For those of you who are on a new plan effective 1/1/14 or later, I'm going to briefly share a few key points regarding your current plan benefits. As the government has changed the Affordable Care Act (ACA) laws 35 times, we are finding our more every day which may affect your choices for the future. Initially, not all of the administrative procedures of the 2014 plans were released because they were still writing the legistlation.
If you are on a new PPACA 2014 plan, depending on how much you use your insurance, you may not realize how differently the benefits are administered this year.
Open enrollment will begin again November 15, 2014 for a January 1, 2015 effective date. It is expected to run through February 15, 2015. We have no information yet on the 2015 plans and what the enrollment process will be. We have not been told yet if you will need to re-enroll.
If you are on a new PPACA 2014 plan, depending on how much you use your insurance, you may not realize how differently the benefits are administered this year.
- The network coverage is very different. Blue Cross Blue Shield has 5 different networks and the bigger the network, the bigger the monthly premium. You must stay in-network to receive benefits. There are no out-of-network benefits on most plans unless the claim is a "true emergency"....now defined as potential loss of life or limb if immediate medical treatment is not sought.
- Primary care doctors must make referrals to specialists and coordinate your care. If you don't have a primary doctor, one will be assigned to you. If you haven't established a relationship with one, please do so and let your insurance company know. An annual physical is paid for by insurance carriers to provide early detection of health issues if you see an in-network provider. Certain other preventative care tests are also covered based on age and frequency.
- If you received a subsidy and the Marketplace has requested information to support your income, and/or identity, please send it in promptly to avoid losing your subsidy.
- If your coverage lapses due to non-payment of premium, you cannot receive a new tax subsidy for your next plan until 1/1/15. This is a new law written last week! If it is close to the end of the month and you haven't yet paid your premium, please pay online or call the carrier to make a payment over the phone. Payment receipt and processing must be completed by the carrier prior to the end of the month.
- If you dropped your plan which was effective before 2014, you cannot go back to it. Think twice before making a change and call us for assistance.
- If a generic is available, you can't get a brand name medicine. If you jump thru lots of hoops, you may get an exception to this rule with your doctor's help.
- If a medicine is available over the counter, you can't get a prescription for it anymore, nor can you pay for it with a
- After March 31st, you cannot change your plan benefits.
- You must have a qualifying event to change your coverage with a special enrollment period. This includes: Marriage, divorce, birth, death, adoption, moving to a new area where your plan isn't offered, loss of coverage, etc. Should you have one of these events, please contact us.
Open enrollment will begin again November 15, 2014 for a January 1, 2015 effective date. It is expected to run through February 15, 2015. We have no information yet on the 2015 plans and what the enrollment process will be. We have not been told yet if you will need to re-enroll.
Jeanine Kinzie is a Licensed Health Insurance Agent, Licensed Life Insurance Agent and a Federally Facilitated Marketplace Enroller / SHOP Marketplace Enroller from Grand Rapids, Michigan.
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