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Group Insurance Analysts – November 2013 Newsletter

In this issue we will discuss more on health reform (The ACA), and Home/Auto insurance.

Health Reform (The Affordable Care Act) Updates

On a national basis, there is only one way to describe the rollout of the Affordable Care Act (ACA) – A Complete Disaster! Between a website that was poorly designed and doesn’t work, existing policies being cancelled when a promise was made that we could keep our current policy if we like it, and the increasing number of scams popping up associated with the ACA there just isn’t a lot of good things we can say about the rollout.

In Colorado, things have gone better but the biggest hang up is the manual process to get a Medicaid denial from Colorado Peak for those individuals who qualify for a premium subsidy. The denial can take up to 45 days to process depending on the situation. This process through Medicaid is taking so long that many people who are applying for a premium subsidy and who are getting cancelled on their existing policy might miss the December 15th deadline to apply for January 1. This is not only unacceptable, it clearly shows that Medicaid was not prepared to handle their part of the rollout, even though they had more than three years to get ready. Accountability for this failure needs to fall squarely on the shoulder of the Governor, assuming you believe that the buck stops there.

One of the lame excuses from Medicaid is that they have sent Washington a list of proposed changes to streamline the system and they are waiting for a response to proceed. This is something that should have been done months ago as we are now approaching a critical deadline and it is basically too late as many people will not get an answer back in time to enroll for 1/1/2014. At this point the Medicaid officials should just adopt those changes and tell Washington what they did and why, and if Washington doesn’t like it they can suggest something better.

Yet through all of this we hear nothing from the Governor. It is also very disturbing that Medicaid has time to enroll over 34,000 new people into the program which requires far more investigation and documentation, yet they can’t get out denial letters to those who clearly do not qualify for the program, leaving us to wonder if there is something political surrounding this, and one reason for the only 3400+ enrollments through the Exchange.


What About Your Insurance?

The following is what you can expect based on your individual situation:

  1. If you have a grandfathered  health insurance policy, you can keep that plan if you desire. If you qualify for a premium subsidy or find a new plan for 1/1/2014 that fits your needs, you can make that switch.
  2. If your plan is non grandfathered, it will expire either 1/1/2014 or your first renewal thereafter depending on the insurance company. All non grandfathered Kaiser and Rocky Mountain Health policies are set to expire 1/1/2014.
  3. If you either need or want to enroll in a new plan for 1/1/2014 and you do not qualify for a premium subsidy, also called the advanced premium tax credit (APTC), the enrollment process is similar to what it is today. The Medicaid rejection through Colorado Peak is not required, and we can sign you up for a new plan either on or off Exchange, whichever you prefer.
  4. If you are signing up for a new plan effective 1/1/2014 and qualify for a premium subsidy but you want to take that credit on your 2014 tax return instead of in advance, we can bypass the Colorado Peak Medicaid rejection process and enroll you in a plan through the Exchange that will allow you to claim the credit when your taxes are filed.
  5. If you are signing up for a new plan for 1/1/2014 with the advance premium tax credit, we will need to go through the Medicaid rejection process through Colorado Peak before we can enroll. This is an online process that can generate a rejection immediately or take up to 45 days for a case worker to review. Upon rejection from Medicaid, you will get a seven digit case number starting with 1B. We will need this code to proceed with the enrollment process through Connect for Health Colorado

Financial Disclosures

Just to clarify, the only situation in which you need to disclose your financial information is when you are applying for a premium subsidy, also called the advance income tax credit (APTC). If you are choosing to buy a policy either “off exchange”, “on exchange” with no APTC, or “on exchange” with a tax credit when you file your tax return, you can apply without going through the Medicaid denial process.

If you apply to get the premium subsidy in advance, you will need to provide financial information to Colorado Peak, then you will need to get a case number that starts with 1B, and a notice of Medicaid denial to proceed with the application. If you do not go through this process, you will not be eligible for the APTC.

Grandfathered versus Non Grandfathered Policies (Remember this from our July 2013 Newsletter?)

