’s health care expenditures. Are you someone who has received this kind of rebate in the past? If so you know that the rebates usually come in the form of a check to the individual, are applied as a credit to their account or are reflected in the rates of the following year of insurance. Or if you are part of a small or large group then the rebate is given to your employer who passes it along to their employees. We hope that this “Did you know” blog was helpful. If you have any more questions about the Medical Loss Provision Ratio, please feel free to call and ask us.

Health Insurance Special Enrollment Period

If you missed out on signing up for health insurance during open enrollment, do not worry! The Federal government has recently announced that they are opening a special enrollment period for those who were not able to sign up for health insurance during open enrollment. This special enrollment period runs from March 15th to April 30th and is the last time that you will be able to sign up for health insurance coverage for 2015. While this special enrollment period only applies to the 37 states that are covered through the federal marketplace, state-run exchanges are expected to follow.

In order to qualify for the special enrollment period, people will have to prove that they only became aware of the tax penalty for not having health insurance when they were filing their taxes. While the special enrollment period will not reverse the fine for not having health care, it will give people a chance to get the right health care plan for their needs.

Under the Affordable Care Act, everyone is required to have a health insurance plan, or face a financial penalty. However, many people were not aware of the penalty for not having health insurance until they started filling out their tax return for 2014.

The government also recently accounted that the wrong information to help calculate whether they received too much or too little of a subsidy for last year was sent out to 800,000 people. People who have been affected should have already been notified by phone or email, and need to wait to file their taxes until they receive a new 1095-A form, which was sent out in early March.

For all of your health insurance needs and to ensure that you have the right amount of health care under Covered California, contact Bernardini & Donovan Insurance Services in Redlands, California.

Forgot To Sign Up For Health Insurance? Special Enrollment Period Is Now Open!

It is not too late to sign up for health insurance! Even though the open enrollment period ended on February 15th, Covered California and the Federal government are offering a new special enrollment period for those who were not able to sign up for health care coverage during open enrollment.

In order to qualify for the special enrollment period, you must prove that you were not aware of the tax penalty for not having health insurance in 2014, or that you may now be facing a penalty for not having health insurance during the beginning of 2015. The special enrollment period opened on March 15th, and will stay open until April 30th to give people the chance to sign up for health coverage.

It is important to keep in mind that while you now have a chance to sign up for health coverage if you are not already enrolled in a plan, the special enrollment period will not get rid of any penalties that you already have to pay. To attest that you did not know about the penalty for not having coverage, you must select “Informed of Tax Penalty Risk” on the drop down menu on the Covered California website.

In addition to the special enrollment period, there are other qualifying life events that may help to qualify you for a special enrollment period. Some of the most common qualifying life events include getting married or divorced, having or adopting a child, or moving to a state that does not offer the same health care plan that you are currently enrolled in.

For all of your health insurance needs and to ensure that you have the right amount of protection, contact the health insurance professionals at Bernardini & Donovan Insurance Services in Redlands, California.

2014 is quickly coming to a close! The middle of November has passed, which means we are in the midst of open enrollment season. If you have not already taken the time to evaluate your current, and future health care needs, now is the time to do so. Knowing what you do and do not need in a health plan will make the selection process much easier.

In order to secure your new health plan, you need to make sure you meet the appropriate deadlines. You are only allowed to go 3 months with a gap in your coverage before you will be ordered to pay an expensive fine. In order to avoid this, and save yourself some time and money, familiarize yourself with these important dates:

  • Open enrollment 2015 officially begins on November 15th of 2014.
  • The final day to enroll for a health plan that will kick in on January 1st, 2015 is December 31st, 2014.
  • All health plans purchased through the 2014 Marketplace will cease to be effective beginning December 31st, 2014.
  • January 1st, 2015 is the first date that new health coverage can begin.
  • Open enrollment 2015 will close on February 15th, 2015.

Make sure that you do not miss any of these crucial deadlines. Do not take the risk of being under or uninsured for any amount of time. You will surely regret it when you are in the face of a health care-related emergency!

The best way to navigate the 2015 Marketplace is to first contact a Certified Covered California Broker. These individuals have the knowledge and experience necessary to guide you through the complex, and often confusing world of health care. They can dispense quality advice that will make choosing the right plan for you much easier. Certified Covered California Brokers can even find ways to save you money! Please contact Bernardini & Donovan Insurance Services to speak with a licensed agent today!

Being a first-time health care policy owner can be stressful, and confusing! What happens if you select a health plan, and then decide that you wish to change it? Are you out of luck, or is there something you can do? We are here to help answer your questions like these! Here are a few pieces of enlightening health care information:

  • You are allowed to change your plan, as long as it falls within the open enrollment window, which spans from November 15th, 2014 to February 15th, 2015.
  • There may be an overlap period where you will live with your previously selected health care plan before your second choice plan kicks in. It is smart to discuss this time period with an insurance agent who specializes in health care.
  • To change your health plan during the open enrollment period, your first step should be to log into your online marketplace account.
  • Next, you should navigate through the “My Plans and Programs” section, to the “End/Terminate All Coverage” tab. Click “Eligibility & Appeals”, then “Continue to Enrollment” where you are welcome to compare and contrast different health plans that you are eligible for.
  • Pay attention to the start date of your policy once you reach a decision.
  • If you have troubles with the process, you should get in contact with one of our certified Covered California agents here at Bernardini & Donovan’s Insurance Services to help you find the right plan for you!

We hope this information has eased your mind if you think you may want to change your plan before the enrollment period is over. If you have health care questions that need answers, please get in touch with the skilled insurance agents at Bernadini & Donovan Insurance, located in Redlands! We are an experienced insurance agency who cannot wait to fulfill all of your healthcare needs!

