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Archive for the ‘Individual and Family Health Insurance Plans’ Category

Covered California ( Announces information about the formation of the California Health Insurance Exchange

Posted on: March 8th, 2013 by Morgan Hege


As the New Year got under way, Covered California shot out of the starting blocks in the final sprint toward the finish line of opening a new and innovative health insurance marketplace in January 2014.  In less than 10 months, Covered California will begin providing quality, affordable coverage for millions of Californians.  This communication provides an update on recent accomplishments and upcoming activities that will prepare us for a successful launch.


Recent Accomplishments


  • Covered California became the first state-based exchange in the nation to require Qualified Heath Plans sold though Covered California to offer standard benefits for each of the “metal tiers” plans will offer.  With these standard benefit designs, consumers will be able to make apples to apples comparisons.


  • Covered California launched a new consumer website at in English and Spanish including a calculator to allow people to estimate what they would pay for coverage.  The website also includes fact sheets in eleven languages and social media links atFacebookTwitterTwitter en EspañolYouTube and Google+. We encourage you to join us on Facebook and send the link of our website to your friends and colleagues.


February Board actions and updates


The Board met in Sacramento on February 26. Materials from that meeting are available here. The following are highlights from the meeting.


  • The Board authorized staff to move forward with development of a “bridge” program that would allow individuals and families transitioning from Medicaid or CHIP coverage to Covered California to stay with the same plan and provider network, preserving existing clinical relationships and continuity of care. Click here for the press release announcing this action.


  • The Board reviewed staff recommendations on how Covered California can assure that employees and assisters having access to personally identifying health and/or federal tax information of applicants have appropriate background checks. The Board Recommendation Brief on employee background checks can be viewed here and the draft regulations here.


March 21 Board meeting preview


The March 21 Board meeting will be held at 1500 Capitol Mall, Sacramento, in the East End Complex Auditorium.  The meeting will begin at 9 AM in closed session with open session expected to convene at 12:30 PM. The following is a preview of some items that will be discussed.


  • The Board will consider for adoption Covered California policy regarding background checks of employees and assisters having access to personally identifying health and federal tax information and draft regulations governing fingerprinting and criminal record checks.


  • The Board will hear a presentation and panel discussion on the role Covered California can play in reducing health disparities.


  • The Board will discuss policy issues related to eligibility and enrollment.  A table of the key policy issues and Covered California staff recommendations can be viewed here.


Upcoming Opportunities for Participation


  • Assisters Webinar: Covered California will host its second webinar to gather stakeholder input on the Assisters program.
    • Tuesday, March 12, 2013
    • 1:00 PM – 2:30 PM
    • Register here


  • Eligibility and Enrollment Webinar: Covered California will host a webinar to receive stakeholder input regarding eligibility and enrollment policy options.

o   Thursday, March 14, 2013

o   9:00 AM – 10:30 AM

o   Register here


  • Town Hall Meetings: To provide the public and interested stakeholders the opportunity to interact with and ask questions of Covered California Board members and senior staff, Covered California will hold town hall meetings throughout California in 2013.  A schedule will be announced in the coming weeks.


Covered California 2013 Board Meeting Date and Location Updates


  • The April board meeting has been moved to April 23, starting at 9 AM.


  • To better facilitate Board meeting logistics and preserve resources, all future meetings of the Covered California Board will be held in Sacramento.  This year’s previously scheduled board meetings in April in the Inland Empire and October in the Bay Area will not be held in these locations and will instead be in Sacramento.  As noted above, Covered California will hold town hall meetings across the state in 2013 to provide opportunities for regional engagement for our stakeholders.

Cigna Healthy Rewards program

Posted on: February 19th, 2013 by Morgan Hege

Many clients are not aware of Cigna’s Healthy Rewards program which gives discounts on many popular benefits like vision, chiropractic, and more! Learn more about their Healthy Rewards program here. Healthy Rewards Flier It is included with every individual and family Cigna Health Plan at no additional cost!

Grandfathered Plans, to keep or replace? That is the question!

Posted on: February 19th, 2013 by Morgan Hege

Grandfathered Plans, to keep or replace? That is the question!

