2016 Health Insurance Checklist

October 14, 2015

Open Enrollment & Your Key to ‘White Glove’ Service

calendar days

November 1st marks the first day individuals and families can review options & make health insurance selections for 2016.  While 2016 plan details and premiums have not yet been released (we expect to have this information by November 1st), here are four(4) important  “to-do’s” for you to prepare in advance:

  1. Stay informed: Sign up for L & A’s blog– this includes the most current news on insurance changes that may impact you.
  2. Look up your doctor– Provider networks are changing every year.  As more limited networks emerge, it’s important to always verify the available plans and networks in which the doctor participates.
  3. Look up or call your pharmacy to make sure they will continue to accept your insurance plan.
  4. See if you qualify for health insurance tax credits,based on your anticipated 2016 income.

For 2016, many health plans must be replaced by December 15th for a January 1st effective date.  It is important to schedule an appointment with us to review your options and guide you to the right plan for next year.

Next, check our availability for a personal appointment for 2016 Health Insurance Open Enrollment.  December 15 is the deadline but we encourage you NOT to wait.  The end of the Open Enrollment period is very busy so to ensure we are able to provide the individual attention you deserve, L&A Services is encouraging each of you to take this opportunity to schedule your appointment in advance.  Review the November calendar then call or email us directly at (602) 996-6010 or ben@lnaservices.com.


BCBSAZ 2016 Individual/Family Plan Renewal

August 27, 2015

bcbsaz logo

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.



February 5, 2015

bcbsaz logocignabannerHealthNet LogoAetna LogoHumana Logo

All individuals who have yet to enroll for health insurance coverage for 2015:  REMINDER – Sunday February 15th is the FINAL DAY of OPEN ENROLLMENT for the plan year 2015. 

Also, remember that the “shared responsibility payment” imposed for 2015 will be 2% of an individual’s adjusted gross income. Seek a tax expert if necessary. 

Those who still need to enroll for a policy and would like to see if their household’s income qualifies for a federal subsidy in the form of a tax credit or premium assistance you may CONTACT OUR OFFICE or go directly to Healthcare.gov to confirm the amount. 

Once your application is submitted call our office at 602-996-6010 for help choosing a plan.

Your enrollment has to be completed by Sunday 2/15/15 for coverage effective 3/1/15.    

At Healthcare.gov please include your agent, Ben Rosky’s information so L&A Services is established as your Broker Of Record (BOR).  Use the NPN number:  6747133.   

Email ben@lnaservices or help@lnaservices.com with any questions.  

Thank you.  We appreciate our friends and we value their trust in L & A Services, Inc. for their insurance needs for almost 30 years.

BCBSAZ Renewal for Individual ‘PLUS’ Plans

October 30, 2014





Blue Cross Blue Shield of Arizona (BCBSAZ) announces details of this year’s renewal for Non-Grandfathered (Suite C) individual plans.  These are plans that were purchased between April 2010 & December 2013, and are easily identified by the name, which will include the word ‘PLUS’.

Renewal mailings for these individual members are scheduled to begin the week of October 20th. The letter you will receive will include your plan information, current and renewal premiums, along with your broker’s contact information.

For members who wish to keep the plan they have, there is no further action you need to take…it will renew automatically.

For those who wish to review alternate health plan choices, we will be able to help you compare all 2015 plan options starting in November.  2015 plan enrollment begins November 15th and ends February 15th.

Overview-  Here’s What’s Happening!

For most, staying in your existing Suite C individual plan will provide coverage at a lower premium than the new, 2015 individual plans.  Exceptions may include those who are subsidy eligible, need maternity coverage, are 65 or older, or were rated up in the Suite C individual due to medical underwriting.

Many of our clients will experience a percentage rate increase this year in the double-digits.  Not everyone will be affected, but these are the factors that will lead to the greatest increases:

  1. Rate Pass in 2014 – Suite C individual customers did not receive a rate increase in 2014
  2. Age – members may face up to two years’ worth of age-related rate increases
  3. New ACA fees – The Affordable Care Act (ACA) mandates certain fees be added to rates

Discontinued Plans– Two existing Suite C individual plans will be discontinued on January 1, 2015.  All discontinued Suite C individual plan members will be mapped to comparable 2015 individual plans. You will also have the right to purchase any individual plan currently sold by BCBSAZ.

