With the onset of the Affordable Care Act (aka
Obamacare), enrolling in a health plan has been restricted to a particular time
frame called Open Enrollment. This generally
happens toward the end of the calendar year, with new plans beginning January 1st
of the following year. But what do you
do if something changes in your life and you need new health insurance
mid-year? You may or may not be able to
get it. Here are the 10 categories that
will afford you a Special Enrollment Period (SEP) in which to enroll in a new
health plan:
Losing other qualifying coverage:
You were on Medi-Cal and no longer qualify
If you newly qualify for Medi-Cal, you can enroll at any time.
You had employer-sponsored coverage and lost/quit your job
You had COBRA and exhausted those benefits. Dropping COBRA because it is too expensive DOES NOT qualify. However, you do not have to accept COBRA if it is offered to you.
You no longer qualify for a student health plan through a university
You turn 26 years old and need to come off your parent’s plan
You turn 19 and no longer qualify for a ‘child only’ plan
You no longer qualify for military coverage
Changes in household size
Marriage, divorce, legal separation
Birth or adoption of a child
Death
Any other situation where you lose a dependent or your status as a dependent
Changes in residence
Permanently moved from out of state
Permanently moved within the state to a location that offers at least one new Covered CA plan to which you previously did not have access
Permanently moved within the state and your current plan is not offered in your new location
Changes in eligibility for financial help
Gain or lose status with Medi-Cal
Lose your ‘share of cost’ with Medi-Cal by reaching your share of cost
Defined types of errors made by the Marketplace, Plans, or Agents
You were given misinformation during the enrollment process
There were technical errors with the software during your enrollment
There were errors in the processing of your eligibility determination
Release from jail or prison
Gained Citizenship or Lawful Presence
Member of a Federally recognized American Indian or Alaska Native tribe
Members have an open Special Enrollment Period and can enroll at any time
Members can change plans once every month
Your provider (doctor) left the plan’s network AND you have one of the following:
Pregnancy
Terminal Illness
Acute Condition
Serious Chronic Condition
Care of a child between the ages of 0 – 36 months
Surgery or Procedure scheduled within 180 days of the provider’s change
All Other Reasons
Natural disaster (fire, flood, hurricane, etc.)
You had a medical emergency that precluded you from enrolling during open enrollment
You are a victim of domestic violence or spousal abandonment
You have a court order to provide insurance for a dependent, even if you will not be claiming that dependent on your tax return.
It’s a long list to remember. So, if you just remember that the
circumstances must be beyond your control, you will probably find that you
qualify for a Special Enrollment Period.
But be mindful: your SEP is only
60 days long and starts the day your change happens. If you miss your 60-day window, you will have
to wait for the next Open Enrollment Period to receive a plan beginning the
next year.
Unfortunately, California no longer allows interim, or
short-term, plans to carry you through.
Your only options are the Marketplace (Covered CA) or purchasing
something directly with the insurance company.
A health insurance broker (like Pronoeo Insurance Agency) can guide you.
There is no entry fee and no purchase necessary to enter this contest.
By entering this contest, an entrant is indicating his/her agreement to be bound by these terms and conditions.
Route to entry for the competition and details of how to enter are via http://tiny.cc/k2073y, Pronoeo’s Facebook page.
Only one entry will be accepted per person per designated action. Multiple entries in the same location from the same person will be disqualified.
No purchase necessary. Void where prohibited. Contest will begin at 12:01 am April 1, 2019. Closing date for entry will be midnight on May 20, 2019. After this date no further entries to the contest will be permitted.
No responsibility can be accepted for entries not received for whatever reason.
The rules of the competition and how to enter are as follows:
Entries can be generated in three ways:
Like Pronoeo Insurance’s Facebook page = 1 entry
Join the Pronoeo Contest Group and comment why you would like to win this contest = 1 entry
Respond to the Giro Bello event posted on the Pronoeo Facebook page = 1 entry
The promoter reserves the right to cancel or amend the contest and these terms and conditions without notice in the event of a catastrophe, war, civil or military disturbance, act of God or any actual or anticipated breach of any applicable law or regulation or any other event outside of the promoter’s control. Any changes to the contest will be notified to entrants as soon as possible by the promoter via Facebook.
