2019 Individual & Family Plan Open Enrollment
This year, Open Enrollment begins Monday October 15th. We expect the quoting engines to have the updated rates and plans by that date in order to review with clients.
If a new enrollment or plan change is necessary, you have until Saturday December 15th to enroll or change for a January 1, 2019 effective date.
We will be available to walk you through any questions or concerns you may have. If you wish to keep your plan as it is, simply let us know and we will renew you.
To schedule a call to speak about your needs, please complete the form to the right or shoot us an email to reserve a specified time slot. Please have 2 date/time preferences to be sure we can accommodate you. As always, you can email us anytime with your questions if you do not require a phone call.
For more intricate needs, we have extended availability during this period to be sure we get you taken care of.
Insurance carriers should have already notified you directly about your upcoming rate action and any changes to your plan if applicable. We don’t anticipate there to be as much volatility as we’ve experienced in the past. This is because we aren’t seeing a significant shift in carriers leaving the market or significant disruption in network changes like we have historically. The main issue of concern, as it has always been, will be the increase to rates which will take into account trend, risk and age up for each member and dependent. Open enrollment is a time to asses the medical needs of you and your family with the opportunity to make plan changes if needed. Taking into account the premium cost per month/year for the ability to finance the cost of care.
Below are the 3 main individual insurance carriers represented for our clients. We are not certified with Covered CA which means if you are eligible for a premium subsidy, we cannot assist you. We can refer you to a Covered CA certified agent for assistance.
Happy Open Enrollment! We look forward to taking care of you!
Blue Shield of CA (PPO & Trio HMO)
For existing clients who wish to simply change plans within Blue Shield, we can take care of that for you if you email us your plan change request in writing.
For new Blue Shield enrollments, below is a link to quote & enroll.
UPDATE reg BLUE CARD out of state coverage
For 2019, coverage out of state will be limited to Urgent Care and Emergency Care. Alternative care options while out of state for non-emergency care:
• Teladoc - talk to a board-certified doctor any time, day or night, over the phone or via video chat.
• NurseHelp 24/7 can provide you with immediate and reliable health advice from a registered nurse any time, day or night, over the phone or via online chat.
Oscar Health (EPO)
What is an EPO? An EPO stands for Exclusive Provider Organization. These plans act very similar to a PPO, however there is NO out of network coverage unless its due to a true life threatening emergency. The benefit of this is the ability for the insurance company to control costs a little better and pass on those savings to the consumer. The network tends to be much more exclusive as well, focusing on high level providers rather than any willing provider. One example of this is OSCAR. Many of you may remember discussing Oscar during last year’s Open Enrollment. It was the first year our firm decided to get appointed and offer their plans as we were waiting until their “newness” to CA wore off a bit. We’re happy to report that almost all the clients who enrolled with Oscar for 2018 have been extremely satisfied. They leverage technology and the importance of communication - offering every member a concierge team to help coordinate coverage and care. The concept that they do not cover out of network providers is mostly physiological in our opinion. This is because even on a PPO plan that does have out-of-network coverage, you will have a significantly high separate deductible ranging around $5,000 or more. Only the “allowed amount” will go toward that deductible. Meaning for non emergency services, you may never really reach the point in which the plan begins to reimburse you. For this ability you end up paying on average more than an EPO. Although an EPO is not the right fit for EVERYONE, it is something to consider if you’re looking to reduce your premium. Please note that Oscar is only available in LA and Orange County.
Kaiser is an HMO which means you must coordinate your care with your Kaiser Primary Care Physician for most services. This coordination of care typically can take out a lot of the guess work for you as to which type of doctor to see or whether or not a service is in network or covered. They are able to control costs, on average, much more efficiently compared to a PPO and for that, the premiums tend to be more competitive than most other PPO plans. If you are not used to a Kaiser provider model, I recommend we discuss your needs prior to enrolling to be sure its a good fit.
HEalth Net (EnhancedCare PPO, CommunityCare HMO, Standard PPO)
Health Net offers plans in most regions but not all. For a list of regions please go here: Plans By Location
“Full Network” PPO is only offered in specific regions. If you are in LA or Orange county, you can view hospital list in the Learn More folder above. This will give you an idea of the network access. It will come down to your physicians being in network and able to admit to those specific hospitals.
For CommunityCare HMO, your Medical Group or IPA and PCP must be contracted.
Health Net also has a narrow network PPO called “EnhancedCare” PPO. For LA this does not include UCLA or Cedars.