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  • InsideTrack
  • November 04, 2015

    Annual Checkup Time: Review Your Options During Health Insurance Marketplace Open Enrollment Through Jan. 31

    With health insurance open enrollment beginning Nov. 1, 2015, now is the time to explore and change your insurance options for your specific situation. If you have questions, the State Bar can help you find the answers.

    Nov. 4, 2015 – Fall is the time to move your clocks back, check your smoke detector batteries, and review your health insurance options.

    The open enrollment period runs Nov. 1, 2015, through Jan. 31, 2016. This is the time to review your health insurance coverage - whether you have an individual or group plan, evaluate whether you need to make any changes in your health insurance policy, and to seek options available through the Health Insurance Marketplace.

    What Should I Consider when Reviewing My Coverage?

    Review your coverage and make any needed changes. Factors to consider when deciding whether you need to make changes in your plan:

    • the product’s premium cost;

    • out-of-pocket health care expenses not paid by insurance;

    • eligibility for government subsidies;

    • the product’s exclusions and benefit limitations; and

    • access to specific health care providers and/or provider networks.

    When Can I Make Changes to My Plan Outside of Open Enrollment?

    Enrollment or coverage changes outside of the open enrollment period is permitted only if you qualify due to special events like marriage, the birth of a child, or loss of other health coverage. A summary of these special enrollment events is available in this InsideTrack article from December 2014.

    Who Can Answer My Questions?

    Bultman Financial Services and Professional Insurance Programs have a long-standing working relationship with the State Bar and are trusted experts in helping State Bar members find coverage. Contact either of them to get your questions answered – they will help you find options that work the best for your situation:

    If You Have Non-ACA Compliant or Group Plans

    If you have a non-ACA compliant plan, or your firm has a small- or large-group plan, keep in mind these considerations as you evaluate your needs for 2016:

    • Non-ACA Compliant Plan Renewals
      If you previously renewed a noncompliant policy, you should contact your insurance company to determine whether an additional renewal is an option for you to consider. The U. S. Department of Health and Human Services (HHS) issued guidance extending the ability to renew certain health insurance policies that are not fully compliant with the Affordable Care Act (ACA). Renewal is allowed only if it is permitted by your state’s law and by the insurance company that issued your policy.

    • ‘Small Employer’ Definition Change Affects Group Plan Eligibility
      The ACA originally included a provision requiring states by law to define a “small group” as fewer than 100 employees for purposes of the small group insurance market rules. This provision was to take effect in 2016. The recently enacted PACE Act amends this provision to define a small employer as one that employed an average of not more than 50 employees in the preceding calendar year. This change means that employers of 50 to 100 employees who previously purchased a “large group” health insurance policy will not need to convert their large group health insurance policy to a small group health insurance policy. This change does not apply to health insurance policies for employers of 50 or fewer employees who were already considered small groups or those who have individual health insurance policies.

    Need More Answers?

    In 2014, the State Bar ran a series of articles and a video to answer questions about changes in health care coverage because of the ACA. These articles provide additional information about the ACA and health care coverage:

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