The promoter is not responsible for inaccurate prize details supplied to any entrant by any third party connected with this competition.
The prize is as follows: Two (2) ride registrations to the Giro Bello for June 22, 2019. Winners will have the choice of riding the Fun, Metro, or Century rides. Each registration will include a swag bag, T-Shirt, route maps, SAG support, rest stops, and tickets for a post ride meal and drink at the Expo. Total value of prize depends on the rides chosen but may range from $130 – $200. The prize is as stated, and no cash or other alternatives will be offered. The prizes are not transferable within the contest but may be transferred per Giro Bello rules and conditions at the event. Prizes are subject to availability and we reserve the right to substitute any prize with another of equivalent value without giving notice. For more information regarding the Giro Bello, go to www.girobello.com.
Winners will be chosen at random by software, from all entries received and verified by Promoter and or its agents.
The winner will be posted on Pronoeo Insurance’s Facebook page on May 21, 2019. Attempts will be made to notify the winner directly by email and/or DM on Facebook within 3 days of the closing date. If the winner cannot be contacted or does not claim the prize within 14 days of notification, we reserve the right to withdraw the prize from the winner and pick a replacement winner.
The promoter will notify the winner when and where the prize can be collected.
The promoter’s decision in respect of all matters to do with the contest will be final and no correspondence will be entered into.
By entering this contest, an entrant is indicating his/her agreement to be bound by these terms and conditions.
The competition and these terms and conditions will be governed by laws of the State of California and any disputes will be subject to the exclusive jurisdiction of the courts of Sonoma County, California.
The winner agrees to the use of his/her name and image in any publicity material, as well as their entry. Any personal data relating to the winner or any other entrants will be used solely in accordance with current data protection legislation and will not be disclosed to a third party without the entrant’s prior consent.
The winner’s name will be available 28 days after closing date by mailing the following address: Pronoeo Contest, PO Box 2593, Santa Rosa, CA 95405
Entry into the competition will be deemed as acceptance of these terms and conditions.
This promotion is in no way sponsored, endorsed or administered by, or associated with, Facebook, Twitter or any other Social Network. By participating in this contest, you are giving complete release of liability to Facebook and Pronoeo Insurance Agency, LLC.You are providing your information to Pronoeo Insurance Agency, LLC and not to any other party. The information provided will be used in conjunction with the following Privacy Policy found at https://pronoeo.net/privacy-policy/.
In consideration for being allowed to participate in this Contest, you agree to release from liability and waive your right to sue Facebook, and/or Pronoeo Insurance Agency, LLC, their employees, officers, volunteers and agents from any and all claims, including claims of the promoter’s negligence, resulting in any physical injury, illness (including death) or economic loss you may suffer or which may result from your participation in this Contest, travel to and from the Giro Bello (including air travel), or any events incidental to this Contest or its prize.
The intent seems to get lost in the translation. People use these words interchangeably, but they really mean different things. There are several proposals on the table in Congress that this article does not address. The two that seem to be gaining popularity are MEDICARE FOR ALL and SINGLE PAYER.
MEDICARE is government insurance alongside private insurance.
There are premiums that are paid by the insured for BOTH the Medicare coverage and the Private Insurance coverage. Typically, there are also deductibles and copays or coinsurance that are paid by the insured as well. There is no coverage for Long-Term Care, Vision, or Dental with Medicare. However, some private insurers have added the opportunity to purchase those services at an additional premium.
SINGLE PAYER is only government insurance.
They cover anything that is MEDICALLY NECESSARY, which may include some form of Long-Term Care, Vision and/or Dental. The insured does not pay any premiums, deductibles or copays. The entire program is funded with increased taxes to the general population. The government controls all aspects of medical distribution, to include payment of claims to doctors and medical facilities as well as access to medical technology. Costs are controlled by controlling/limiting access to services.
