In the case of a submission via the Marketplace, the data is submitted within 72 hours to the carrier, and this begins the setup process (approximately 5-10 business days). If the application is submitted directly to the carrier, it is setup within 48 hours. In both scenarios, the application must be entered into the carrier’s system and then an invoice is generated. Turn-around time, depending on time of year (i.e. during health reform or “off season”), can range 10-20 business days until receipt of invoice.

No matter the type of policy you hold, it is important that you wait until you receive your invoice to make a payment. Additionally, your payment must be received by the carrier before the 1st of the month. If you do not receive an invoice within 5 days before your effective date, please contact us via our customer service help ticket below. Once you received your invoice, our suggested method for the initial payment is to mail it with the invoice, and note the policy ID on your check for reference; this ensures proper processing of the first payment. With this initial submission, most carriers will allow you to set up preferred payment methods, such as recurring bank drafts. If you do not receive a letter from the carrier with these options, you may call their customer service number (see our customer service numbers below) to make arrangements. No matter the method you decide, it is still important to check your invoice each month, as it could have adjustments.
If you need to get your payment to the carrier quickly, you may use the carrier’s pay-by-phone number listed on their welcome letter or reference our customer service numbers below. Once you make your 1st payment, by whatever method you choose, you will receive your ID card and can set up an online account where you may make payments, review claims and view plan details.

You will receive an invoice and/or letter from the carrier (within 14 business days based on time-period, i.e. open enrollment), and ID cards arrive after the first premium payment has been made. Once you have made the premium payment, please allow up to an additional 10 business days to receive the ID cards, with again, consideration for back-log if you apply during open enrollment.

You may call customer service and request a new card; set up an online account and print a temporary card; or request a new card direct from your online portal (see customer service numbers below for help on how to do each of these steps). Also, some carriers now have cell phone applications that you can use to have your ID card available at a moment’s notice. If you need further assistance, you may fill out a customer service help ticket below.

To enroll in automatic deduction through My Health Plan:

1. Have your ID card handy, you will need the ID number from the card.
2. Visit Member.Medmutual.com to log into the secure member website, My Health Plan.
3. Click, “Pay Your Premium” and follow the on-screen instruction to connect to the bill payment system.
4. Click “Payments”, then “Manage Auto Pay” to be guided through enrollment.

If you still have trouble, you may contact Customer Care at 800.242.1936 and ask for help. They will walk you through the process and help you get set up.

Please see the customer service numbers below. We have listed the most frequently requested carriers, with their online portal setup pages. By clicking the link below, you will be routed directly to your carrier’s website to set up your online portal. If you need further assistance with the setup or you do not see your carrier below, please fill out a customer service help ticket below.

You may view claims, your certificate of coverage, and find details about services on your policy within your online portal. Please see the question above on how to set up your online portal. If you cannot gain access to the member portal due to password or technical issues, please contact the carrier using the customer service numbers below. If you are confused on how to decipher the information, please feel free to submit an inquiry by creating a customer service help ticket below.

You may view all of your billing information via your member portal, call customer service to review (see customer service numbers below), or submit an inquiry via our form below and we will research. It is possible it has “crossed in the mail” and does not have all your payments posted, or something has occurred with your subsidy (if applicable). If you are disputing an invoice, the carrier will want proof of payment.

As part of our process in reviewing your coverage options, each staff member checks the carrier’s website to verify network coverage, prior to submitting an application. However, due to current legislation issues with the Ohio Department of Insurance, carriers reserve the right to change their networks at any time. While it is the position of MyHealthQuoter.com that this ruling negatively affects consumers, it is beyond our control to change this legislation at this time. It is our strong suggestion that you check your doctors network affiliation by calling or going online to the carrier’s website, prior to any new appointments. This will avoid any undue charges to you. If you would like to make a difference in this current legislation, you may contact the Consumer Complaint division at the Ohio Department of Insurance.

