RE: 2017 Open Enrollment & Client Service Change Announcement

Transcription

1 RE: 2017 Open Enrollment & Client Service Change Announcement Dear Individual, Family & Medicare Clients, We have appreciated your business. We hold ourselves to a higher level of performance when it comes to guiding and supporting our clients. In order to continue to offer that level of service, we are making some significant changes in how we support our Individual, Family, & Medicare clients. Since the 2014 launch of ACA (Affordable Care Act aka Obamacare), insurance companies must enroll everyone that applies regardless of health conditions. This is a good thing for the general public, but it has become extremely challenging now that more high cost clients are insured and low cost young and healthy clients are not contributing to the pool of funds that pay out claims. Subsequently, we have seen significant cuts in commissions (a percentage of the premium you pay), which are the traditional way agents are paid to service clients. Those used to range from 8 to 10 percent which allowed agencies to do quite a bit for their clients. Now the average is 3 percent or less: not enough income to support all of the systems, employees, and man hours just to advise clients on their renewal once a year. We recently received word that one particular insurance company has stopped paying commissions. It will not be long before the rest of the market follows suit. We applaud the profound impact that ACA has had on creating coverage for all, and we know that it will continue to grow and improve. As an agency that values good response times, staying on top of specifics in the industry, and truly caring about our client's well being, we need to be willing to grow and improve along side it. As income and living situations change, being available only once a year for guidance is not good customer service or what we wish to provide to our clients, so For open enrollment, we have outlined our new offer to you. After reviewing it, you will need to decide if you want to continue working with our agency or choose a new agency on your own. We respect whichever decision you make, and will continue to wish the very best for you and yours. As for us, we will re evaluate this change in our service model during the summer of 2017 to assess sustainability for the long term and how many clients have chosen to embrace our new model. If the new system does not show potential for sustainability, we will begin the process of phasing out our Individual, Family, and Medicare business. This is not our preference, and we will only do so if necessary. Sincerely, Rudy R Garcia President, Qandun Insurance Agency

2 NEW CLIENTS At this time we will not be accepting any new individual, family, nor Medicare clients with a few exceptions : Existing clients keeping the same plan or changing plans with the same carrier Existing clients needing to add or remove family members from their existing coverage. Existing clients with immediate family or direct referrals that have not yet worked with us. We will charge a consulting fee of $35 per 15min increment. For clients that decide to write their insurance polic(ies) with us up to $100 of consulting fees each year can be applied to our concierge services outlined below which will earn our clients in person or phone time with us. EXISTING CLIENTS We will provide , phone and in person annual support for mid year guidance/changes and annual renewal depending on the number of policies/services you have in force with our agency. For each policy you have in force, we will include 30 minutes of support time. Example: Medical, Dental and Vision (1.5hrs) If you need more time than your policy time provides: Additional time can be invoiced at increments of $20 per 15 minutes. Individual, Family & Medicare additional product and service offerings: Medical, Dental and/or Vision Insurance Qandun Clear Enhanced Benefits (see below for more details) International/Expatriate Medical Insurance Pet Insurance

3 How can you make the best use of your available time with us? Always contact the carrier first to resolve issues. If you have a patient advocacy service, definitely tap into them when appropriate. Open/read every letter from your insurance carrier, especially during open enrollment season. Call the carrier first if you have any confusion about their letters. Pay your insurance premiums on time and double check your auto pay regularly. Clients have lost or nearly lost coverage due to this oversight of payments. Getting back on a plan typically is not possible until the following January. When you do not pay your premiums, we do not get paid. When your plan terminates, we do not get paid. Have all of your documentation ready before calling or attending a scheduled meeting with us. Identification Income and Tax Documentation when necessary Prefered provider names and locations Prescription drug list and dosage information Social Security Numbers Current Insurance Coverage Documentation Summary of Current Benefits Current Premiums ID Card of Current Coverage

4 Introducing Qandun Clear Our new Qandun Clear product family has been created to help our clients with their most time consuming needs related to health insurance. These products count toward your enrolled services and carry a little extra support time with us. We have invested time, talent, and money into the creation of these solutions. Because we see a need in our individual market, we have had to get very creative so that it is affordable for our clients and brings more value than the cost to enroll. We are very happy to bring you something that we honestly feel our clients will love even more than just their health insurance policy. Let us know if you have any questions about these services. Clear Prime Bonus 60 minutes of support time TeleMed, Patient Advocacy, Claims Resolution, and a suite of discounted services to fill in the gaps of traditional medical, dental and vision insurance. Individual $11.95/mo Two Persons $14.95/mo Family $19.95/mo Clear Plus Bonus 90 minutes of support time All Clear Prime services plus discounted chiropractic, acupuncture, massage therapy, and health club memberships. Individual $14.95/mo Two Persons $19.95/mo Family $24.95/mo Clear Premier Bonus 120 minutes of support time All Clear Prime & Plus services plus discounted access to financial and tax guidance, identify theft protection, and discounted pet care and products. Individual $19.95/mo Two Persons $24.95/mo Family $29.95/mo

