GUIDE. Your. To Public Health Insurance Marketplaces. Find Coverage for You and Your Family

Transcription

1 GUIDE Your To Public Health Insurance Marketplaces Find Coverage for You and Your Family

2 We are Towers Watson s OneExchange We help you shop for a health plan. We hire and train licensed benefit advisors who understand health insurance. Our OneExchange advisors are available to help you understand your choices, see if you qualify for a subsidy and enroll you in the health plan you choose. Over the phone. For free. That s right, it s free Your company has already paid for our services. Read this guide to learn what a health insurance marketplace is, and to understand your options. Then call us to make an appointment. We will match you with the right person to advise you. It s that easy. Call and make your appointment now Or, save time! Go online and set up a private account and make an appointment. OneExchange benefit advisors are here to help you find insurance Important! regardless of your state of residence. Please note that in some states, your advisor may refer you to the marketplace for your state to complete your application and enroll in coverage. How to contact us Call us at the number below to set an appointment. You must complete your application by the 15th of the month before the month you want your new insurance to start. (For example, if you want your coverage to start on January 1, you must complete your application by December 15th.) Make your appointment at least one month before you want your new coverage to start to give yourself enough time to understand your health care insurance options and enroll in new coverage. Please allow one hour per person you want to cover to complete your call (TTY: 711) Monday through Friday, 7:00 a.m. until 8:00 p.m. Central Time OneExchange.com/motorola Ready to get started? let s go! 2 Motorola Solutions ACC-HIMG-2015

3 OneExchange is Your Marketplace Resource Towers Watson s OneExchange is not an insurance company. We are here to help make it easier for you to: Understand the marketplace Compare your insurance options Enroll in a health insurance plan that fits your unique needs How we can help you Health insurance is hard to understand. It has its own language, and the terms are technical. You might think it s just easier to ignore the whole thing. But if you are a citizen of the United States, as of 2014, the law says you have to have it or you ll pay a penalty when you file your federal tax return. In 2015, that will be $325 or 2 percent of your taxable income, whichever is greater. The long name for this new law is the Patient Protection and Affordable Care Act, usually called ACA for short. Sometimes people call it health care reform, or Obamacare. Whatever you call it, we ll help you learn how it works, and what choices you have for coverage. You can do that by phone, by reading the materials we send you or by visiting our website. Your choice! In addition to this guide, you will be receiving our Enrollment Guide to help you with enrollment. And, a licensed, certified benefit advisor will help you figure out all the details, step-by-step. Help you answer questions about things like: Is a subsidy a good choice for me? How do I know which plan to choose? When should I enroll? What happens if I don t enroll by my deadline? We ll work together Your OneExchange benefit advisor will need information about your income and health care needs. Providing this information will help us determine if you qualify for financial assistance, and find the right plan for your unique needs. After you enroll in your new insurance, you ll be able to call on us at any time. If you move, get married or divorced, have a baby, lose a job or get one, or simply have a question about a letter from your insurance company, you can call OneExchange. Our contact info is on the inside front and back covers of this guide. ACC-HIMG

4 Exchange or marketplace: You may hear the public health insurance marketplaces called exchanges. These terms mean the same thing: an online store where you can view, choose and enroll in a health insurance plan. Understanding the Public Health Insurance Marketplace What is the public health insurance marketplace? Public health insurance marketplaces opened in October 2013 to offer the American public an easy way to purchase health care coverage. A key part of health care reform, these marketplaces operate in every state. They help simplify your search for health coverage. Some states have their own marketplace. Other states use the federal government s marketplace. The marketplace collects all of the information on available plans in one place. Your state-specific health insurance marketplace is a one-stopshop that allows you and your family to compare health insurance plans, select one and enroll in it. It simplifies your search for health coverage by allowing you to easily compare price, quality, benefits and other important features side-by-side. The marketplace also determines whether you are eligible for federal subsidies and cost reductions that can help pay monthly insurance premiums and other costs related to health coverage. You ll see the amount of savings you re eligible for when you fill out your marketplace insurance application. Coverage outside the marketplace Not everyone has to buy insurance on the public health insurance marketplace. But all insurance, no matter where you buy it, has to follow all the rules of the ACA. For some people, it can make sense to consider plans that are available outside the marketplace. Others can get insurance through a spouse s employer, or through their parents. It may make sense for you to shop off-marketplace if you don t qualify for lower costs on your premiums based on your income. Since off-marketplace plans do not offer subsidies, your benefit advisor can help you learn about plans both on- and off-marketplace to find the one that works best for you. We can help you shop for off-marketplace plans in almost every state. Call us if you have questions about the off marketplace plans available in your state. Rest assured that off-marketplace plans include all of the consumer protections that the on-marketplace plans do, such as covering Essential Health Benefits, requiring coverage for pre-existing conditions, and letting children up through age 26 stay on the plan. 4