First it is important to check if the doctor was considered in-network with the carrier; this would be the main reason a claim was rejected. The next possibility is the service you had performed was not listed as a “covered service”. Covered services can be found in your certificate of coverage, within your member portal. If you have any concerns over something that is showing as covered, but not paid, it could be a result of your deductible not being met. If you have questions regarding your deductible, feel free to submit a customer service help ticket below for our help.
The other common issue we see is when a claim has been incorrectly coded. An incorrect code can cause the carrier to deny a claim, even though it is a covered service. This is simply a human error originating with your doctor’s office. This is a quick fix by contacting your physician’s office and reviewing the service code with them.

You have two options in this scenario. Your first option is to work with the carrier direct, taking it through the appeals process. Your second option is our claims service, where we review all claims, and work with the doctor’s office and the carrier to ensure proper resolution. If an appeals case is necessary, we help you prepare the documentation for this process as well.
Due to the increased complexity and time involved in resolving claims in health reform, our office assists in these areas on a fee basis. However, if it is found that we do not need to be involved, we will refund this cost back to you. If you are interested in our claims service, please fill out the form below to move forward. Thank you!

You can cancel your health insurance coverage at any time you wish; however, there are a couple of things to consider.

The ACA law requires that everyone has coverage throughout the year, with not more than a 3 month gap in coverage (i.e. if your employer coverage ends on April 1st, you have until June 30th to obtain new coverage). Additionally, if you go without “creditable coverage” (listed as an ACA plan, employer coverage, or coverage that began before 1/1/14; short-term medical not included), during the year for more than 3 months, you will be assessed a penalty (2016 = 2.5% of household income). Furthermore, if you miss the 60 day period between the last day of your credible coverage and picking up new coverage, you will not be able to apply for insurance as a “Special Enrollment” (see definition below; losing your coverage due to non-payment of premium does not qualify). It is important to understand that if you have issues resulting in a loss of coverage, you are only able to obtain coverage during Open Enrollment OR if you have “Special Enrollment”.

If you need to cancel the policy, the manner in which you request the cancellation will be different by the effective date/type of health insurance policy you have:

*Note: for any of the three situations above, it is strongly suggested that if you have auto-withdraw payments set up on the account that you contact the carrier and tell them to stop this method of withdrawing your payments PRIOR to requesting the cancellation. The cancellation request and how the payment is processed is within different departments so you can have issues if not requested directly.

For more details concerning Special Enrollments, please visit: https://www.healthcare.gov/glossary/special-enrollment-period/

Ultimately, if you are shopping for insurance coverage today, your only options are group (employer) coverage, health reform coverage (with or without subsidy), or short-term medical coverage (subject to coverage penalty). Health reform is called many things- ACA coverage, “Obamacare”, etc. but it is one in the same, and the only qualifying coverage available for purchase in the individual market today. In 2010, health reform began by making changes to the required health benefits that carriers had to include on coverages in the market (i.e. preventive services). However, there are many plans still in existence (i.e. industry lingo of ‘grandmother’, ‘grandfather’ or pre-ACA coverage) that are not “health reform coverages”, but are being phased out by pricing, or the carrier not allowing changes to be made to the policy.

When you apply for coverage in the Marketplace, they will estimate the amount of subsidy for the tax year, using information you provide about your family composition and projected household income. Based upon that estimate, you can decide if you want to have all, some, or none of your estimated credit paid in advance directly to your insurance company to be applied to your monthly premiums. If you choose to have all or some of your credit paid in advance, you will reconcile on your tax return the amount of subsidy the government sent on your behalf, based on your actual household income and family size. If you do not opt for advance credit payments, you may claim the credit when you file your taxes, which will lower the taxes owed or increase your refund.

1. Has an annual household income between 138% – 400% of the FPL (in Ohio).
2. Is a lawfully present citizen (or between 0% and 400% FPL if a lawfully present non-citizen who is ineligible for Medicaid by reason of immigration status).
3. Be part of a tax household that will file a tax return for the coverage year, and does not use “Married filing Separately” status on the return¹¯².
4. Is not eligible for coverage an employer (if it meets affordability standards), Medicaid, CHIP, Medicare, Tri-health, etc.

