Tag Archives: qhp

The biggest health insurance news in North Carolina this week is the recent press around Bluecross Blueshield of North Carolina filing a BCBS-NC 26% rate increase for 2016 ACA plans. A detailed overview of these filings can be viewed at at www.ratereview.healthcare.gov or by clicking here.

Who will this affect? These rate increases will likely affect all North Carolina residents who have an ACA compliant plan purchased on or off the marketplace.

Rate increase got you down? Click to compare plans!

However, it is important to note that the “26% rate increase headline number” is simply an average increase across all areas. Some areas may see increases that are lower or possibly higher. In addition, it is important to note that the Blue Select products are only anticipating a 17.72% rate increase, on average, for 2016. It is also important to note that these rate increases have NOT YET been approved. CMS and the NC Department of Insurance will need to review and approve these filings before they take effect on January 1st, 2016.

How do these 2016 BCBS-NC rate increases compare to the competition?

Aetna (the parent company of Coventry) have filed increases on their various ACA compliant plans ranging from 17.23% to 25.78%.

United Healthcare has filed for a 2016 rate increase of 12.48%.

In addition, as previously reported by www.NChealthconnector.org, Humana is expected to enter the North Carolina health insurance marketplace for 2015. This additional competition could be great news for many North Carolina residents!

Stay tuned to NChealthconnector.org for the latest North Carolina health insurance news! Need to get enrolled? We can help!

North Carolina newborn insurance coverage

We can help get your child covered!

Over the course of the year, we have received many inquiries from people wanting to know when a North Carolina newborn can get insurance coverage through the health insurance marketplace. As many people may be aware, most marketplace enrollments are effective the 1st day of the month following the date of enrollment.

However, for newborn children in North Carolina who need insurance coverage, a Special Enrollment Period or SEP is available that will provide coverage effective on the date of birth! This is great news for new parents worried about the hassle of getting a newly born child insured.

What is a a Special Enrollment Period? A special enrollment period is when you have a qualifying life event that allows you to enroll in coverage on or off of the marketplace, outside of open enrollment. Of course, giving birth to a child is one of the many life events that would qualify you for a Special Enrollment Period.

Below is the specific guidance, directly from CMS, that details how Special Enrollment Periods for Nouth Carolina newborn insurance coverage work:

Per 45 CFR §155.420, Special Enrollment Periods (SEPs) constitute periods outside the initial or annual
open enrollment when a QI may enroll in a QHP and QDP or a QI can elect to change a current QHP and
QDP selection as a result of a triggering event, such as birth/adoption, relocation, death, or loss of MEC.
It is the responsibility of the FFMs to determine whether a QI meets eligibility requirements for a SEP.
The FFMs determine eligibility for SEPs, which are described by regulation at 45 CFR §155.420(d). In the
individual market FFMs, Special Enrollment Periods generally last 60 days from the triggering event, per
45 CFR §155.420(c). In SHOPs, including FF-SHOPs, Special Enrollment Periods generally last 30 days
from the triggering event, although there are two exceptions, when an enrollee loses Medicaid or CHIP
coverage and when an enrollee becomes eligible for Medicaid or CHIP coverage For the Medicaid and
CHIP exceptions the SEP is 60 days. The start date of an SEP is based on the date of the triggering event.
Although certain SEPs adhere to the standard effective dates described earlier in section 1.2, there are
exceptions to this rule. For example, for birth, adoption, placement for adoption, or placement in foster
care, coverage is retroactive to the date of birth, adoption, placement for adoption, or placement in
foster care.

North Carolina Newborn Health Insurance Coverage enrollment example:

Example : An enrollee contacts the Marketplace on 09/25/2014 to inform the Marketplace of the birth of
twins on 09/01/2014. The Marketplace does a redetermination of the enrollment group. The Marketplace sends
an 834 change transaction to the selected Qualified Health Plan adding the newborn children with a coverage
effective date 09/01/2014.

Do you need help with North Carolina newborn insurance coverage?

Of course, if all of this sounds complicated, please call (843.882.7062) or email us directly. or leave a comment. We can HELP!

During the first week of open enrollment for the Affordable Care Act, the Federal Health Insurance Marketplace has had a rocky start, to say the least. As your trusted North Carolina Obamacare Agent, we are continuously checking the status of the enrollment portal at www.healthcare.gov, as well as keeping an eye out for any pertinent news regarding open enrollment. Recently, while perusing the news, we found a particularly disturbing article from CNBC.

You can read the original article here. On Friday, CNBC reported that as many as 99% of Obamacare enrollment applications contain enough information for the insurance carrier to process the application! Another insurer reported that approximately half of all applications received did not have enough information to process the enrollment. Don’t let this happen to you!

This is why you need a North Carolina Obamacare Agent!

As your North Carolina Obamacare Agent, our agency tracks every application to ensure that your enrollment is complete! Sure, you could go to healthcare.gov and enroll on your own – but why risk not having insurance on January 1st? As your North Carolina Obamacare Agent, we have the knowledge, resources and experience to help ensure that your health insurance enrollment application is complete!

North Carolina Obamacare Agents must be CMS certified before helping consumers apply for Obamacare plans. North Carolina Obamacare Agents must complete assigned training and pass exams before they may assist individuals with an application, plan selection, and enrollment through a Federally-facilitated Marketplace.

North Carolina Obamacare Agent vs. Navigators

Navigators may help you navigate the Federal Marketplace. By law, the Affordable Care Act forbids navigators from actually recommending what specific health plan or coverage people should purchase. Navigators are only allowed to help people understand their options and they’re banned from receive compensation from insurers, as North Carolina Obamacare Agents can.

North Carolina Obamacare Agents are not only certified by the Federal Government, but also licensed, trained, and appointed with each insurance company they represent. This relationship ensures that your North Carolina Obamacare Agent has a professional working knowledge of the plans they represent.

NC DOI officials have approved 67 on exchange health plans for North Carolina’s Federally Facilitated Marketplace, opening on October 1, 2013.

Health insurance plans will be offered by 3 companies:

Bluecross Blueshield of North Carolina – 26 plans in all 100 counties.

Coventry Healthcare of the Carolinas – 25 plans in various metro areas.

FirstCarolina – 16 plans in six counties: Lee, Moore, Richmond, Hoke, Montgomery and Scotland.