Navigating the Health Care Reform with Your Newly Designed Insurance Marketplace

  1. What is the insurance marketplace?
  2. How is this marketplace different than the Federal and State health insurance marketplaces/exchanges?
  3. What is the process of enrolling in a health insurance plan?
  4. What insurance carriers and plans are available through this insurance marketplace?
  5. What is Health Care Reform, and what does it mean for me?
  6. Do I have to purchase an insurance plan from a state or federal exchange?
  7. How much do I have to pay for my insurance plan?
  8. How can I find out if I am eligible for the government to pay for a percentage of my health insurance costs in the form of a subsidy?
  9. Am I purchasing a discounted group health insurance plan?
  10. What is the advantage of using this marketplace instead of a federal or state insurance marketplace?
  11. Is this marketplace available to my family as well?
  12. What if I have a pre-existing condition?
  13. How do I avoid paying a fine?
  14. What is a subsidy?

1. What is the insurance marketplace?

Brought to you by Augeo Benefits and BenefitProtect, this newly designed insurance marketplace is a one-stop shop created to help you and your family members navigate the complicated and often time-consuming process of finding and purchasing just the right health insurance plan. The call center features over 300 licensed benefits counselors who are available Monday through Friday, 6am – 6pm PT/ 9am – 9pm ET to assist you with the following:

  • Shopping for and comparing insurance plans both on and off the federal and state marketplaces.
  • Enrolling in the insurance plan of your choosing.
  • Finding out if you qualify for financial assistance (a subsidy) and helping you obtain that assistance.
  • Answering any questions that you have about Health Care Reform.
  • Helping you with all of your post-enrollment needs and questions.

When you purchase health insurance through this marketplace, you will be purchasing individual coverage, and not a group insurance plan. The health insurance coverage will be directly between you and the insurance carrier.

2. How is this marketplace different than the Federal and State health insurance marketplaces/exchanges?

We have worked hard to expand our platform to help you understand all of your options now available under the new Health Care Reform; creating a one-stop shop to accommodate all of your health insurance needs. With one call, our benefits counselors will give you access to both the Federal and State Insurance Marketplaces, along with other health insurance options that are available in your specific state. Remember, not all health insurance carriers are included in the federal and state insurance marketplaces. Our counselors will perform a needs analysis to see if you qualify for financial assistance (a subsidy) in paying for your health insurance costs, help you obtain that financial assistance, and then help you find and enroll in the plan (whether on or off the federal/state marketplaces) that best suits your needs. Subsidies can cover anywhere from 0-100% of your health insurance costs.

3. What is the process of enrolling in a health insurance plan?

  1. Call the number listed on the main landing page of your insurance marketplace website.
  2. You will be greeted by one of our licensed benefits counselors, who will ask you some questions to determine the coverage that best fits your specific needs and budget. Keep in mind, pre-existing conditions are no longer a factor when applying for health insurance during the open enrollment periods or when you qualify for a special enrollment period. The counselor will also determine if you qualify for lower insurance premiums in the form of a subsidy.
  3. The representative will then generate quotes for both government and private plans, based upon your desired coverage.
  4. Once you choose a plan, the representative will fill out an application on your behalf.
  5. The counselor then submits the application to the insurance company and your policy is issued.
  6. ID cards and policy information will be sent to you directly from the insurance company.

4.What health insurance carriers and plans are available through this insurance marketplace?

You will have access to the health insurance plans and carriers that are available through the federal and state insurance marketplaces, along with other health insurance carriers that are available in your state that are not currently found on the federal/state marketplaces (private plans). Our goal is to help you shop for and compare health insurance both on and off the government insurance marketplaces to find the coverage that will satisfy your physical and financial needs.

All of our carriers are A- rated or better, and include companies such as Humana, United Healthcare, Aetna, Blue Cross and Blue Shield, and many more.