¹As a result of DOMA (Defense of Marriage Act) ruling in 2013, eligibility rules with respect to tax credits treat same sex spouses in the same manner as opposite-sex spouses, so long as the taxpayer and his/her spouse do not file a tax return using “Married filing Separately” for the year. Additionally, tax credit payments are not available for the purchase of catastrophic coverage.

²A married taxpayer who lives apart from his or her spouse for the last six months of the taxable year is considered unmarried if he or she files a separate return, maintains as the taxpayer’s home a household that is also the main home of a dependent child for more than half the year, and furnishes over half the cost of the household during the taxable year.

For purposes of receiving subsidy, your household income is the Modified Adjusted Gross Income of all individuals that are on your taxes. You should only include the individuals in your household who you will claim on your taxes to make up the estimated figure. Anyone not on your taxes, but still in your household will file their own application for coverage, and estimate their own Modified Adjusted Gross Income. Please fill out a customer service help ticket below if you need a copy of the Modified Adjusted Gross Income document to consult with a tax advisor.

Open enrollment currently begins in November and runs through the end January. After January, due to specific guidelines by the government, you are unable to change plans unless you have a qualifying event (also known as Special Enrollment) that will allow you to do so. There are very specific details involved in what qualifies, so if you want to know more about special enrollment, please fill out a customer service help ticket below.
You may cancel your coverage at any time during the year if you have employer coverage available to you, or you simply do not wish to keep the coverage going forward. However, a note of caution- once the policy is terminated, you may not enroll in new coverage until the next open enrollment, unless you qualify for a special enrollment. Again, the requirements are very specific, so if you need more details to make the right decision, please do not hesitate to fill out a customer service help ticket below.

If you do not have “creditable and qualifying” coverage during the calendar year, yes, you will be subject to a penalty by the IRS. This penalty is payable during the tax season of the applicable year. During the 2016 year, the penalty for not having “creditable” coverage is 2.5% of your household income (realized in April 2017). After the 2016 tax year, the government will adjust for inflation. For more information on your specific situation, you should seek the counsel of a tax adviser.

There are certain exemptions that qualify but each exemption has a specific set of rules. If you are interested in knowing more about one of the exemptions listed below, please fill out a customer service help ticket below.

• The individual is uninsured for less than three months of the year.
• The lowest-priced coverage available to the consumer would cost more than 8% of the consumer’s household income.
• The individual does not have to file a tax return because their income is too low.
• The individual is a member of a federally recognized tribe or eligible for services through an Indian health care provider.
• The individual is a member of a health care sharing ministry since 1999.
• The individual is a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare.
• The individual is incarcerated, and is not awaiting the disposition of charges.
• The individual is not lawfully present in the United States.
• The individual has experienced a hardship (hardship exemptions covered below).

Some types of exemptions are available only through the tax filing process; some are only available through a Marketplace; and some are available through either channel.

To make the determination of a hardship exemption, the Marketplace considers whether an individual has experienced one of the following events:

1. Becomes homeless.
2. Has been evicted in the past six months, or is facing eviction or foreclosure.
3. Has received a shut-off notice from a utility company.
4. Recently experienced domestic violence.
5. Recently experienced the death of a close family member.
6. Recently experienced a fire, flood, or other natural or human-caused disaster resulting in substantial damage to individual property.
7. Filed for bankruptcy in the last six months.
8. Incurred medical expenses in the last 24 months that resulted in substantial debt.
9. Experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.
10. Expects to claim a child as a tax dependent who has been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, the individual would not have to make a payment for the child.
11. Experiences another hardship in obtaining health insurance.

Only individuals under age 30 and individuals with hardship exemptions may purchase a catastrophic plan. Catastrophic plans typically have high deductibles, and mainly protect individuals from very high medical costs.