Generally “that” is not much of a question.  Long story short, ditch the Grandfathered Health Plan. Find a new health plan.  By definition  Grandfathered  Health Insurance Plans are closed plans at this point, meaning the government has made them illegal to sell to new members because they do not meet the new health insurance plan requirements.   Closed plans are generally bad for consumers because there is no new premium (also read as healthy subscribers) coming onto the plan. Therefore the rates start to sky rocket as utilization begins to increase as existing members age, get sick or get injured. The pool of money is evaporating just as the increase in utilization begins. “No Bueno”

Lets look at a comparison I did for an existing client recently between her existing Grandfathered Anthem Blue Cross Tonik 1750 plan, and the new Cigna Open Access 5000/100% plan:


  1. $115 X 12 = $1380 total premium on Cigna vs $212 X 12 = $2544 on Tonik a savings of $1164
  2. Cigna $40 copay vs $45 copay on Tonik. Advantage Cigna.
  3. Cigna Non-Grandfathered status vs Tonik Grandfathered status = Push, no significant difference
  4. Cigna has a $5000 deductible vs Tonik has a $1750 deductible = $3250 in favor of Tonik.
  5. Cigna Dental is optional but better vs Tonik dental is included. Advantage Tonik.


So which one is better? I always like lower cost. $115 vs $212 a month is a good thing. Even though the worst case scenario is about $2000 more, the difference in premium makes up for it in my opinion. Call Morgan Hege at 1-877-758-7587 to discuss your plan and to shop for a better health insurance rate.

California Healthy Families program Discontinued, Children being transitioned to Medi-Cal

Posted on: February 19th, 2013 by Morgan Hege

Healthy Families program begins transition of children to Medi-Cal (The California State Medicaid program) Many parents may find it is time to apply for individual health insurance coverage for their dependent children rather than continue with the state sponsored Medi-Cal program they are being offered. To receive a free quote on guaranteed issue minor child health insurance, visit or call Morgan Hege at 1-877-758-7587 to discuss affordable health insurance options.

If your child is being transitioned from Healthy Families to Medi-Cal now is the time to consider finding alternative coverage with better protection and point of service care from a traditional health insurance plan. Currently Anthem Blue Cross and Blue Shield of California  as well as Health Net of California all offer guaranteed child plans even with pre-existing conditions. If your son or daughter is healthy, it is a great time to transition to one of these plans.

Health Net offers the most affordable plan’s as low as $55/mo for an 18 year old in San Diego county. on their Health Net PPO Advantage 6500 featuring a $40 copay for the first two office visits and No Charge for an annual physical and routine scheduled shot and wellness care. Get a health insurance quote on this and other plans now!

Anthem Blue Cross announces: Shingles vaccine now covered at pharmacy

Posted on: February 15th, 2013 by Morgan Hege

Shingles vaccine now covered at pharmacy

On January 1, 2013, we began pharmacy coverage of the brand-name vaccine, Zostavax. This is a one-time-only adult immunization against the shingles virus. At this time, there is no generic alternative for Zostavax.

Because the shingles vaccine needs special handling, many doctors have stopped making it available in their offices, making it harder for members who want to get the immunization.

Where should members get their one-time-only shingles immunization?

  • Older adult members can get the shingles vaccine at a participating network pharmacy.
  • Many major pharmacy chains, such as CVS, Rite Aid and Walgreens, take part in the shingles immunization program. We encourage people to call the pharmacy first, to make sure it is in the shingles vaccine program and has the serum in stock. They might also want to confirm whether a doctor’s prescription is needed to get the vaccine, as this may vary.
  • Members also may get their shingles vaccine through their doctor, if he or she stocks the serum in the office.
  • If the doctor doesn’t stock the vaccine in the office, he likely will refer patients to a pharmacy for their shot.

How is the benefit paid?  
All prescription drug plans, except generic-drug-only plans (there is no generic for Zostavax), include this now. However, benefits will vary from plan to plan, based on whether the plan is “grandfathered,” meaning that it does not include the preventive care provisions of the Patient Protection and Affordable Care Act (PPACA).

  • Members on a non-grandfathered plan will not need to pay a cost share.
  • Members on a grandfathered plan – one that did not implement the PPACA preventive care provisions –may pay a cost share based on their benefit design.

What is shingles?
Shingles is a painful skin rash caused by the varicella zoster virus*. This is the same virus that causes chickenpox.Shingles most often appears in a band, a strip, or a small area on one side of the face or body. It is also calledherpes zoster.

