search engines, no index, follow Pages #14241 (no title) ACA Health Care Reform – Obamacare Introduction 10 Essential Mandatory Benefits + CA Benefits ACA Compliant Plans vs Skinny Plans? Chiropractic – Get additional coverage Clinical Trials Infertility Laboratory Charges Mental Health – An Essential Benefit CA Mental Health Parity AB 88 (1999) Federal Parity Individual Therapy Native American Talking Circle Resources – Mental Health Autism Blame – Your fault or being scapegoated? Being Misunderstood? Non Verbal Communications Sales & Relationship Rejection Toxic and Controlling People Enmeshment – unclear boundaries Inhospitality Meme’s on Better Relationships Co Dependency FSP Full Service Partnership Lanterman – LPS – Conservatorship Gravely Disabled – What exactly is it? Definition? Criteria? IMD – Institute for Mental Disease Medical Care – Court’s Permission 7 Point Letter Murphy Conservatorship Probate Regular Conservatorships Laura’s Law – Court Mandated Mental Health Treatment Organizing, Hoarding, & Cluttering Orthotics Corrective Shoe Inserts Prescriptions Drugs – Rx Bronze Plan – How are Drugs Reimbursed? Is my prescription on the formulary – approved list? Pain Management, Optoid Crisis, Mental & Physical Theraphy Preventative Care & Wellness Programs 80% Medical Loss Ratio (MLR) CA Insurance Rate Regulation Actuarial Value Premium increases? Why are they always going up? Financial Impact of Health Care Reform on Premiums Agent Compensation Medical Loss Ratio – Agent Role Cadillac Tax Risk Corridor – Reinsurance – Adjustment Proposition 45 Rate Regulation 2014 – Historical – Didn’t Pass Rate Regulation Heath Reform Upheld as a tax NFIP vs Sebillius California vs Texas Supreme Court – ACA unconstitutional Metal Levels – Platinum, Gold, Bronze – Silver & Enhanced Enhanced Silver – Cost Sharing Reductions §156.410 Cost-sharing reductions – Enhanced Silver Cost Sharing Reductions (CSR) Enhanced Silver – Lawsuit Mirrored Plans – same network & benefits in and out of Covered CA Covered CA vs Direct Provider Lists? Q & A Open Enrollment & Special Enrollment Get Instant Health Insurance Quotes California Special Enrollment Periods Covered CA & Direct with Broker Federal Qualifying Events, Triggers CFR §155.420 conical MD not in Network? Right to Special Enrollment? Move – New County, State or Back in USA Pre-Existing Conditions – No more! Domestic Abuse – Can’t be used in underwriting Appeal & Grievances? Covered CA Appeals Insurance Application Disclosures – Table of Contents only Disclosures – Application Mistake? Deadline to Report? Rescission ACA prohibitions Fioretti v Mass General Life Last Minute Application? When does coverage start? Medical Necessity – reasonable and necessary Independent Medical Review Right to review your Medical Records Plain Meaning Rule – Read the statute 3 times EOC Evidence of Coverage Value and how to find 30 Day Free Look – Right to view EOC Breast Cancer Reconstructive Surgery Must read your policy Buy Travel & International Insurance – Geo Blue – Insubuy Blue Shield PPO Out of State & Country Companies – Carriers Blue Cross – Anthem Blue Cross Dental Grandfathered Plans – April 2020 Grand Fathered Plans What does that mean? Provider Lists – Definitions HMO, Tiered – PPO, PPO, EPO Blue Shield 2021 PPO & Trio 2021 Trio HMO ACO Blue Shield Dental & Vision FAQ’s from retired pages Member Portal – How to set yours up Provider Finder – Instructions * Exclusive PPO – Trio HMO MD says they accept Blue Shield – must they? Health Net 2021 Individual Information – Direct HN Covered CA 2021 Member Portal, Wellness & Video’s Provider Networks & Search Kaiser Permanente Kaiser Medical Financial Assistance Program (MFAP) Young Adult Program Pay Premium ONLINE? Member Services Provider Search Oscar Health Insurance Member Portal Financials – Oscar Pharmacy, Doctor & Provider Finder Sharp Health Plan Pharmacy Sutter Health 2021 Pharmacy Western Health Advantage Covered CA Tax Credits – Subsidies APTC & Rules Covered CA Rules – Introduction 2021 Rates & Benefits – average 0.6% premium increase Create Account for Covered CA from access code Native American – Indian – Chumash – Lakota – Aho MAGI – Modified Adjusted Gross Income – Line 