This situation can be tricky, as the IRS notes whatever ‘status’ (divorced, married, single, etc.) you are at the end of the year, is what you will file. So what this means to your household situation, IF you were receiving subsidy, is that it will completely change at time of tax filing (April). This could result in repayment requirements of subsidy you received during the year based on the previous status of married + the number of people in your household. If you exceed a specific percentage (FPL %), you may end up with a significant tax burden. Additionally, you will need to separate the policy and as a result, you may pay an additional cost for the same insurance coverage, because the household dynamic has changed. It is best to speak with a licensed broker regarding this situation prior to finalizing your date for divorce/dissolution so you know all your options and what steps should be followed to ensure there is no gap in coverage.
To schedule an appointment with a broker: www.calendly.com/insurancereview
For details regarding IRS law: www.irs.gov/uac/eight-facts-about-filing-status

This is a very important part of the process, and this request should not be ignored. You typically only have 90 days to submit the documentation prior to the Marketplace adjusting or removing your subsidy all together. Sometimes the outcome of not submitting documentation is losing coverage completely. Submitting documentation may be inconvenient, but the process to recover your policy is lengthy and can leave you without coverage for up to 30 days. Best solution is to be proactive!
Submitting your documentation in the proper manner is also important. We strongly suggest that you take the following steps to ensure it is received and processed correctly. First, only send copies. Second, at the top of each page, please write the policyholder’s name; date of birth; last 4-digits of social security number; State where the coverage is held; application ID number. Finally, send via US post office to the address listed on the documentation request, with a tracking number. This seems to get the mail where it needs to go and it is a verifiable receipt that you submitted.

There are a few reasons the subsidy can change during the calendar year. If you add or remove a member of the household from your application, or if you were requested to submit documentation to the Marketplace, and it was not accepted or not received, your subsidy could change. Additionally, based on the application submitted to the Marketplace, if your data does not match with government databases (State or Federal), the subsidy will be adjusted. However, the Marketplace requests documentation before these changes occur, so keep a look out in your mail for anything that contains “Health Insurance Marketplace” on the envelope. These notices are important and usually arrive when there is a change pending.

You will need to determine how much of your income estimated will change, and then make that change based on the Modified Adjusted Gross Income standards. There is a specific document to help you calculate this estimate. If you do not have this document, please fill out a customer service help ticket below and we will send you a copy. Usually someone that is a W2 employee should consider last year’s wages, and estimate for 2016 based upon any wage increase that may occur (a raise; a second job; new job, etc.). In the case of being self-employed, we suggest that you speak with your tax advisor to know what is considered a write-off for insurance purposes, as they are different than your tax write-offs. In either case, a change to income will affect your subsidy amount, so it is important to understand the full scenario prior to making an update with the Marketplace. Contact our office by creating a customer service help ticket below for additional support.

If the subsidy credit was an overpayment, the taxpayer will be required to repay all or part of the overage depending on the taxpayer’s final income for the tax year. However, repayments are capped on a sliding scale for families whose annual income is under 400 percent of the Federal Poverty Level. If you would like help on where you fall on the federal income scale, please contact us by submitting a customer service help ticket below.

1. If annual family income is under 200% FPL; repayment is capped at $600 ($300 for individuals).
2. If annual family income is at least 200% FPL but less than 300% FPL, repayment is capped at $1,500 ($750 for individuals).
3. If annual income is at least 300% but less than 400% FPL, repayment is capped at $2,500 ($1,250 for individuals).
4. If the final annual family income is 400% FPL or greater, the subsidy must be repaid in full.

You will want to make sure the Marketplace has your correct address so your 1095A form can be mailed in February of each year, as well as the carrier having the correct address for your policy invoice, materials and updates. You may update your address by calling the Marketplace (available 24 hours, 7 days a week, except major holidays) at 800-318-2596.
If you desire to update your income on your own, please contact the Marketplace direct at 800-318-2596 (24/7). Please note, if you update information in your application with the Marketplace, you must give our office information each time so we may legally assist on your policy. Please ask the representative to place the broker information as- Broker: Matthew Byrne; FFM ID: Spiralight; NPN: 15288826

A 1095A is mailed out during the month of February to the last address on file from your application. If you have moved, please reference the question above. If you have a Healthcare.gov account set up, you may obtain a copy of your form via your policy portal. If you do not an online portal set up, you may call the Marketplace at 800-318-2596, and ask for another copy to be sent to you. Unfortunately, our office does not have access to this tax document, so it must come from the Marketplace.

