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Golden Ocean Insurance Center Covered California 2014.

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Presentation on theme: "Golden Ocean Insurance Center Covered California 2014."— Presentation transcript:

1 Golden Ocean Insurance Center Covered California 2014


3 Covered California Insurance Carriers 보험 회사 1. Alameda Alliance for Health HMO Hospitals: 12 Physicians: 3,100 2. Anthem Blue Cross of California EPO HMO Hospitals: 300 Physicians: 30,000 3. Blue Shield of California PPO Hospitals: 223 Physicians: 22,048 4. Chinese Community Health Plan HMO Hospitals: 9 Physicians: 315 5. Contra Costa Health Plan HMO Hospitals: 10 Physicians: 5,000 6. Health Net PPO HMO Hospitals: 204 Physicians: 44,000 7. Kaiser Permanente PPO Hospitals: 35 Physicians: 14,219 8. L.A. Care Health Plan HMO Hospitals: 35 Physicians: 1,005 9. Molina Healthcare HMO Hospitals: 29 Physicians: 4,568 10. Sharp Health Plan HMO SAN DIEGO ONLY Hospitals: 7 Physicians: 2,600 11. Valley Health Plan HMO SANTA CLARA ONLY Hospitals: 4 Physicians: 993 12. Ventura County Health Care Plan HMO VENTURA Hospitals: 6 Physicians: 176 13. Western Health HMO 8 NORTH COUNTIES Hospitals: 15 Physicians: 3,000

4 1.Ambulatory patient services 의료 수송 2.Emergency services 긴급 서비스 3.Hospitalization 입원 4.Maternity and newborn care 임신 5.Mental health and substance use disorder services, including behavioral health treatment 정신 건강 6.Prescription drugs 처방약 7.Rehabilitative and habilitative services and devices 재활 및 서비스 8. Laboratory services 실험실 서비스 9. Preventive and wellness and chronic disease management 예방 검진 10. Pediatric services, including oral and vision care 소아 구강 및 비전 케어 MINIMUM ESSENTIAL HEALTH BENEFITS 필수 보험

5 Product Framework for Exchange Plans 보험 Plans sold before 3-23-2010 are grandfathered and they can remain on the current coverage or move if they like. Plans sold after 3-23-2010 are non- grandfathered. These will be migrated into the “off exchange” precious metal plans. IN OFF

6 Coverage CategoryBronzeSilverGoldPlatinum Covers 60% avg. Annual Cost Covers 70% avg. Annual Cost Covers 80% avg. Annual Cost Covers 90% avg. Annual Cost Deductible$5,000$2,00000 Preventive Care CopayNo Cost Primary Care Visit Copay$60 for 3 visits$45$30$20 Specialty Care Visit Copay$70$65$50$40 Urgent Care Visit Copay$120$90$60$40 Emergency Room Copay$300$250 $150 Lab Testing Copay30%$45$30$20 X-Ray Copay30%$65$50$40 Generic Medicine Copay$19 or less $5 or less High cost and infrequent services like Hospital Care and Outpatient Surgery 30% of your plan’s negotiated rate 20% of your plan’s negotiated rate HMO Outpatient Surgery - $600 Hospital - $600/day up to 5 days PPO – 20% HMO Outpatient Surgery - $250 Hospital - $250/day up to 5 days PPO – 10% Imaging (MRI, CT, PET Scans)30%$250 $150 Annual Out-of-Pocket Max for Individuals $6,350 $4,000 Annual Out-Of-Pocket Max for Families$12,700 $8,000

7 Tax Penalty for individuals 벌금 처벌 2014: Greater of $95 or 1% of taxable income 2015: Greater of $325 or 2% of taxable income 2016: Greater of $695 or 2.5% of taxable income 2017 and beyond: Annual adjustments

8 8 Annual Open Enrollment Period 등록 기간 October 1 st 2013 through March 31 st 2014 October 15 th 2014 through December 7 th 2014 October 15 th 2015 through December 7 th 2015 October 15 th 2016 through December 7 th 2016

9 Marital Status Changes to marital status are a qualifying event, which allow the policyholder to make changes to his policy. This can include adding a new spouse or removing a spouse. Employment An employment status change in a policyholder's dependent or spouse allows changes to health insurance coverage. For example, if a spouse changes from a full-time employee to a part-time employee. Or loss of Group coverage. Childbirth The birth of a child is a life event that allows the baby to purchase off AOE. Change in Eligibility Dependents may become ineligible for health insurance coverage after completing school or getting married. Affordability My current plan has become too expensive. Just moved to the state Qualifying events to purchase “OFF” Open Enrollment

10 Making Care More Affordable 세금 공제 Number of People in Your Household Annual Household Income Medi-CalPremium Assistance 1$0 - $15,856$15,856 - $45,960 2$0 - $21,404$21,404 - $62,040 3$0 - $26,951$26,951 - $78,121 4$0 - $32,499$32,499 - $94,200 5$0 - $38,047$38,047 - $110,280

11 Household size 100% 138% 150% 200% 300% 400% 1$11,170$14,856$16,755$22,340$33,510$44,680 215,130 20,12322,695 30,26045,39060,520 319,090 25,39028,635 38,18057,27076,360 423,050 30,65734,575 46,10069,15092,200 527,010 35,92340,515 54,02081,030108,040 630,970 41,19046,455 61,94092,910123,880 734,930 46,45752,395 69,860104,790139,720 838,890 51,72458,335 77,780116,670155,560 For each additional person, add $3,960 $5,267$5,940 $7,920$11,880$15,840 FEDERAL POVERTY LEVEL CHART

12 Modified Adjusted Gross Income (MAGI) is calculated by adding back certain items to your Adjusted Gross Income. Your Adjusted Gross Income (AGI) can be found on line 38 of your Form 1040; line 22 of your Form 1040A; or line 36 of your Form 1040NR. The following items must be added to your Adjusted Gross Income (AGI) to calculate your Modified Adjusted Gross Income (MAGI): Traditional IRA contributions that were deducted. Student loan interest amounts deducted. Tuition and fees deducted. Domestic production activities deducted. Foreign income or housing costs excluded on Form 2555. Foreign housing deduction taken on Form 2555. Savings bond interest excluded on Form 8815. Adoption benefits from an employer excluded on Form 8839. Modified Adjusted Gross Income (MAGI) Line 32 on your 1040 form

13 The big picture for individuals Every American not covered under a government plan will have three options for health insurance in 2014: 1.Get coverage through their employer if available 2.Buy an individual market plan through either: The individual market exchange – Purchaser may be eligible for subsidy The off-exchange market 3.Go uninsured (will pay penalty unless they qualify for an individual exemption)


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