What is Proposition 45?

There has been a lot of debate over California Proposition 45, the Public Notice Required for Insurance Company Rates Initiative. Prop 45 would require certain regulations on health insurers similar to homeowners insurance and automobile insurance industries. Essentially, the initiative would give the elected Insurance Commissioner a pretty broad authority to either approve or disapprove anything affecting health insurance. This not only includes rates but also coverage for individuals or small group plans.

If approved, Prop 45 would:

  • Mandate that any changes regarding health insurance rates be approved by the California Insurance Commissioner prior to taking effect
  • Require that the public be notified of any health insurance rate changes
  • Prohibit health, auto, and homeowners insurance from denying coverage or determining enrollment eligibility based on credit history or previous coverage
  • Health insurers would be required to give a sworn statement regarding the accuracy of their proposed rates and justification of any changes
  • Large group employer health plans would be exempt (this proposition only applies to small group business and individual policies)
Why are people opposed to Prop 45?
  • Individuals and organizations would be able to collect fees and challenge insurer rates in front of a court room (Similar to how Consumer Watchdog does this to keep home and automobile rates down)
  • The are concerns that the Insurance Commissioner will change over time and thus may side differently (either with consumers or with the insurers)
  • The Insurance Commissioner will be an elected official who can receive funding for his or her campaign from insurers or people with special interests which may cause bias

What are your thoughts on Prop 45?

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What You Need To Know For Open Enrollment

October is when the open enrollment period kicks off. This is the time where people are eligible to either renew their current plans or enroll in other health care options. It’s also a time when new applicants are eligible to get coverage. This is an opportunity for participants in the Covered California exchange to modify their current health plan options or elect a different carrier. If you are unhappy with your plan, now is the time to think about what you want to change it to.

What does this mean for Covered California?

  • Navigators on the California exchange will be responsible for educating consumers about the open enrollment period and help them get coverage.
  • More importance is also placed on the navigators to help retain the current participants enrolled in a Covered California policy.
  • If consumers aren’t enrolled in a policy, they could face penalties so get prepared ($95/adult and $47.50/child).
  • Covered California is also working on improving call centers and their website chat since they were inundated last year. This caused frustrations for applicants who were waiting for hours to get assistance and complete applications.

Are there any changes to expect in this open enrollment period?

  • The period to register for a health care policy under Covered California will be three months shorter than last year.
  • Anyone enrolled in a current Covered California plan who does not make a change to their policy by December 15th will be automatically re-enrolled for 2015.

Advice before entering this open enrollment period:

  • Evaluate your current health policy. Are you happy with it or is there something you would like to change?
  • Get educated. If you are thinking of modifying your health plan or look into alternative options, do some research. Navigators are also there to help you find the plan that fits your needs.
  • Be prepared. If you want to change your plan, do so before December 15th. If you want a certain expense covered, find out which policies will help you get the best coverage for that need.

If you have any questions regarding a health policy, please feel free to contact our office. We’d be happy to help.


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Navigators Given Grants to Boost Enrollments

On Monday September 8, 2014, Health and Human Services (HHS) agreed to give $60 million in federal grants to help navigator programs on the health care exchange. Last year, HHS awarded states $67 million dollars in grants to help build out the navigator programs. Navigators are individuals who help consumers with questions regarding enrollment. They are  trained individuals who are able to assist consumers, small businesses, and their employees looking into health care options. Navigator grants are only permissible in states where the federal government is setting up the exchanges. States with their own healthcare exchanges (like California) must set up their own navigator education program to assist individuals during the enrollment process.

Last year, it was reported that the navigators helped around 10.6 million U.S. residents during the initial open enrollment period of the ACA. This year they are hoping that even more navigators will get involved with the program to help consumers get covered.

Navigator grants are awarded to:

  • Charities
  • Non-profits
  • Universities

It is important to note that there are some new rules and requirements to be eligible to become a navigator including:

  • Navigators must reside in the area they serve
  • Navigators must submit weekly progress reports to HHS
  • Navigators who are grant recipients must receive formal training and adhere to privacy standards

Despite these new navigator eligibility rules and the funding made available for the navigator programs, there is still some concern from many regarding the training and confidentiality of information when working with navigators. These navigators will be responsible for handling very private and secure personal information for millions of Americans. It is important to look into the training and background of each navigator to ensure that there will not be a breach of security with this private information.


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Healthcare Website Hacked

Last week, reports were released that hackers got access to the Healthcare.gov server and initiated a malware attack. They hackers went undetected for almost 2 months and the government only became aware of the attack after running a manual scam of the database. This is the first noted case of a hacker successfully getting through the site’s defenses. This news comes only a year after the numerous crashes to the website upon open enrollment. According to the Wall Street Journal, malware was uploaded to one of the servers signaling a fake wave of traffic. This increased wave of traffic could crash the site making online users unable to access it.

What about personal information?

The Centers of Medicare and Medicaid Services claim that there was no private information leaked or hacked during this incident. After authorities reviewed the server and conducted the manual scam, they found that there wasn’t any personal information on that specific server. Therefore, the attacker should not have anyone’s private or personal information. Still, they are working on improving the website security to prevent any future re-occurrences.

What are people saying about this breach?

People are worried about the security of the website. The site contains personal and confidential information for millions of Americans. While it wasn’t accessed during this attack, it does raise concerns regarding the security and safety of this information.If you would like more information regarding the cyber attack of the Healthcare.gov website, please read more here.

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Consumers Must Verify Lawful Presence in California to Continue Receiving Benefits

Due to a high number of errors and inconsistencies in the Covered California application documents, agents and counselors are reaching out to about 98,000 families in order to verify their citizenship and enrollment documents. Families must submit documents showing proof that they are legally present in the United States as citizens or have eligible immigration status. Notices will be mailed or emailed and proper proof needs to be submitted by September 30, 2014 or else these families risk losing their health coverage.

The goal of getting these documents is to provide a solution to the errors in applications and develop a smoother transition process for the next enrollment period. Thus far, over 700,000 documents have been verified and processed according to the Executive Director of Covered California Peter Lee.

What does this process entail:

  • Agents need proof of citizenship (sometimes there are two documents and one may have been illegible so they are asking for families to resubmit these materials)
  • Notices will be delivered to families in English and Spanish describing the documents they need to rectify the situation
  • Families can upload documents to their Covered California account or send them via UPS or fax
  • If anyone has questions, certified agents and call centers will be available for help
  • Documents must be submitted by September 30 or families risk termination of coverage (this means they may face a tax penalty for not being enrolled)

Overall, this process is meant to ensure proper eligibility for enrollment in a Covered California health plan and help transition smoothly with future enrollments.

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