37* Now 7 or 8b Income Chart – Line 8b 1040 Covered CA MAGI More FAQ’s – on FPL Income Chart Frequently Asked Questions Even more FAQ’s Tax Credits? ObamaCare? Reply to Web Visitor’s Question Table of Contents – Details of Income, Deductions & Expenses for MAGI Alimony – From a Divorce Settlement Child Support Health Insurance Court Order to provide Child Tax Credit Adoption Credit Married – Must File Jointly, Single, etc? Filing Status? Annuity Income? IRA, Pension # 1040 Line 4 Calif. Earned Income Tax Credit Capital Gains – Line 6 Sale of Home Capital Gains Caregiver Income? Charitable Donations Clergy – Housing Allowance? Debt Cancellation? Foreclosure? Educational Credits Employee Business Expense Unreimbursed Foreign Income IRC §911 Fudging the Income or Deductions? Gambling Income & Losses – Other Income Line 21 Gift Income? Interest Income – Line 8 a & b Itemize or use Standard Deduction? Life Insurance Proceeds Medical Expense Deduction – Line 40 Individual Rental Income? Line 17 Schedule C – Self-Employment Income – Line 12 Hobby or Business? Home Office Deduction SDI State Disability Benefits Taxable? Unemployment Compensation? MAGI Income? Sharing, Gig, On Demand, Access Economy, Air Bnb, Lyft, Uber Social Security Benefits Line 5 a & b Student Loan Interest? Report a Change – How & When – Especially Income Conditional Eligibilty Proof of Income – Accepted Documents Who can sign an application? Tax Credits & Subsidies Introduction 1095 A Covered CA Statement of Subsidy & Proof of Coverage #1095 B Confirmation of Employer, Medi-Cal & Non Covered CA Coverage 1095 C Large Employer Coverage 8962 Premium Tax Credit APTC Form attaches to Form 1040 IRS 12 c letter – need to file 8962 Premium Tax Reconcilation Maximum Pay Back of APTC? Medi Cal – Income Drop? Tax or Subsidy Pay Back? VITA FREE help – Covered CA Warning Memo APTC Advance Premium Tax Credit – Subsidies – Introduction Premium Subsidy Now or Tax Time? Credit APTC at tax time if not requested when you enroll? Tax Loss – Negative MAGI Income – Medi Cal? Subsidies? Premium Subsidy to 600% FPL + Mandate Penalty? Tax Credit Calculation? CFR 1.36 B-3 36 B Tax Credit Calculation Technical Stuff APTC Subsidies in Health Care.Gov Upheld – King v Burwell Affordable Health Coverage? 9.86% Employee ONLY Age 65 – Tax Credits? Estimated Income Change – Covered CA not paying enough subsidies? Definitions – Glossary Dual Coverage – Who pays 1st? Collect Twice? ERISA Employee Retirement Income Security Act — 1974 SPD Summary Plan Description OOP -Out of Pocket Maximum – Participating or Not? Deductibles & Co- Pays Dental & Vision for Adults and Mandatory Pediatic as an essential benefit Covered CA Dental Dental Implants Vision Grace Periods? NEVER get cancelled Non-Pay!!! Automatic Premium Payments – Benefits and Advantages Grace Periods – How long? Premiums Due? Subsidy Pay Back? Narrow Networks – 3 month grace period Pay ALL premiums – even if you lose subsidy Paying Back Premiums to get reinstated? Was the cancellation legal? Web Visitor Q & A How to properly terminate coverage Never got bill? USPS Informed Delivery – Proof you never got the bill? Individual & Family Health Insurance CA Mandate Penalty no health insurance for California §5000 A – Requirement to maintain Health Insurance Minimum Essential Coverage QHP – Qualified Health Plan Standards & Definition 10 Reasons that you need Health Insurance Exemptions from CA Mandate Penalty Health Sharing Ministries – Not Protected by Insurance Guarantees Lawfully Present – Public Charge – Immigration Status Misc. Coverages Cochlear Implants HSA Health Savings Accounts Employer Equal Contributions for employees? Medical Bankruptcy Privacy – HIPAA CA Privacy Laws Email Privacy Telemarketing Harassment? Unsolicited Email? Provider – Doctor & Hospital Finder Narrow Lists? Fewer MD’s than before? Continuity of Care same doctor chronic illness if you change plans Emergency Room – Obligation to treat uninsured patients Negotiated Rates – Itemized Bill – Regular Price? Site Map zHistorical & Agent Info Pay the bill? ID Card or Policy # ? SNAFU SNAFU’s 2015 Powered by "WP Sitemap Page" Share this:LinkedInEmailWhatsAppMorePrintPocketTwitterPinterestTumblrReddit