Discontinued Plan Mapped To
BlueSecure HMO Plus  —-> CopayComplete 40 PPO
Comp One Plus           —-> EverydayHealth 1000 PPO

Changes in Benefits– The following changes apply to: BlueOptimum Plus, BlueValue Plus, BlueBasic Plus, BlueEssential Plus, and BluePortfolio Plus:

Behavioral and Mental Health Services

  • Plans will now cover behavioral and mental health partial hospitalization services. (Precertification is required.)
  • Coverage for inpatient admissions to behavioral health subacute facilities will be expanded.
  • Care coordination will no longer be required for services provided through the behavioral services administrator (BSA).

Emergency Services

  • Reimbursement for emergency services provided by non-contracted providers will be based on billed charges.

Preventive Services

  • Additional preventive care services will be covered. (A list of covered services will be included in the Preventive Services section of the member’s benefit plan booklet, and available from BCBSAZ.)


  • Plans will cover telemedicine services delivered by an in-network provider through interactive audio-video electronic media to treat burns, cardiologic conditions, dermatologic conditions, infectious diseases, mental health disorders, neurologic diseases, and trauma.
  • Benefits are also available for emergency or urgent telemedicine services provided by out-of-network providers to treat these conditions.


  • Currently, services are denied or members pay a $300 charge if the member’s in-network or out-of-network provider fails to obtain precertification for covered services that require precertification. Except for medications that require precertification, services will no longer be denied and members will no longer pay a $300 charge if an in-network provider fails to obtain precertification for a service that requires it.

Depending on the type of service, services will continue to be denied or members will continue to pay a $300 charge if the member’s out-of-network provider fails to obtain precertification

Pre-Existing Conditions

  • Plans will no longer exclude pre-existing conditions for members of any age (currently 19 and older).

The following changes apply only to BlueOptimum Plus, BlueValue Plus, BlueBasic Plus, and BlueEssential Plus:

Office-Visit Copays

  • The in-network copay for a primary care physician visit will increase to $35, the in-network copay for a specialist office visit will increase to $60*, and the in-network copay for an urgent care visit will increase to $75.

* Specialist office visit cost-sharing for BlueBasic Plus will remain at 20% member coinsurance after deductible is met.

Out-of-Pocket Coinsurance Maximums

  • The in-network per-member out-of-pocket coinsurance maximum will increase by $500. The out-of-network per-member out-of-pocket coinsurance maximum will increase by $1,000.
Plan 2014 Out-of-pocket Coinsurance Maximum  (per member)  2015 Out-of-pocket Coinsurance Maximum (per member)
In-network Out-of-network In-network Out-of-network
BlueOptimum Plus $2,500 $5,000 $3,000 $6,000
BlueValue Plus $3,000 $6,000 $3,500 $7,000
BlueBasic Plus $4,000 $8,000 $4,500 $9,000
BlueEssential Plus $5,000 $10,000 $5,500 $11,000

The following changes apply only to BluePortfolio Plus:


  • The in-network deductible on the BluePortfolio Plus $2000 deductible plan option will increase to a $2,600 deductible for individuals and a $5,200 deductible for families.

All plan changes effective December 31, 2014. All benefits covered by benefit plans, including the benefits discussed in this notice, are subject to applicable law, BCBSAZ medical coverage guidelines and benefit plan limitations and exclusions.

Remember, if you are happy with your plan and the new rate, you don’t need to do anything. The Suite C individual plans will automatically renew. (This option will be noted in the renewal letter, along with notice of any benefit changes to the current plan.)

For more information, please contact your Broker Service Representative, L&A Services, Inc.

Aetna 2015 Plan Updates – Arizona

October 15, 2014

Aetna Logo

In October Aetna will be mailing out letters to members outlining options for 2015 and informing them that some plans are being terminated at the end of 2014.

Most members will be automatically enrolled into a new plan.  But others are being informed that their coverage will be ending December 31, 2014.

This includes pre-ACA plans as well as those who purchased ACA compliant plans both “ON” and “OFF” the exchanges.

In most cases, Aetna will automatically renew members into a 2015 plan. The letter will include information about the plan benefits and premium. If the member likes the new plan, they need to do nothing.

In some situations, Aetna will recommend a plan but will not be able to auto‐enroll the member. These members will need to submit a 2015 application when open enrollment begins on November 15.

Members always have the option to decide not to take the recommended plan, whether Aetna automatically enrolls them or not.