There are advantages and disadvantages to both:
MEDICARE FOR ALL would still allow your doctor to make medical decisions based on your needs as opposed to a governmental agency regulating your care. People would still have choices regarding their private insurance portion, which would maintain some sort of competition between insurance companies to vie for your business. Increasing the number of people on Medicare would be expensive. Our current Medicare system is not financially sound – adding the entire population to it would mean a large increase in taxes to pay for it.
SINGLE PAYER would lower some administrative costs, as well as some profits. But putting the entire medical bill on the government means putting it on the taxpayers. Studies have also found that, in a Single-Payer system, research and development of new technologies and medications goes out the window because there is no funding and no incentive for that market.
How Much Are You Willing To Pay?
In either situation, the cost of these programs is coming out of your pocket. People don’t seem to understand that the government has only one source of income: YOU. When you say, “let the government pay for it,” what you are really saying is “let the people pay for it.” The people are the only source of income for the government. For them to have money to pay for something, they must raise taxes.
In California alone, it is estimated that we would need to add over $418 Billion to our current $209 Billion state budget in order to begin to pay for healthcare, with the numbers anticipated to rise from there – rapidly. The numbers nationally are mind-boggling.
Conclusion
The US currently spends 2-3 times more per capita than any other country for medical care. Then again, we are on top for research and development. People from other countries come here to be treated because they can get relatively quick access to services and technology compared to what they have in their country.
I can’t help but be reminded of the Scripture in 1 Samuel 8:19 where the people of Israel cried out, “We want a king over us. Then we will be like all the other nations…” As it turned out, being “like all the other nations” didn’t work out too well for them. We will have to see how this healthcare situation flushes out and see if history really does repeat itself.
Many think of Cyber Liability Insurance as the protection major corporations need when their computers get hacked. That is partially true:
1. Cyber Liability is NOT just for major corporations. Smaller businesses have been the latest targets of cyber theft – you just don’t hear about it because larger losses make better news stories. The most often targeted are Accounting Firms, Payroll Processors, and Human Resource companies. But in reality, any business that has access to names, addresses, social security numbers, dates of birth, medical record or credit card information is a target for cyber thieves.
2. Computer hacking is not the only way your information can be compromised. Did you know that employee error accounts for 24% of all system compromises? It could be as simple as misdialing a fax number or opening a phishing email that can cause a breach of information. Have you ever had an employee lose a laptop or their smartphone? This can make your business vulnerable for cyber liability. And we won’t discuss that one rouge employee that is using his/her position in the company to access others’ personal information for their own benefit. But it could happen.
Cyber Liability isn’t just a fad. The FBI reports that. from 2015-2016, Cyber scams have increased 270%. That is why insurance companies have created policies that can protect you and your business should a breach occur.
No one can prevent a breach from happening. Yes, there are things you can do to minimize the possibility, like encrypting your records and having policies and procedures in place that employees can follow for best practices in handling information. But a Cyber Liability Policy can help you restore your business and your reputation once a breach occurs.
Many people believe they can self-insure against a breach. In reality, here are the expenses incurred when a potential breach happens:
1: Legal Counsel: to minimize lawsuits
2: IT Forensics: to determine how the breach occurred and how to prevent it in the future.
3: Customer Notification: every customer that has a POSSIBILITY of being breached must be notified.
4: Customer Call Center Support: you must supply someone that concerned customers can talk to about their questions and can advise customers as to how they should proceed.
5: Credit Monitoring must be offered to all potential victims of the breach.
6: Public Relations Expenses are incurred to rebuild your business reputation.
They say costs after a breach can run an average of $30 per victim’s name. For every 1000 people in your database (client or not), that is a $30,000 expense. Cyber Liability insurance can cover these expenses and help you get back to what you do best – your business.
Let Pronoeo Insurance Agency help you minimize your risk and protect your livelihood with Cyber Liability Insurance. Call us at 800-495-2886 for your free quote.
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