Anyone who has had chickenpox can get shingles. It most commonly occurs in older adults and people who have weakened immune systems due to stress, injury, certain medicines, or other reasons. Most people who get shingles will get better and will not get it again. Sometimes, it can have lingering side effects, such as nerve pain, which is another good reason to get the vaccine and avoid getting shingles in the first place.

Rate Increase Roll Back on Anthem Blue Cross Individual plans

Posted on: February 15th, 2013 by Morgan Hege No Comments

Is a roll back on a rate increase still a rate increase?  Anthem Blue Cross confirmed today that they have partially rolled back the February 1st, 2013 rate increase that effected over 600,000 individual and family plan policy holders. Originally the rate increase was 17.9% but after pressure from the California Department of Insurance, Anthem Blue Cross has reduced the rate increase to only 13.9%.

That is still a large rate increase! Many  notices already received by policy holders are now incorrect, adding to confusion. Also, new plans issued by Anthem Blue Cross with a 2/1/2013 effective date will also be rolled back to the lower premium amount.

Much of this confusion arises out of the ongoing and evolving process of Health Care Reform, which has turned into Health Insurance reform. For more information about affordable health insurance quotes in California, visit or call Morgan Hege at 1-877-758-7587

A weekly compilation from Aetna of health care-related developments in Washington, D.C. and state legislatures across the country

Posted on: November 20th, 2008 by Morgan Hege No Comments

The pressure is mounting on President-elect Barack Obama to do something about health care reform sooner rather than later. Senator Max Baucus last week unveiled his plan (see below) to reform health care, and Senator Ted Kennedy is expected to do the same in the near future. Outside the Capitol, The Business Roundtable, the National Federation of Independent Businesses, AARP and the Service Employees International Union are pressing, in a letter sent last week, Obama to make an overhaul of health care a priority in his Administration’s first 100 days. This timeframe would be a monumental challenge, given the nation’s economic woes.
Senator Baucus, Chairman of the Senate Finance Committee, released an 89-page blueprint for health care reform titled “Call to Action: Health Care Reform 2009.” The plan calls for several policies with which Aetna agrees, including an individual mandate, subsidies for low-income individuals, expanded health information technology, tax credits to small businesses, Medicaid and SCHIP expansion, a comparative effectiveness research institute, medical liability system reform and a strong focus on primary care, wellness, prevention, transparency and quality care. But some aspects of the plan are problematic: a “play or pay” employer mandate; a federal health insurance exchange (similar to the Massachusetts Connector); a competing public plan; and lowering Medicare Advantage payments. Aetna has been helping to inform the Senator’s health reform plan, through Aetna Chairman Ron Williams’ testimony before Congress in June, and through both formal and informal conversations. Senator Kennedy also plans to release a health reform proposal later in the year, and Aetna has been invited to participate in those conversations as well. Whether the two proposals can be forged into one legislative package by January remains to be seen, but it seems clear that each will support a major push for health care reform early in 2009.
ARIZONA: Proposition 101, a ballot measure billed as an attempt to amend the state constitution to protect the rights of Arizonans to make their own health care and health insurance choices, was defeated by fewer than 11,000 votes. Proponents argued the measure would prevent the government from enacting a single-payer health care system. However, the scope of the language helped fuel the argument that it would apply to the state’s Medicaid/SCHIP programs and private managed care plans as well. Legal experts opined that if the measure had passed, a strong case could be made that the state’s use of private plans to deliver Medicaid benefits limits consumers’ choice of providers. Likewise, commercial plans’ use of physician networks could have come under legal scrutiny.
MAINE: As expected, the “People’s Veto” measure has passed, repealing the newly enacted beer, wine and soda taxes that would have replaced the savings offset payment (SOP) used to provide subsidies for the state’s Dirigo Health plan. The legislature passed the beverage taxes to avoid contentious litigation around the SOP and to create an equitable, sustainable funding mechanism for Dirigo. Currently, the SOP is levied on health plans and TPAs according to a formula that has been challenged every year since its inception in 2003. The SOP for 2008 was reduced from $140 million to $48 million and is the subject of litigation again this year.
NEW YORK: In anticipation of the legislative special session set for November 18, Governor David Paterson has proposed increasing the covered lives assessment by $120 million this year and next, a move already defeated once in 2008 by the State Senate. The Governor also proposed shifting the funding source for mental-health parity small employer subsidies to the revenue stream raised by insurance taxes known as “HCRA” (the Health Care Reform Act). This shift would amount to $88 million this year and $91 million next year. The state set aside $100 million annually to subsidize small businesses when it passed the mental-health parity law. It is not clear what would happen to the additional $21 million for the two years. The Governor also reintroduced his proposal to increase the State Department of Insurance’s Section 332 assessment, which is a tax on all lines of insurance premiums. The Republican majority will continue to control the state Senate until January 2009 and remains committed to opposing new taxes.
PENNSYLVANIA: The House Insurance Committee held a three-hour roundtable discussion last week with Highmark, IBC, the insurer trade representative, providers, Capital Blue Cross and UPMC Health Plan of PA concerning the proposed Highmark-IBC consolidation. The contentious meeting pitted the insurance industry against Ken Melani of Highmark. Highmark dismissed the Department’s expert report on competition as an academic exercise completed during a different economic climate (this past September). This could open the consolidation to the same argument: the Blues projections were based on a different economic environment. The House Insurance Committee plans to meet again on November 19 to discuss what, if anything, it will recommend to the Insurance Commissioner. The House and the Senate Banking and Insurance Committees have until November 29 to submit comments to the Insurance Commissioner. It is not clear what position the House will take. The Senate (at least as a majority position) is prepared to recommend disapproval or conditional approval.
Transforming Health Care in America