When President Obama promised that if you like your current plan you could keep it, there was one catch in the fine print. You had to buy your policy prior to March 23, 2010 and make no changes since then in order to keep your current insurance. Those are considered grandfathered policies. Any policy bought or modified after March 23, 2010, which is non-grandfathered, will need to be replaced on or after 1/1/2014 depending on your renewal date. You will not be allowed to keep those plans, even if you like it.

Updates on Individual and Family (non group) Health Plans

It is very important to understand how and when your existing medical plan will be affected. If you have a grandfathered medical plan, you will be allowed to keep that plan. A grandfathered plan is one that became effective prior to 3/23/2010. If you want to cancel that plan and buy a new plan for 1/1/14, we can do that starting 10/1/13.

  1. If your health plan is not grandfathered, the following will occur depending on which insurance company you are with and what rules they are implementing:
  2. If you are with Kaiser Permanente or Rocky Mountain Health plans, your existing non grandfathered policy will terminate on 1/1/2014. To continue coverage, you must elect a new plan for 1/1/2014 otherwise you will not be covered. This election can be made beginning 10/1/2014 and we can help you with this election whether or not your policy is purchased on or off the Exchange. However, if you qualify for a premium subsidy, the plan must be bought on the Exchange, also known as Connect for Health Colorado.
  3. If you have a policy with Cigna, you will be offered an early renewal option for 12/31/2013 which will allow you to stay on that plan until 12/31/2014. This would be an attractive option if you do not qualify for a premium subsidy or if the premiums for the new plans offered in 2014 are higher than your current premiums. If you do qualify for a subsidy or if your premium is lower in 2014, you can cancel your existing plan and enroll for a new plan beginning 10/1/2013. If you do not elect the early renewal option, your policy will expire 1/1/2014.
  4. If you are with Anthem Blue Cross & Blue Shield, you will be able to keep your policy until your renewal date in 2014, at which time it will cancel and you will need to elect a new plan. It has been indicated that they will also offer an early renewal option that will allow you to extend your plan until the end of 2014.
  5. If you have a plan with Humana, that plan will end on 1/1/14 unless you elect their early renewal option. If you make that election, you can keep your plan until 12/31/2014, otherwise you will either need to elect a new plan to maintain coverage.
  6. We will need to look at several factors to help you determine whether it is more cost effective to keep your existing plan for as long as possible or if you should buy a new plan for 1/1/2014. Those factors include your household size and income, your current plan, and your premiums.  We have already starting the process of reaching out to you, but feel free to call us at any time to discuss.

Help With Premiums

Households with income less than 400 percent of the Federal Poverty Level (FPL) may qualify for premium assistance through an advanced premium tax credit when purchasing health insurance through the State Insurance Exchange, called Connect for Health Colorado. However, to qualify for assistance you cannot have access to other affordable health coverage such as Medicare, Medicaid, CHIP, or affordable employer based group coverage.

For families/households with more than 8 persons, add $4,020 for each additional person.



Small Group Health Plans

Small employer health plans will be required to comply with the requirements of the ACA effective 1/1/2014 or their first renewal thereafter. If your health plan renews May 1, 2014 then you can retain that plan until then, unless you want to switch to an ACA compliant plan for 1/1/2014. Some of the insurance companies will offer early renewal options for December 1, 2013 to allow employers to keep that plan until 12/1/2014.

To determine whether you should keep your plan until renewal, early renew, or switch to a new, ACA compliant plan for 1/1/2014, we will need to consider several factors. First, are you getting the small employer tax credit. If you are and want to continue to get that tax credit, you will need to buy your plan through the new SHOP Exchange effective 1/1/2014. Enrollments for the SHOP Exchange will begin October 1, 2013 for a January 1, 2014 effective date and we will be able to assist you with that process. Other considerations will be what are your current premiums, your plan design(s), employer contribution, employee participation, and how busy you might be in the fourth quarter.

Most of our agents have begun to reach out to you already, but feel free to call or contact us whenever you are ready to discuss.