1. Log in to your Marketplace account. No account set up? No problem- click here!
2. Click the green “Start a new application or update an existing one” button.
3. Choose “Go to my applications & coverage” at the bottom of the screen.
4. Under “Your existing applications”, select your previous year application – not your current year application.
5. Select “Tax forms” from the menu on the left.
6. Download all 1095-A on screen.

Congratulations- you’ve made it to the “finish line” in the insurance world! The days of complex coverages are over… well almost. Medicare can be a confusing experience for many individuals because there is so much information out there, but it does not have to be, and MyHealthQuoter.com can help you in this area as well. To get started, you should know it is required to have Original Medicare, and Part D (drug coverage), but Supplement and Advantage plans are for your additional protection, and are optional.
Furthermore, there are necessary steps that you need to take as you approach 65. First, 3 months before your birthday, be sure you contact the social security office near you by visiting https://secure.ssa.gov/ICON/main.jsp or go direct to the online website to apply at https://www.ssa.gov/medicare/apply.html. You’ll need to determine in this first step if you will collect your social security or keep working. These are conversations you will want to have with the Social Security office at 800-772-1213. These are the first steps you must take before you enroll in any other coverage. Next, fill out a customer service help ticket below so we can send you details on everything you need to know and guide you through the next steps of plan selection.

Employer insurance is considered affordable under the health care law if the employee’s share of the premium for the lowest priced plan available that would cover the employee only — not the employee’s family — is 9.66% or less of their household income. For an example, if your household income is $50,000 with 4 people on your taxes, the calculation would look like this… $50,000 (household income) * 9.66% to determine if affordable = $4830 a year for employer coverage (employee share) or $402.50 per month.

Therefore, in this scenario if the employer coverage is less than $402.50 per month for employee costs only, the coverage would be deemed affordable. The law states that anyone offered job-based coverage that’s affordable (by the 9.66% rule above), and provides minimum value, is not eligible for a premium tax credit if they buy a plan through the Health Insurance Marketplace. However, if you desire to purchase “off-exchange” (without any subsidy), you could do so. Our office can assist you with any quotes desired.

For a personal review of your situation, please schedule a free phone consultation with us: www.calendly.com/insurancereview.

Per Federal law, an employer is not allowed to pay “pre-tax dollars” toward an employee’s insurance premiums. If the employee receives the funds to pay for the premiums as part of their wages, this changes things, but employers and employees should understand that if an employer is paying the premium direct, without it being subject to tax, this is illegal and subject to fines. Under IRS Notice 2013-54, such arrangements are described as employer payment plans. An employer payment plan, as the term is used in this notice, generally does not include an arrangement under which an employee may have an after-tax amount applied toward health coverage or take that amount in cash compensation. As explained in Notice 2013-54, these employer payment plans are considered to be group health plans subject to the market reforms, including the prohibition on annual limits for essential health benefits and the requirement to provide certain preventive care without cost sharing. Notice 2013-54 clarifies that such arrangements cannot be integrated with individual policies to satisfy the market reforms. Consequently, such an arrangement fails to satisfy the market reforms and may be subject to a $100/day excise tax per applicable employee (which is $36,500 per year, per employee) under section 4980D of the Internal Revenue Code.

If you do not purchase health insurance that qualifies as minimum essential coverage (group or individual coverage [short-term medical excluded]), you may have to pay a penalty for the months you’re uncovered. The penalty is pro-rated based on the months you did not have coverage during the year (excluding the 3-month gap allowance). The penalty assessed would be the higher of these two amounts: 2.5% of your household income; or $695 per adult ($347.50 per child), up to a maximum of $2,085. You will pay this penalty at the time of filing your annual taxes; however, people with very low incomes, or certain circumstances may be eligible for exemptions.

For more information about estimating your penalty, please visit the IRS Penalty Estimator: http://www.taxpayeradvocate.irs.gov/estimator/isrp/.

For a personal review of your situation, please schedule a free phone consultation with us: www.calendly.com/insurancereview.