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. Those companies include Aetna Health Inc., and Aetna Health Insurance Company.
© 2008 Aetna Inc.

Information about online Health Insurance Quotes

Posted on: November 20th, 2008 by Morgan Hege No Comments

There are several factors to consider when shopping for health insurance quotes online. Like not putting your information into lead generation affiliate web sites!  Read more below.

Rule #1 – Avoid Affiliate Sites: When shopping online for health insurance quotes there are several factors to consider. Most sites out there are affliate sites that do not actually provide any service to you directly. Instead they sell your personal information to several agents or brokers (some times as many as 30!) When they turn around and sell your information to someone else, you have lost control over your personal information often times including date of birth. You don’t want that!

For example, when people search in Google for “California Health Insurance Quotes” the first listings that come up are generally affiliates that make money by selling your information to insurance agents. And not just one agent, but sometimes as many as 30 agents. The last thing you want is 30 insurance agents calling you to try and give you a quote, and calling you back 3-4 times as well. That can get very very frustrating.

Rule #2 – Check the Site for a Phone Number: The best way to make sure that doesn’t happen to you is to use a site where the phone number is clearly displayed. Generally that means they would be willing to take your call and hear from you directly if you prefer. You should avoid sites that do not have a prominately displayed telephone number on them.

Rule #3- Deal with a Licensed Agent It is best to deal with a licensed professional insurance agent who has taken the time to develop an online web presence as well as having an office in the state you are dealing with.

Rule #4 – Check their License Status: The next suggestion is to check the department of insurance for your state and make sure the person you are talking to is a licensed insurance agent. For example in California, you can visit the California Department of Insurance. There are many people out there pushing health discount card plans as “Guaranteed issue” that are not licensed insurance agents. If they are unlicensed, you may want to consider reporting them to you states department of insurance as well.

Rule # 5 – Get It In Writing: Finally you should insist on seeing the plan in writing before you apply. It doesnt have to kill a tree, it can be a pdf, or published information on the website that explains the plan benefits, but it is a good idea to see that what the agent is telling you is also in black and white. Just because the agent says “You are covered” doesn’t mean you really are going to be when claim time comes.

Rule #6 – The Price is the Price: Many people do not realize the prices for health insurance are fixed by the insurance company. So if you choose to try to buy direct (and run into hassels with the applicaiton process) or decude to buy from a licensed insurance agent – the price you pay is the same for the same plan.

Rule #7 Get Educated: Lastly educate yourself about the difference between HMO, PPO, and HSA style plans. And become familiar with the terminology like co-pay, deductible, co-insurance, out of pocket maximum, and the like. Use the agent you are speaking to as a resource, but if she cannot explain it to you clearly; its time to find a different insurance agent.

Thank you for taking the time to listen to an old insurance agent who has had to help too many people out of bad plans that cost too much and didn’t cover what was necessary. The internet is a wonderful tool that allows people to find what they need quickly and easily, but…

To contact me, you can call me at 1-877-758-7587, or log onto my website or a “California Health Insurance Quote” I look forward to hearing from you.