Medicare Annual Election Period

In addition to all of the changes coming associated with the ACA, please remember that the Medicare annual election period (AEP) begins October 15, 2013 and ends December 7, 2013. This is the time of the year to review and make changes to your Medicare Prescription (Rx) plan, or your Medicare Advantage plan. Please remember that Medicare Advantage is not a Medicare supplement, but a way to get your Medicare benefits through a private insurance company.

Medicare supplements do not have an open enrollment period every year. You can apply for a new Medicare supplement anytime during the year as long as you are on original Medicare Parts A and B. However, unless you are in your first six months of enrolling in Part B, or in a special enrollment period caused by a loss of coverage, you will need to answer medical questions and can be declined.

Business Insurance

There are many types of business insurance a business owner must consider to protect themselves from financial loss. They include:

  • General Liability
  • Commercial Auto
  • Commercial Property
  • Excess Liability
  • Professional Liability
  • Workers Compensation
  • Inland Marine

Workers Compensation

State law requires that every employer provide Workers’ Compensation insurance for their employees. This insurance provides coverage for accidents or disease arising from employment as prescribed by these state laws. Benefits may include lost wages, medical expenses, and permanent disfigurement/disability payments.

Monopolistic States/Stop Gap

This endorsement is used to provide Employers Liability coverage for operations that are conducted in monopolistic fund states. It is needed because Worker’s Compensation policies written by monopolistic state funds do not provide Employer’s Liability coverage.

Bodily Injury by Accident Limit

This is the maximum amount your insurer will pay under Coverage B, Employer’s Liability, for all claims arising out of any one accident, regardless of the number of claims that may arise out of the accident.

Bodily Injury by Disease – Each Employee

This is the maximum amount your insurer will pay for damages due to bodily injury by disease to any one employee.

Bodily Injury by Disease – Policy Limit

This is the maximum amount your insurer will pay, in aggregate, for employee bodily injury by disease claims during the policy period regardless of the number of employees who make such claims.

Updates on Auto and Home Insurance

GIA Risk Management, LLC is considered to be one of the fastest growing, locally owned, independent P & C insurance agencies in Colorado. We do this by contracting with many different insurance companies so that we can offer our clients the choices and options they seek. Because we are not employed by one insurance company, we can truly represent the needs of our customers.

Insurance companies use many different criteria to determine rates, which is why rates can vary dramatically from one insurer to another. Some insurers have very low rates for those with exceptional credit, while other insurers might be better for teenage drivers. This is why it is so important to review and shop insurance coverage’s.

As you are probably aware already, the recent weather related events in Colorado and the rest of the United States is causing significant increases in property insurance for the first time in several years. Some large insurers are now refusing to write property insurance on a stand alone basis, but only as part of a package with an auto insurance policy. Other insurers are offering larger discounts for bundled policies, or putting restrictions on roof damage from wind and hail.

As weather related claims hit, most homeowners need to be aware that standard homeowner’s policies do not cover damage from flooding. Earthquakes are another standard exclusion. Flood insurance is a separate policy that can be purchased in addition to your homeowners insurance even if you are not in a flood plain. If you don’t have flood insurance and a severe rains storm floods your basement, that damage will not be covered. If you are interested in a quote for flood insurance, please let us know.

As independent brokers, we shop the market to help our customers find the right coverage at the best price. This is a value proposition that is difficult for a captive agent to match. We now quote the following insurance companies for our clients though a computer program that compares the rates and coverage:

  • Safeco ( A Liberty Mutual Company )
  • Progressive
  • Travelers
  • Hartford and Hartford AARP
  • Allied ( A Nationwide Insurance Company)
  • MetLife
  • GMAC
  • Electric Insurance ( A General Electric Company)
  • Pacific Specialty
  • ASI
  • And more, depending on the risk.

For a quote and/or review of your home and auto insurance, please click here. If you would like to run some online quotes on your own, please visit our web site self service center here.

We will keep you updated throughout 2013 as we continue the implementation of the ACA, and we are now assisting everyone with these changes.  If you have questions in the interim, please don’t hesitate to contact us at 303-423-0162 ext 100, or visit


Article contributed by Group Insurance Analysts.


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