November 4, 2015


If all Meritus policies terminate 12/31/15 and if Meritus does not offer renew or offer new policies in 2016, as we are being led to believe by the AZ Dept. of Insurance, then the loss of individual Meritus coverage is a Qualifying Life Event which will allow individual policyholders to submit an application to another carrier until 12/31 for a 1/1/16 effective date in order to avoid a lapse in coverage.

After 12/15 a paper application must be submitted.

Online applications for 1/1/16 are only accepted up until 12/15.


BCBSAZ 2016 Individual/Family Plan Renewal

August 27, 2015

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This week, Blue Cross Blue Shield of AZ (BCBSAZ) unveiled their new proposed plan and premium information for individuals and families in 2016.

There are many changes, and many customers will be required to take action to avoid losing coverage at the end of the year.  We are prepared to assist these customers with this process as early as September 9th.

Although BCBSAZ will be sending written notification to all affected members in the coming months, we wanted to provide the information in advance to help better prepare these customers for this year’s renewal.

These are the most important changes to know for 2016:

  1. Metal level plans (Platinum, Gold, Silver, Bronze) are considered ACA-compliant plans, since these were plans purchased and effective from January 2014 to now.
  • In 2015, these plans included three networks:  Statewide PPO, Alliance HMO, and Select HMO.   For 2016, BCBSAZ will only offer the two HMO networks in Maricopa County…the Statewide PPO plan is being deleted.   If you have an ACA-compliant plan with the Statewide PPO network, either purchased through the federal marketplace or directly from BCBSAZ, you MUST select a new plan by December 15th to avoid losing coverage on January 1st.  Customers living in all other counties will have access to the Statewide PPO network, as well as another regional network.  Note: the HMO plans do NOT require a primary care physician assignment, NOR do they require a referral to see a specialist.  However, it is important to check the list to make sure desired doctors participate in the network or else they are not covered.
  • The BlueEssential & Copay Complete plans have been deleted, so these customers will need to move to a new plan, as well.
  • For customers on a plan with either the Alliance or Select network, BCBSAZ will automatically enroll in the next closest available plan available for 2016.  This does not preclude you from changing your plan during open enrollment (November 1 – January 31), so contact our office if alternative choices are desired.
  • BCBSAZ ACA-compliant plans experienced an average rate increase of 21.4%.

2.  Grandmothered Plans are those plans purchased and effective between 2010-2013, and will include the word ‘Plus’ in the name of the plan.

  • All of these plans are being renewed without any changes to benefits or to the PPO network.
  • The average rate increase on these plans is 21.2%, however, the new rate will be guaranteed until April 30, 2017.  This will lock in the rates for a full 16 months.
  • Despite the increase, these plans continue to offer greater premium savings over the ACA-compliant plans.  Most customers in these plans will want to keep what they have.
  • Nothing is required to keep these plans, but customers still have the ability to either 1) change the deductible to lower the premium, or 2) consider moving to an ACA-plan during open enrollment (November 1 – January 31) if desired.  If a member moves away from a Grandmothered plan, they cannot get it back later.  We are able to assist with customers with this evaluation.
  • BCBSAZ will be sending a letter to each affected customer on October 12th.

3.  New Dental Plan

  • BCBSAZ is now offering their group BluePreferred Dental plans to individuals and families.
  • Contact our office if interested in private PPO dental coverage from BCBSAZ

We suspect there will be many changes in 2016 from all of our carrier partners.  We know there will be many questions, and we are here to answer them.  Please keep in mind that this is an extremely high-volume time of the year, so time is of the essence…the sooner you take action, the smoother the process will go for you.

Thank you to all 266 of our individual BCBSAZ customers.  We look forward to serving you during this time of change.


Feds To Impose Penalties On Small Business

July 23, 2015


A little known rule that will impose penalties on small businesses for “not meeting the required group coverage plans that provide health care assistance to employees through the use of traditional HRA accounts” went into effect July 1.  The delay in the implementation of the rule came from a delay at the U.S. Treasury Department in the enforcement of the technical guidance issued in September 2013 for health reimbursement arrangements (HRA).

This means fines will start being imposed on small businesses not meeting those requirements.  The IRS rule mandates that small businesses that help their employees buy individual insurance or pay medical bills directly can be fined.  The reason for this fine is that, if the employer pays these costs, the IRS considers the organization to be operating a group health plan.  Since these reimbursements are not for a qualified group health plan under the ACA, they may be subject to a fine.

The fine averages about $100 per day, per employee. At the end of the year, those fines can add up to $36,500 per employee, or $500,000 total.  The fee applies to organizations whether they offered their employees before-tax or after-tax assistance.  The fine does NOT apply to employers who contribute towards the cost of a qualified group health plan.