5. What is health care reform, and how does it affect me?

“Health care reform” refers to the Affordable Care Act that was signed into law in March of 2010. The purpose of the Affordable Care Act is to provide more individuals with affordable health care coverage, as well as help them receive better medical care. With the Affordable Care Act came the requirement that as of January 1, 2014 most people who can afford to purchase health insurance must have ‘minimum essential’ coverage, or face paying a fine. Another key feature of the Affordable Care Act is that health insurance companies can no longer deny you coverage based on pre-existing conditions. Understanding this law is extremely important, and our licensed benefits counselors will help you understand what your specific requirements and responsibilities are under this law, as well as how to avoid paying a fine.

6. Do I have to purchase a government insurance plan?

No, you are not required to purchase insurance from the federal or state insurance marketplaces. In many states, there are health insurance carriers that are not offered on the government sponsored marketplaces, but still offer the required health insurance plans to help you avoid paying a fine. However, to receive financial assistance (a subsidy) from the government that will help pay for your health insurance costs, you must purchase a state/federal marketplace plan. Our licensed counselors will help you shop for and compare both types of plans to find out which option is both affordable and fits your needs.

7. How much do I have to pay for my insurance plan?

The cost of health insurance varies widely based on many factors such as which state you live in, what benefits your plan includes, who all is covered under your plan and with which insurance company you have your plan. Depending on your income and a few other contributing factors, you may also qualify to receive a subsidy (financial assistance) from the government to help pay for your health insurance costs. These subsidies can pay anywhere from 0-100% of your health insurance costs. Our benefits counselors will be able to enroll you into the plan of your choosing, as well as help you obtain a subsidy.

8. How can I find out if I am eligible for the government to pay for a percentage of my health insurance costs in the form of a subsidy?

When you call the number listed on your insurance marketplace home page, you will be greeted by one of our licensed benefits counselors, who will ask you a few questions to determine the following:

  1. If you qualify for a subsidy
  2. The dollar amount of your subsidy
  3. What type of plan you are looking for
  4. What type of plan will best address your needs

Subsidies are only available if you purchase a state/federal marketplace health insurance plan, but to make sure you are receiving the most affordable coverage, our counselors will generate quotes for plans both on and off the state/federal marketplaces; and then help you enroll into whichever plan you choose.

9. Am I purchasing a discounted group health insurance plan?

No. The health insurance plan that you purchase through this marketplace is an individual plan, and is not between you and your employer.

10. What is the advantage of using this marketplace instead of a federal or state insurance marketplace?

While the federal and state insurance marketplaces provide you with many options for purchasing health insurance, in most states not all of the insurance carriers and plans that are available can be found in those marketplaces. We have created a one-stop shop for you to compare insurance plans both on and off the federal and state marketplaces to enhance your options, and help you find the plan that is specific to your needs and budget. Our licensed benefits counselors will give you access to the government exchanges, allowing you to apply for financial assistance (subsidies) and enroll in a government-sponsored plan, and also give you access to health insurance plans and carriers located off of the exchanges!

Even after you purchase a health insurance policy, our licensed benefits counselors will be on hand to provide you with professional assistance in helping you navigate and understand the health insurance world. They will be able to address any concerns, questions, or policy changes that may arise.

11. Is this marketplace available to my family as well?

Yes. You and your family members can use this service to obtain health insurance coverage.

12. What if I have a pre-existing condition?

In accordance with the health care reform, pre-existing conditions are no longer a factor when applying for major medical insurance during the open enrollment periods or when you qualify for a special enrollment period.

13. How do I avoid paying a fine?

The Affordable Care Act requires that those who can afford to pay for health insurance purchase a plan that meets the “minimum essential coverage” guidelines as of 2014. These plans do not have to be a government-sponsored health insurance plan, and can be found both on and off of the federal and state health insurance marketplace websites. To find a plan that meets the minimum essential coverage guidelines, please call the number listed on your insurance marketplace home page to speak with one of our agents. The agent will be able to help you understand all of the regulations associated with avoiding government fines under the Affordable Care Act, and enroll you into the plan of your choosing.

14. What is a subsidy?

A subsidy is a form of financial assistance from the government that can help you pay for a portion of your health insurance costs. Based on income related criteria, you may be eligible to receive a subsidy that will cover anywhere from 0-100% of your costs. To find out how to receive a subsidy and see if you qualify, simply call one of our licensed benefits counselors today.

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