Patient Protection and Affordable Care Act (ObamaCare)

What our customers are saying…








Thank you so much for helping me get my insurance so quickly. I appreciate all of your help. I will definitely recommend you to my fellow classmates.
— Dave
Mr. Higgins explained in ways that I can understand. His compassion was unequal!
— Roxanne,
Thanks, Michael, I truly appreciate your prompt assistance…
— Laura
Thank you. This is helpful and I appreciate your time and assistance.
— Rick,
I was glad that you answered the phone. I know I made a good choice choosing you as my broker and applying with Blue Cross Blue Shield of Arizona. The more I think about it, the more I want to be with a company that has widespread recognition and is everywhere. So thanks again for everything!
— Liza,
“Hi Mike,
…my mother lives in Texas, but I thought I would ask you (a question about health insurance,) since the
comments about you on the website were heartfelt.

Thank you.

-L.M.
Houston, TX
— Rick,

“Mike,

You have provided professional & friendly guidance to our family for so many years and I hope you know how much we appreciate your help!!

Sincerely,

Charlotte”

The requirement to have qualified health insurance began on 01/01/2014. Not having health insurance will likely result in a substantial tax being assessed by the IRS. For the uninsured, purchasing health insurance must be done within the open enrollment period at the end of each year. Not obtaining coverage during the open enrollment period will result in the individual being uninsured and liable for any medical expenses incurred during the year, and the tax assessed by the IRS. It is possible to obtain coverage throughout the year if a qualifying event exits.

Based on income, those that qualify for financial assistance can shop for health insurance through an exchange created by either the federal government or the state. The federal government operates the Arizona health insurance exchange, www.healthcare.gov. Michael Higgins Insurance is a federally certified Marketplace/Exchange broker, and can assist those wishing to obtain federal premium assistance and purchase a policy on the Exchange.

For those individuals and families making between 133% and 400% of the FPL (approximately $15,000 for an individual-$92,000 for a family of four,) financial assistance is available on a sliding scale to help pay the monthly premium. Cost sharing reductions may also apply (lower deductible and co-pays.) Those making more than the FPL may purchase coverage outside of the exchange, and those making less will be enrolled in AHCCCS, (Medicaid.)

The question on most of our minds is, “What is this going to cost me?” It is clear at this point that premiums will not be going down, unfortunately. It is more realistic to prepare for premiums to increase, dramatically for many. Though hard to believe, Arizona, along with a dozen other states, historically have had some of the lowest premium rates in the country, primarily due to having fewer state mandates. The new federal health insurance law now requires every state to offer, “Essential Health Benefits,” that must be included in each policy sold in and out of the exchanges. There are a total of ten categories of benefits that must be covered by all health insurance policies offered.

Health insurance companies are now required to spend at least 85% of all group premiums collected on claims payments, 80% on individual plans, with an additional requirement to refund any excess premiums collected to the policyholder. Rebates are rarely issued, as most insurers stay within the MLR, (Medical Los Ratio.)

Many insured may experience sticker shock when the true cost of covering these federally mandated additional benefits is revealed. Several new benefits that must be included range from maternity coverage, free breast pumps, free physicals, mental health and substance abuse parity coverage, and the removal of higher deductible options.

Please feel free to call or write at your convenience, seven days a week, with any questions that you may have, 602.405.8769.

Here are the latest requirements regarding the Patient Protection and Affordable Care Act, (ObamaCare,) and answers that will help you understand your responsibilities according to the law. There are different requirements for individual policyholder’s, small businesses, and businesses with 50 or more employees.

PPACA for Group Employers and Employees:

The Affordable Care Act, a.k.a. Obamacare, the ACA, or the PPACA, requires all Arizona health insurance companies, and certain self-insured group policies, to supply all those enrolled with two new forms entitled, “Summary of Benefits and Coverage,” (SBC,) and the, “Uniform Glossary.” These forms must also be available to those speaking Spanish, Navajo, Mandarin, and Tagalog.

Implemented September 23rd, 2012, all policyholder’s, whether group or individual, must be sent an SBC and UG from their insurer. Distribution of these forms is very important because the SBC and UG distribution requirements have multiple deadlines that must be met by the group policyholder and the Arizona health insurance company. These deadlines will be clearly spelled out in the instructions included in your SBC and UG packet from the insurer. If these deadlines are not met the federal government may impose hefty fines. How much? The fines start out at $1000.00 per employee and go up from there. In addition, a penalty of $100 per day, per individual, may be assessed until an employer or insurer complies, (regardless if the insurer or employer is willfully out of compliance or not.)

The best way to avoid these fines is to simply get all renewal paperwork in on time to the insurer, and distribute the SBC and UG forms immediately to all employees once received from your insurer. Another way to avoid these requirements and fines is to simply cancel the small group policy and have the employees obtain individual plans.

The purpose of the SBC and UG forms is to give the policyholder a way to compare plans, listing the benefits and exclusions of each plan. This information was widely available in multiple forms prior to the implementation of this new law.

Because the SBC and UG forms are now being distributed to all insured as required by law, Blue Cross and Blue Shield of Arizona will no longer create informational brochures for each plan.

You may view the Uniform Glossary, (UG) here… www.cciio.cms.gov.