5 The Patient Protection and Affordable Care Act (ACA) in a nutshell The ACA is the law passed in 2010 that requires all Americans to carry health insurance, or pay a tax penalty. The law itself is thousands of pages long (for more information, visit healthcare.gov), but here s the bottom line Having health insurance that meets certain standards means you will be following the law. 2. It also means that your financial health may be better off if something goes wrong with your physical health. 3. And, it means that you can take advantage of all the positive changes in the insurance industry! Health insurance reforms created by the ACA Here are a few of the ways the ACA changed the rules for the insurance industry. No pre-existing condition limits. Insurance companies cannot refuse to cover you or charge you more because you received care in the past for an illness. Also known as guaranteed issue. Free preventive care. All plans must provide coverage for free preventive care. This includes preventive screenings like blood pressure and cholesterol tests, mammograms, colonoscopies and more. It also includes coverage for some vaccines and new preventive services for women, like contraception and cervical cancer screening. Most of the time, you ll need to see a medical professional within your network for the care to be free. Qualified Health Plans. The government certifies all plans in your health insurance marketplace as Qualified Health Plans. That means they cover a set of services called Essential Health Benefits (EHBs). No dollar limits on Essential Health Benefits. No plan can put an annual or lifetime dollar limit on coverage of Essential Health Benefits. Plain language. Insurance companies must use plain language to explain your benefits and coverage. Easy comparison shopping. Insurance companies must give you a standard form, called a Summary of Benefits and Coverage, that lays out your potential costs so you can compare apples-to-apples across plans. They must also give you a glossary of terms used in health coverage and medical care. 5

6 No cancellations for honest mistakes. It s illegal for insurance companies to cancel your health care plan if you make an honest mistake on your application. (But they can cancel your health insurance plan if you purposely put false or incomplete information on your application, or if you don t pay your premium on time.) Thirty-day notice. Your insurance company must give you a 30-day notice before canceling your health coverage, which gives you time to appeal the decision or find new coverage. No additional cost for out-of-network emergencies. Insurance companies can no longer charge more, or require pre-approval, for out-of-network emergency care. If you have a true medical emergency while traveling out of your network, you should seek care at the closest medical facility and not worry about paying extra out-of-network coinsurance or copays. Kids can stay on longer. Children can stay on their parent s plan up to age 26. Young adults up to 26 years old can stay on or rejoin a parent s health insurance plan even if they are: Married Not living with their parents Attending school Financially independent Eligible to enroll in their own employer s health insurance plan What are Essential Health Benefits? Under the law, EHBs must include items and services in at least the following categories: Ambulatory patient services like going to the doctor or visiting the hospital as an outpatient Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services, and chronic disease management Pediatric services, including oral and vision care 6

7 While all health insurance plans must cover these services, some plans may vary in the costs that you will pay for each service. And some states require coverage for items not on this list, like autism services or hearing aids. When you review your marketplace plan choices, you ll be able to compare them side-by-side based on their cost and coverage. Determine if you are eligible for financial assistance If your estimated household income is between $11,490 and $45,960 (individual) or $23,550 and $94,200 (family of four) the government will probably be able to help make your health insurance and medical care expenses more affordable. These amounts are based on 2014 numbers for people living in the lower 48 states and are likely to be higher in 2015 as well as for people living in Hawaii and Alaska. If your income is lower, you may be able to get a different kind of coverage through your state. States sometimes have different names for these insurance programs, but most call them Medicaid (for adults) and Children s Health Insurance Program (CHIP) (for children). If your income is higher, you may not be able to qualify for Medicaid, CHIP or financial assistance from the federal government. You ll learn more about eligibility for financial assistance in your Enrollment Guide, or when you speak to a OneExchange benefit advisor. 7

8 Review health plans In general, if you pay less for your monthly insurance premium, your cost for medical care will increase. If you pay more in premiums, you ll likely pay less in medical expenses. There are five categories of insurance plans: Catastrophic, Bronze, Silver, Gold and Platinum. These plans differ based on how you and the plan share the costs of your care, but NOT on the amount or quality of care you get. This chart gives you an idea of the types of plans and costs offered both on- and off-marketplace. Plan Level Percentage of Health Care Costs Covered Monthly Premium (Up front costs) Potential Out-Of-Pocket Costs (Costs when you need care) Catastrophic Varies Lower Higher Bronze 60% Silver 70% Gold 80% Platinum 90% Higher Lower Health Plan Design Before you go shopping, it s good to know some things about health plan design. For example, health plans usually: Have a doctor/hospital/other provider network. It will cost you less to use doctors that are inside your plan s network. Pay different amounts of your medical expenses. A plan that pays less of your expenses will have a lower monthly premium. A plan that pays more of your expenses will have a higher monthly premium. Require a deductible. Just like your car insurance, you must spend a specific amount before your health plan begins to pay for your health expenses. Some health plan deductibles can be high up to several thousand dollars. 8