L&A Services will help these members understand their options, including shopping on the public exchange.

Can you keep your health plan?

August 1, 2014

Grandfathered health plans are those purchased with no major changes since March 23, 2010. Some insurance companies choose not to renew grandfathered health plans, while others are preserving these contracts. If your insurance company has not forced you off of your grandfathered plan yet, it is likely you will be able to continue your plan.


Grandmothered health plans are those purchased (or changed) after March 23, 2010, but before January 1, 2014. In an effort to facilitate the transition  from a grandmothered plan to a new Affordable Care Act-compliant plan, the federal government approved an extension for these plans, known as  ‘transitional relief’. Arizona also approved the transitional relief, but final decisions were left with the insurance companies. Below are a list of the insurance  companies and how they decided to handle their grandmothered small group and individual health plans in Arizona:

Company’s allowing you to KEEP your plan in 2015:

  • BCBSAZ (Individual)
  • BCBSAZ (Small Group) – if renewing 8/1 – 12/15
  • Golden Rule (UH1 Individual)
  • Humana (Small Group)
  • Assurant Health (All)

Company’s that require a REPLACEMENT plan starting in 2015:

  • Aetna (Individual)
  • HumanaOne
  • HealthNet – already transitioned to ACA plans

How long these plan will be extended for depends on the insurance company. Please refer to the notice you receive from your insurance company for details.

If your insurance company is not listed here, contact us and we can find out if your plan will need to be replaced in January or not.

In some cases, a new plan may be a better solution than your current plan. We recommend you contact your broker or L & A Services to review your options during the 2015 open enrollment, which runs from November 15th, 2014 – February 15th, 2015. After open enrollment, you must have a qualifying life event to purchase health insurance.

This information is accurate as of the day of this post, and is subject to changes made by the USA, the state of AZ, and/or the insurance companies themselves.

ACA (a.k.a. OBAMACARE) 5 QUICK FACTS to KNOW for 2014

December 4, 2013

With much confusion about the implementation of the Affordable Care Act in 2014, let us validate some facts and dispel some myths that really matter to most Americans.

These are just a few of the more common questions.  Please do not fail to ask your question about your specific situation by calling or emailing our office.

1.  Will I have to pay a fine if I don’t have health insurance in 2014?

YES.  Starting in 2014, most U.S. citizens and legal residents will be required to carry health coverage* for the majority of the year or pay a penalty.  There will be exceptions for those with religious objections and for those whose coverage would cost more than 8% of their annual income.

2.  Isn’t my employer required to provide my health insurance next year?

NO.  While the law does impose penalties on some businesses that do not provide affordable coverage, it does not require employers to provide health coverage in 2014.  However, small employers may qualify for TAX CREDITS if they pay at least 50% of the cost of their employees’ coverage.   For more specific information on 2014 TAX CREDITS for small employers click here.

3.  Do I have to use a government website or the Federally Facilitated Marketplace (FFM) to obtain coverage?

NO.  No one is forced to use Healthcare.gov, also known as the FFM (Federally Facilitated Marketplace).  In fact, many will continue to obtain health insurance coverage the same way they do today.  If you already have government-based insurance like Medicare, Medicaid, or CHIP or have satisfactory insurance through your job, no action is required.  If you do not have access to health insurance through your job or these government programs in 2014 and make less than 400% of the Federal Poverty Level, it may be to your advantage to apply through the FFM.  This is the only way to get help with monthly premium costs and reduced out-of-pocket costs.  See our instructions.

4.  Are premium rates going to be affected?

IT DEPENDS.  All plans must meet the requirements of the ACA in 2014 so the game has changed.  No one can be denied coverage for pre-existing conditions.  Women will no longer pay more than men.  How rates are affected will depend on individual factors, place of residence, the insurance company and whether you will receive a subsidy.   Talk to a broker for advice on all your options (see #5 below).

5.  Can I still use a broker for advice and coverage?

YES.  In fact, the federal government is encouraging broker involvement to make the process easier for the consumer.  Agents must be certified to assist those wishing to purchase insurance through the FFM.  Our agents are certified to assist businesses and consumers find the best path to affordable health insurance whether that’s through the government’s FFM or directly from the top carriers in the industry.  Plus, L&A Services, Inc doesn’t charge our clients for our services.

*Warning:  Not all health coverage is qualified, so contact a broker to make sure your coverage meets the new ACA standards.