The Consolidated Omnibus Budget Reconciliation Act or COBRA, as it is more commonly called, is a Federal law that may allow you to temporarily keep health coverage after your employment ends; if you lose coverage as a dependent of the covered employee; or another qualifying event. Employees who are covered by their employer’s group health insurance plan can continue their coverage even after a “qualifying event” that would otherwise terminate their coverage. Qualifying events for employees include quitting, getting laid off or fired (for reasons other than gross misconduct), or getting a cut in hours that brings the employee below the employer’s threshold to qualify for benefits. If you elect the coverage, you can pay up to 102% of the premiums- 100% on the share the employer used to pay, plus up to a 2% administrative fee.

COBRA is typically offered by an employer with 20 or more employees, and applies to plans maintained by private-sector employers and sponsored by most state and local governments. The coverage lasts for 18 to 36 months, depending on your specific circumstances. Your Human Resources department should go over the specifics with you, and what the costs to continue the coverage would be. In addition, spouses and dependents can continue coverage after an employee dies, the employee and spouse divorce or legally separate, the employee becomes eligible for Medicare, or the dependent loses dependent status under the plan.

The initial payment must be received within 45 days after the date of the COBRA election. Payment is considered made on the date is it sent to the plan. If premiums are not paid by the first day of the period of coverage, the plan has the option to cancel coverage until payment is received and then reinstate coverage retroactively to the beginning of the period of coverage. Any payment after the initial payment is received, has a grace period of 30 days. If the amount of the payment made to the plan is made in error but is not significantly less than the amount due, the plan is required to notify the qualified beneficiary of the deficiency and grant a reasonable period (for this purpose, 30 days is considered reasonable) to pay the difference. The plan is not obligated to send monthly premium notices. Additionally, COBRA premiums may be increased if the costs to the plan increase but generally must be fixed in advance of each 12-month premium cycle. The plan must allow qualified beneficiaries to pay premiums on a monthly basis if they ask to do so, and the plan may allow them to make payments at other intervals (weekly or quarterly).

When a COBRA offer is made, it is important to understand all the options available and to closely look at the plan offered. If you would like to review your situation, please visit: www.calendly.com/insurancereview to schedule a free phone appointment. Thank you!

1-866-336-8253: (will direct to correct product division).
Note: You may download temporary ID cards, view billing statements and review claims at https://member.aetna.com/memberRegistration/register/home by setting up an account with your ID card.

(Policy effective AFTER 1/1/14, with subsidy): 855-748-1808.
Note: You may download temporary ID cards, view billing statements and review claims at https://www.anthem.com/health-insurance/login/registration by setting up an account with your ID card via the registration link in top right corner.

(Policy effective AFTER 1/1/14, NO subsidy): 855-330-1106.
Note: You may download temporary ID cards, view billing statements and review claims at https://www.anthem.com/health-insurance/login/registration by setting up an account with your ID card via the registration link in top right corner.

(Policy effective PRIOR to 1/1/14 – NOT a Marketplace plan): 888-613-6097.
Note: You may download temporary ID cards, view billing statements and review claims at https://www.anthem.com/health-insurance/login/registration by setting up an account with your ID card via the registration link in top right corner.

855-690-7796 / 800-467-1199.
Note: You may download temporary ID cards, view billing statements and review claims at https://www.anthem.com/health-insurance/login/registration by setting up an account with your ID card via the registration link in top right corner.

866-649-2037.
Note: You may download temporary ID cards, view billing statements and review claims at https://www.anthem.com/health-insurance/login/registration by setting up an account with your ID card via the registration link in top right corner.

866-755-2776.
Note: You may download temporary ID cards, view billing statements and review claims at https://www.anthem.com/health-insurance/login/registration by setting up an account with your ID card via the registration link in top right corner.

(address updates, income updates, 1095A forms, etc; available 24 hours, 7 days a week, except on major holidays, ie. Christmas): 800-318-2596.
IMPORTANT: If you update information in your application with the Marketplace, you must also give our office information each time so our office may legally assist on your policy.
Please ask the representative to place the broker information as-
Our information – Broker: Matthew Byrne (company owner) and NPN: 15288826