9 Types of Health Plan Networks Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations (EPOs). These plans usually only pay for care that you get within their network of doctors and hospitals. HMOs and EPOs require that you choose a primary care physician (PCP) for treatment, coordination of care and specialist referrals. Preferred Provider Organizations (PPOs) PPOs allow you to get care both inside and outside your network. But when you use providers or facilities outside your network, you will have to pay more than if you stay in-network. Even if you pick the same insurance company you had through your employer, your new plan may not include all of your current doctors. Your benefit advisor can help you check to see if your provider participates in the plan you select. Network: Most health insurance plans work with a specific group of doctors and health care providers. These doctors and providers have contracted to provide health care services to plan members. They have agreed to see members under certain rules, including billing at lower rates. If you see doctors outside of your network, you will probably pay more for their services than you would for services from an in-network doctor. What you can do now There are two important things you can do right away. Make an appointment Make an appointment with a OneExchange benefit advisor as soon as possible. You can schedule an appointment online, or by calling the phone number listed on the front and back cover of this guide. Scheduling a call ensures our advisors have the time to understand your insurance needs, answer any questions you may have and help you find the plan that fits your needs. We will automatically match you with someone who is trained and licensed for the insurance plans in your state. This benefit advisor will guide you through the enrollment process. You ll need to budget an hour if you re enrolling in insurance just for yourself. Schedule an hour-and-a-half if you re including others. You can do it in more than one call, if you choose but please plan to be available for at least half an hour each time you call. This may seem like a lot of time, but you ll need it because: Your situation is unique The choices are complicated We never rush you through the process Also, it may take longer if you haven t completed your personal profile online. Your benefit advisor will need to confirm your personal information before being able to answer your questions. 9

10 Create an account on online To reduce the time you spend on the phone when you enroll, create an account on our website and fill out your household information. You ll also find easy to use tools, infographics, frequently asked questions, and information to help you to enroll in a health insurance plan. In most states, you ll also be able to browse through health plans to get a feel for the types and costs of the different plans in the marketplace. Prepare Get ready to enroll (after you make your appointment with a benefit advisor). The Enrollment Guide, the next mailing you will receive from us, will go into much more detail about what s involved in the enrollment process. For now, read this brief overview to learn about what OneExchange recommends you do before your call with a benefit advisor. Estimate your household income for the coming year The application requires you to enter your expected household income for If you choose to apply for federal subsidies or other lower cost health coverage options you will need to estimate your household income. Write down any expected medical expenses Answers to these questions will help determine what kind of plan design best fits your needs. Here are some medical needs to consider: Do you or does someone in your family have a chronic condition, like asthma, diabetes or heart disease? Do you or your family see specialists on a regular basis, like a heart doctor, allergist or pain center? Do you have any upcoming treatments or surgeries planned? Do you take prescription drugs every day, like insulin, inhalers or blood pressure medicine? Are you planning to have a baby or adopt a child? A couple of other things that can affect the type of plan you choose: Do you spend time in another part of the country or travel often? How much can you afford to spend on out-of-pocket costs throughout the year? 10

11 Required information checklist Use this checklist to make sure you have all the documentation you will need for your enrollment call. Social Security numbers (or document numbers for legal immigrants) for all members of your family Employer and income information for everyone in the family (for example, from pay stubs or from W-2 tax and income statement forms) Policy numbers for any current health coverage for anyone in your family A list of your prescriptions, including dosage and frequency Names of any doctors and hospitals you want to continue to see Planned doctor visits and procedures in 2015 If you are able to get insurance through someone in your household, you may need to fill out a separate form. You can find information on the Employer Coverage Tool form online at [ Application_508_ pdf]. The form has a section that must be completed by the employer. Be sure to give yourself enough time to fill out this form before you start your enrollment. Be even more prepared! If you have a computer, or can use a friend s, relative s or the library s, start the enrollment process online. How to contact us After you have read through this guide and gathered all the information you need, you ll be ready for your first call with a benefit advisor. If you haven t done so, please make an appointment. You can do it online or on the phone. The phone number to schedule an appointment or ask questions is the same. Make your appointment at least one month before you want your new coverage to start to give yourself enough time to understand your health care insurance options and enroll in new coverage. Please allow one hour per person you want to cover to complete your call. Contact us by phone (TTY: 711) Monday through Friday, 7:00 a.m. until 8:00 p.m. Central Time Learn More Online OneExchange.com/motorola 11

12 let s go! Contents Towers Watson. All Rights Reserved. The information offered on our website and provided in this mailing is believed to be true and correct. Extend Insurance Services, LLC is Towers Watson s licensed insurance agency. Extend Insurance Services, LLC is a Utah resident insurance agency (Utah License No ) and licensed as a non-resident insurance agency or otherwise authorized to transact business as an insurance agency in all states and the District of Columbia. Extend Insurance Services, LLC represents, and receives payment of commissions from, the insurance companies for which Extend Insurance Services, LLC is an agent and sells insurance products and services and may receive other performancebased compensation for its sale of the insurance products and services provided to you. Insurance rates for the insurance products and services offered by Extend Insurance Services, LLC are subject to change. All insurance products and services offered by Extend Insurance Services, LLC may not be available in all states. It is your responsibility to enroll for coverage during the annual Open Enrollment period. TGT-H /14 1