Column 25 Status Update Deadlines Near

It's crunch time if you want your insurance to be effective 1/1/2014!  Application deadline for Covered California and Anthem Blue Cross (off-exchange) is 12/23/2013.  Blue Shield's deadline for off exchange is 12/15/2013. I expect many offices will be like ours and on a short day or closed on 12/23, so it's best that to pay attention to this now.  If you want to wait for a 2/1/2014 effective date, you must apply before 1/15/2014.

In addition, if you or your agent submitted a paper application and you have not heard anything, it's likely that it has not been processed.  After being told to submit paper applications initially, we followed up on a regular basis for status.  When we did reach Covered CA after the standard 45-60 minute hold time, we were told they could only check 3 at a time and that if it didn't show up to call back later.  This went on for weeks.  Last Thursday we received a notice from CAHU (California Association of Health Underwriters) that they had worked on our behalf and that all of our apps were going to be submitted.  But, they added, if the cases did not show up on our portal by the next day, we needed to go back and resubmit them all online.

Perhaps I am a cynic, but it was pretty clear at that point that all the paper applications for 7000+ agents would not be input in a day and they were simply attempting to placate us (and thought we were very stupid).  So we started inputting applications and asking our clients to also go online themselves, and appoint us as the agent.

In 35 years of practice, I have never experienced anything like this.  Anthem's commercial individual enrollment site has been glitchy at best. We still do not have an EOC (evidence of coverage document for the Anthem plans).  So on behalf of all the agents out there I ask for your patience.  We are doing everything we can to assist our clients to get the best available insurance at the lowest cost, but there seem to be more challenges than ever.  Should you decide to go it alone on the Covered CA site, I strong suggest that you add an agent to your account.  There are many qualified agents in our area.  After you log in and have started your application, click on "Find Help Near You", then click on Certified Agents, and you can search our local area for your favorite agent.  Designating that agent will not cost you more, but will give you an additional advocate during the process and after enrollment as well.

Here's a strategy worth considering for small employers. In some cases your employee's income may qualify them for no or low cost insurance on the Exchange.  This would only be if you are not offering "affordable" group insurance.  "Affordable insurance is defined as the employee's share of premium for "employee only" coverage does not exceed 9.5% of the Employee's W2 income with you.

In some cases the employee can get the bronze H.S.A. (Health Savings Account) eligible plan for little or no premium cost after the APT (advance premium tax credit).  If that is the case, you can still benefit your employee by funding an H.S.A. for the employee.  This may still be a pre-tax benefit to the employee that could fund all or a portion of their deductible, thus creating a better over-all benefit to them than the current group insurance plan.

Some employers are frustrated by trying to find affordable health plans for their employees and this strategy could prove to be a win-win for employer and employee.  The risk to the employee is that if the employer is funding the H.S.A. monthly and they have a big claim early in the year, they may not have adequate funds in the H.S.A. to pay the full expense. Also if their income increases, the subsidy may decrease, thus making the insurance premium greater. 

The employer must be careful not to discriminate.  If H.S.A. contributions are provided they must be provided to meet the comparability standards for all employee that are covered by a qualified high deductible health plan.  If an employee chooses to enroll in a Silver or higher benefit plan, they are not eligible for the H.S.A. contribution and the employer is not required to fund it.  It will take a little work with the Covered CA calculator to determine if it works, but it could be a new benefit strategy that helps the employer fix costs and the employee to have a better overall benefit package.

*Information provided in this column is "to the best of my knowledge based on press deadline. Submit your questions to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it to be answered in the paper.