5 OPEN ENROLLMENT GUIDANCE for Individuals, Families & Medicare Beneficiaries A WORD ABOUT COMPLIANCE & SHARED RESPONSIBILITY Keeping compliant coverage in force is very important. There are tax implications for not holding compliant major medical health insurance for at least ten months out of the year. For 2016 there is a 2.5% penalty that will be paid as part of income taxes for those who did not hold health insurance in accordance with the new rules. For 2017 and beyond the penalty continues to increase each year based on inflation. Check with your tax expert for more information if you are concerned that you may be subject to a penalty. Our view is that going without insurance and then being responsible for all of your own medical bills is the worst penalty and much more costly than the shared responsibility tax penalty. DIRECT CARRIER & COVERED CA ENROLLEES This year s Open Enrollment for individual and family health insurance takes place from October 1, 2016 January 31, During Open Enrollment you can change plan designs or insurance carriers. All changes made during Open Enrollment will take effect on January 1 st, February 1 st or March 1 st, 2017, depending on the date your renewal is submitted as per the following schedule: Open Enrollment Dates October 1, 2016 October 31, 2016 November 1, 2016 December 15, 2016 December 16, 2016 January 15, 2017 January 16, 2017 January 31, 2017 February 1, 2017 October 31, 2017 Who Can & What Will the Effective Date Be? Existing Enrolled can RENEW their existing plan ONLY with an effective date of January 1, 2017 Anyone can enroll or change plans with an effective date of January 1, 2017 Anyone can enroll or change plans with an effective date of February 1, 2017 Anyone can enroll or change plans with an effective date of March 1, 2017 Closed to Enrollment except Qualifying Events

6 Our preferred medical carriers with IFP plans available for 2017 are listed below: Oscar Healthplan most competitively priced EPO plans (low cost leader 2016 & 2017) Blue Shield of CA most competitively priced PPO plans (lowest cost when you want Cedars Sinai in the network) Kaiser Permanente most competitively priced HMO plans Anthem Blue Cross PPO with largest network of providers yet most expensive The below carriers are not among those we recommend but we can write your policy with them if you so desire. HealthNet of CA HMO/HSP (largest of the skinny networks) Molina Healthplan HMO (ultra small network) LA Care HMO (ultra small network) DIRECT CLIENTS (Not enrolled through CoveredCA/Not getting a Tax Credit) If you are happy with your current health plan at renewal rate and your insurance carrier is continuing to offer it, no action is required. Your plan will auto renew. Watch for the carrier renewal letter* to find out your price changes. Direct carrier relationships not through CoveredCA tend to have more choice of plans. *Some carriers are ending certain plans. Pay close attention to all letters you receive.* COVERED CA CLIENTS (with or without a Tax Credit) If your ID card has a CoveredCA logo on the front or back, your policy was written through them even if you do not qualify for the tax credit. In addition to the steps for Direct Clients, between Oct 20 th and Dec 15 th : Schedule a 15 min call with us to renew your plan. Have all of your financial documentation ready if you need to report a change in income. Fuz Edwards is our new individual / family specialist. I will only be involved when he has no time on his schedule or when the situation requires more involvement.

7 We will validate your new tax credit and premiums, and you will have the ability to change plans and add dental or vision coverage through the CoveredCA options provided. Keep in mind that when you file taxes for 2016 the IRS will send updated income info back to CoveredCA which can cause multiple outcomes.** You may owe some of your 2016 subsidy back to the IRS or you may be eligible for additional tax credit as part of your tax return. CoveredCA may change your subsidy amount and/or change your enhanced silver plan if you are on an enhanced silver plan. CoveredCA may send you to Medi Cal if your income falls below California s 138% of the federal poverty level. MEDI CAL (Medicaid and Other State Sponsored Programs) Programs that provide lower and no cost health insurance and other support to low income families is an option for those individuals, families and Medicare beneficiaries that are at or below 138% of the Federal Poverty Level. These programs do not provide agents nor brokers with tools nor compensation to assist those qualifying for these programs. If you are qualified for these programs please contact your local Department of Health & Human Services to confirm your qualifications and proceed with enrollment steps. You can also visit CoveredCA.com and click on GET HELP. You can contact local certified enrollment counsellors in your area for assistance. Medi Cal has ongoing open enrollment so once you qualify financially, you can be enrolled regardless of the time of year. MEDICARE BENEFICIARIES We have decided to contract with only our preferred carriers for 2017 and future years. Our preferred carriers are those with a solid reputation and high marks for customer service. Qualification for Medicare typically occurs at age 65 but there is a provision for those deemed completely disabled by Social Security for 24 months to be given eligibility as well. If you are or about to become eligible for Medicare, the following information pertains to you.