With November on our tails, we will soon be consumed with thoughts of health coverage. The time has come to sit down, and critically evaluate our current and future health care needs. Finding the right coverage is an art of sorts. You want to make sure you can afford the plan, but that the plan will do its job in keeping you adequately covered. In order to master this art, you will need to team up with a health insurance agent. Here are just a few of the many reasons why this is a good idea:

  • The open enrollment process is only a couple of years old. While many adjustments have been made to make online enrollment less challenging, it is not a guarantee that all individuals will not run into technical difficulties. A certified Covered California agent here at Bernardini & Donovan Insurance Services is well versed in the process, and can help you overcome any speed bumps you may encounter.
  • Many individuals take less than 15 minutes to evaluate their options for a plan, and settle before thoroughly understanding how their decision could affect their life. An agent will not let you make this hasty, and unwise decision.
  • Health insurance agents have years of experience with health care, and are familiar with scenarios where an individual’s coverage was not enough. They can use this expertise to guide you in the right direction, and ensure you are not taking any risks.

You need a certified and experienced insurance agent to guide you through the process. Their assistance can help you to avoid overpaying for your plan, or having to settle for less coverage than you need. Never sacrifice coverage for price when collaborating with an agent! Please reach out to the experienced insurance professionals at Bernadini & Donovan Insurance for any assistance you may need.

With open enrollment 2015 right around the corner, you may be stressed out, especially if this is your first time applying for health coverage. However, there is no need to fret! We are here to break down the process and help you understand the often-confusing subject of health care. Here are a few useful tidbits of information to help ease your mind:

  • The only way to apply for health care before November 15th is to qualify for a Special Enrollment Period.
  • Your current health coverage will end on December 31st of 2014 if it was purchased prior to November 15th, 2014.
  • To apply online for health coverage, you will first need to make an account. Be prepared with a username and password that are secure, and memorable.
  • You can begin filling out your application on the 15th of November.
  • Be prepared to answer questions regarding your income, current health plan, how many individuals are in your household, and more.
  • After your application has been filed, you will be presented with the coverage options that you are eligible to take advantage of.
  • Once you have evaluated your options, you should select the plan that best suits your lifestyle.
  • Your next and last step is to enroll in the plan of your choice, and to pay your first premium before the payment is overdue.
  • Get in touch with one of one of our certified Covered California agents here at Bernardini & Donovan Insurance Services to help you through the process!

We hope that these tips have proven useful to you! For any additional answers to your health insurance questions, contact the insurance professionals at Bernardini & Donovan Insurance Services, located in Redlands! We cannot wait to assist you, today!

 

Before we know it, November will be nipping at our heels! Along with November comes Open Enrollment 2015! It is time to start thinking about your health insurance needs. During this time, you have the opportunity to adjust your current health insurance policy, or purchase a new one altogether. Being prepared for open enrollment now, will lead to less stress headaches come November. Here are a few things to think about before next month rolls around:

  • Be prepared to have the addresses for every individual that will be covered under your policy.
  • You will need to have your social security number on hand.
  • If you are a legal immigrant, you should have your immigration documents handy.
  • Be prepared with your pay stubs or W-2 forms to verify your employment and income status.
  • Try to find an estimate of your household income for the last year.
  • Be equipped with the insurance policy of your existing health coverage.
  • If you or anyone in your household is eligible for an employer-sponsored health plan, you should complete the employer coverage tool prior to open enrollment.
  • Make sure you know the start and end dates for open enrollment. The first day is November 15th, 2014 and open enrollment ends on February 15th, 2015. Make sure you do not miss any of the deadlines!
  • Contact your certified Covered California agent at Bernardini & Donovan Insurance!

If you still have questions about the open enrollment process, or your current health insurance, please contact the trusted agents at Bernardini & Donovan Insurance! We are located in Redlands, California, and are prepared to find you a comprehensive health plan that meets all of your needs. As healthcare continues to increase in price, so does your need for an advocate in the health insurance world. Let us be your advocate, and contact us, today!

Did you know that as a small business owner with fewer than 25 employees you may be eligible to receive a tax credit? This is only of course if you qualify to offer your employees health coverage through the Small Business Health Options Program, also known as SHOP.

The Small Business Health Care Tax Credit is typically awarded to small businesses whose full time employees make an average of $50,000 or less annually. In order to qualify, you must be willing to pay at least 50% of the premium costs of your full time employee’s health care. You will not be required to offer health coverage to your part time employees or to the dependents of your full time employees. If you have fewer than 10 employees, expect to receive the ultimate benefits. The smaller your business, the larger tax credit you can expect to receive.

Employers abiding by the SHOP qualifications can receive up to 50% of their contribution towards employees’ premium costs. As a tax-exempt employer, you can receive up to 35 percent of your contribution towards employees’ premium costs in tax credits. Remember, this tax credit is only available for those employers who have provided their employees’ health coverage through the SHOP Marketplace.

How to Qualify for the Benefits of the Small Business Health Tax Credit:

  • You must have 50 or fewer full time employees in order to offer health coverage through the SHOP Marketplace.
  • As a SHOP member, you must offer health coverage to each full time employee.
  • In order to qualify, about 70% of your employees must enroll in your SHOP plan.
  • You will need to be relatively close to a SHOP service area in order to take advantage of this program.

Bernardini & Donovan Insurance Services strives to provide Redlands, California residents with excellent insurance services custom tailored to meet your unique needs. Contact us today and allow us customize a unique health insurance package for your family based on your needs.