Specifically, the rule applies to employers with more than one employee participating in an employer health care or coverage pay arrangement. Employers can exclude workers who:

  • Have less than three years of employment at the company
  • Are under the age of 25
  • Are part-time or seasonal workers

Given the few exemptions, it comes as little surprise that the $100/day fine then applies to all other employees covered by the payment arrangement. S Corporations, though, are exempt from this rule through the end of 2015.

Please contact your L&A Services representative with any questions.

TASC Provider Learns the Value of ERISAEdge

June 17, 2015


Do you know anybody who wants to be audited? I don’t! Recently, a TASC Provider witnessed firsthand the benefits of signing Clients with TASC’s ERISAEdge. Thanks to TASC and ERISAEdge, Keith Zuckerman, President of Professional Group Plans, Inc. was very pleased with the results of a Department of Labor (DOL) audit.

After the DOL audit, Keith told his staff how thankful he was that the Client in question had signed with ERISAEdge. After all, as directed by ERISAEdge, the Client had distributed Plan information in a manner acceptable to the DOL. Having done so, the Client was able to quickly provide the information requested in the audit. Indeed, the DOL Senior Investigator said the quick turnaround truly helped. And thanks to ERISAEdge—and the Client’s promptness—the DOL Investigator started the meeting by saying it would be brief and painless. And it was. He said he had not seen a group with…

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When can I buy a health plan?

March 24, 2015

CB065532Open enrollment is over, but you can still buy health insurance if you experience a qualifying life event.  Here are a few examples of Life Events Qualifying for Special Open Enrollment:

  • Loss of full-time employment status
  • Moving to a different state
  • Loss of employer sponsored coverage
  • Marriage
  • Divorce
  • Birth or adoption of a child
  • Termination of domestic partnership
  • 26 year olds’ change in dependent status
  • Return from active military duty
  • Gaining US citizenship

If you can properly document any of the following qualifying life events within the past 60 days, you may enroll or make changes to their health insurance plan coverage at

Last chance to enroll:  Did you have to pay a penalty on your taxes?  Read this.

Up to Six Million People Predicted to owe IRS “Shared Responsibility Payment”

March 24, 2015

According to a recent article by Robert Pear, a well-known health reporter for the The New York Times, up to six million people, or 2-4% of tax filers, will have to pay penalties this year because they chose not to buy health insurance.  Others also probably will not purchase health insurance due to being confused about the process and the ACA mandates.

As a result, CMS is providing individuals and families who owe the fee when they file their 2014 taxes with one last chance to get covered for 2015.cms logo pic

The Special Enrollment Period begins March 15 and ends on April 30.  During this time, you’ll have the opportunity to enroll in health coverage for 2015 only if you are currently uninsured & owe the fee for 2014.

See our Marketplace Instructions for help applying for coverage during this Special Enrollment Period.

Important: The fee for people who don’t have coverage increases in 2015. If you don’t have health coverage for 2015, the fee is $325 per person or 2% of your household income – whichever is higher.

International Travel ? Safety Tips To Observe

March 18, 2015


The recent surge in the U.S. dollar has made international travel more affordable than in many years and experts predict U.S. travel internationally to increase as well as what the travelers will come back with – more than souvenirs. You may hear of chikungunya in the Caribbean or measles in the Phillipines. The benefits of international travel are many but travelers should be aware that they risk sickness or injury when they travel. Travel Health Insurance If you need to go to a hospital or clinic overseas, you will probably be asked to pay out-of-pocket for services which can be very expensive. Consider your options in case you need care while you are abroad; especially if you have health conditions or if you will be engaging in adventure activities. Find out if your health insurance plan covers emergencies that happen abroad.  Ask about the exclusions, such as preexisting conditions or adventure activities. Consider buying a short-term supplemental policy.  Look for a policy that will make payments to hospitals directly. Discuss Travel Plans with Primary Care Physician

  • Where you are travelling and length of trip
  • Activities you might do
  • Other applicable personal factors:  age, medical condition/history
  • Make sure you are up-to-date with routine vaccinations including flu
  • Learn more about vaccinations by country :  Vaccination Page

Avoid Bug Bites Several diseases are spread by mosquitos and other bugs.  Us an insect repellant, wear pants and sleeves if necessary and sleep in air conditioned rooms or at lease have window or door screens. Choose Safe Transportation Traffic accidents are the #1 cause of death among international travellers, so practice road safety.  Don’t ride in a car at night in a developing country.  Avoid overcrowded or top-heavy buses.  And don’t ride motorcycles. Thank you for reading/sharing and contact us if you have additional questions or concerns.