8 Most programs require that you have your Medicare A&B benefits active. Part A is Medicare Hospital Inpatient Coverage, Part B is Medicare Outpatient Coverage, Part C allows beneficiaries to combine their Medicare benefits with a private carrier, and Part D is Medicare Prescription Drug coverage. There are many more details to learn about Medicare before making a decision. Starting with 2017, we will only be writing policies with a limited number of carriers that have proven to us they are easy to work with and have little to no complaints from current clients. Please note, Medicare Advantage products require time consuming certifications annually and additional costs for our agency to remain eligible to enroll clients and receive commission payments. Here are our preferred Medicare carriers for 2017: Medicare Supplement Plans Mutual of Omaha Blue Shield of CA We will shop other carriers in the market on a case by case basis for supplemental products. If we can activate commissions on the carrier of your choice, we will count other carrier policies toward your allotment of support time. Medicare Drug Plans Silver Scripts (currently among the highest rated drug plan carriers by Medicare) If we do not support the plan you choose, we will provide you with the link to run your own application directly with the carrier. We will not be paid so we cannot count other carrier policies toward your allotment of support time. Medicare Advantage Plans Blue Shield of CA (HMO) SCAN (HMO) Aetna (new PPO in Los Angeles County) If we do not support the plan you choose, we will provide you with the link to run your own application directly with the carrier. We will not be paid so we cannot count other carrier policies toward your allotment of support time. Dental, Vision and Qandun Clear Dental DeltaDental of CA (HMO and PPO options)

9 Blue Shield Dental available when enrolling on Blue Shield medical products (HMO & PPO options) SCAN Dental only available when enrolling on SCAN medical plans Aetna Dental available when enrolling on Aetna PPO medical Discount Dental (not insurance) included in all Qandun Clear bundles. Vision VSP Davis Blue Shield Vision available when enrolling on Blue Shield medical products. Discount Vision (not insurance) included in all Qandun Clear bundles. Qandun Clear Please refer to the Qandun Clear portion of this letter for more information. Medicare Coverage Type Medicare Advantage and Medicare Drug Plans Medicare Part B Activation Medicare Supplemental Plans Effective Date of Coverage Open Enrollment: October 15, 2016 December 7, 2016 Effective Date: January 1, 2017 Dates vary but generally you can activate part B when you turn 65, when you are awarded permanent disability by Social Security, when you lose coverage through a non Medicare plan, or annually on July 1st. You must have Part B in order to enroll on Medicare Advantage plans or Supplemental plans. Guaranteed Issue when turning age 65 and during certain other Qualifying Events. Medical Underwriting when applying any other time. Switching to plans of equal or lesser coverage can be done in the state of CA with a Guaranteed Issue if it is done within 30 days of your annual birthdate

10 QANDUN BUSINESS REFERRAL BONUS PROGRAM We are on a mission to show employers how affordable and valuable it is to their business to have comprehensive employee benefits in force that employees actually value and love. If you work for an employer that either does not have a robust benefits program or that has no benefits at all, we would like to help you by helping your employer bring in benefits that are actually considered valuable by the employees and the employer. At Qandun we specialize in helping businesses create or revamp their employee benefits programs. We help companies find savings in various areas of their business while ensuring their employee benefits are strategic, complete, attractive and affordable. We ensure our business clients are in full compliance with all applicable regulations related to employee benefits and provide additional support for Human Resources while integrating and streamlining systems to reduce or eliminate paper from the HR and Benefits process. The more businesses that offer insurance, the fewer folks that have to hunt around in the individual market for solutions. Business plans typically have larger provider networks than individual plans and typically give people more plan design options as well. If you have a business with 20 or more full time employees that would like to consult with our agency refer them our way. As a thank you, we would like to send you a referral bonus. Refer a 20+ employee business where we are able to meet with the Owner, CEO or CFO (basically with the decision makers) A one time $100 Thank You. If the referred client makes Qandun their agency for health insurance we also pay a per enrolled employee bonus. A one time $20 per enrolled employee Thank You. For small groups with less than 20 full time employees, we can help them on a case by case basis depending on an initial evaluation and whether the owner will be the contact. If we deem it is a worthwhile prospective client, we will work with them. No initial meeting referral fee. If they become a client of Qandun for medical insurance, we will pay out a one time $10 per enrolled employee referral bonus.