Health Care Reform Fact or Fiction

A good fact or fiction piece by Cigna (Connecticut General Life Insurance Company):

Fact or Fiction: Navigators are going to replace the role of the broker.

FICTION! A navigator and a broker are not the same. A Navigator cannot promote one carrier or plan over another and are objective. Also, Navigators are not compensated like a broker. Unlike brokers, who are compensated by the carrier through commissions, Navigators will be funded through the exchange. The Navigator program within the exchange needs to be self sufficient. Navigators will be funded by the government in 2014, and in 2015 and beyond, they will be funded through the exchange funds.

Fact or Fiction: Everyone is guaranteed issue in 2014 and beyond.

FACT! There will no longer be any medical underwriting after January 1, 2014.

Fact or Fiction: Open enrollment for 2014 sales is October 1, 2013 through March 31, 2014

FACT! The open enrollment periods have been determined by the federal government and not by carriers. For the first year only there will be an extended open enrollment period. In subsequent years, the open enrollment period will be October 15 through December 7th.

Fact or Fiction: Customers whose income is 100%-400% of the Federal Poverty Level can be eligible for a subsidy on the Exchange.

FACT! Individuals and families whose income falls between 100%-400% of the Federal Poverty Level, and don’t have access to affordable health insurance, will be eligible for a Federal Premium Assistance Tax Credit toward an Exchange Plan.

Fact or Fiction: If a customer changes their mind and wants to switch to another plan or carrier after the open enrollment period, they are permitted to do so.

FICTION! Once a plan is selected, a person cannot change or move to a different carrier outside of an open enrollment period. If a person has a life changing event, then there are exceptions to enroll or change.

Fact or Fiction: In most cases, rates for individual plans will triple.

FICTION! some people will actually see their rates decrease. Carriers will only be allowed to have a 1:3 spread between the youngest rate and the oldest rate, compared to a 1:6 spread today.

Fact or Fiction: You will be able to sell child-only policies in 2014 and beyond

FACT! Beginning with January 1, 2014 effective dates, child-only policies will be available through all carriers in the marketplace.

Fact or Fiction: Deductibles and out-of-pocket maximums will remain similar to today’s commonly sold plans

FICTION! Due to health care reform regulations, deductibles and out-of-pocket maximums will generally be lower. It is currently estimated that the highest deductible available will be $6,400. Regulations state that all in-network benefits, copays, deductibles, and coinsurance must accumulate to the out-of-pocket limit.

Fact or Fiction: All customers will have the same rate in 2014

FICTION! Rates will vary by age, plan and carrier. Gender and health status no longer will be factors in pricing

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