Question About ACA & USHEALTH GROUP

[SamIam]

I had a discussion on Linkedin ( I thought it was a discussion) he got offended though with some guy with US HEALTHGROUP. He said they can enroll people year round. I told him unless its a qualifying event that is not true.

Well it turns out he is correct they have a rider on their fixed indemity plan you can purchase at application that you can buy into one of their ACA compliant plans throughout the year. The plan is securecare plus. He said he is now reporting me, what can happen if I said a false statement about that carrier. I based my knowledge on we we were all certified on.

 

[bluediamond]

Yep, some clown that represents them out of Panama City has a list of Blue Cross clients in the panhandle and is calling on them and replacing grandfatherred plans. He said it was a golden rule plan, is that true? Checked him out on OIR and only appointment is with freedom life, which is parent of USHG, so I've been told. Told my client of 8 years that Blue Cross rate increase was going to be 50% next January on the grandfathered plans. Well they don't have a rate increase on Jan 1, their plan year is either July or August for the older plans.

 

[HealthGuy]

Sam this guy seems like a real winner...I read the brochure, I wonder how soon you can exercise the option of getting into an ACA compliant plan year round? the brochure seems unclear and nondescript, any surprise there?

 

[SamIam]

Can I get in trouble saying something that was incorrect about a company even though on in our certification it said you can only enroll in a qhp outside of the enrollment period if its a qualifying event? Plus this was in a linkedin group it wasn't like I was advertising this to a client? I'm just wondering if I can get in trouble and what's the penalty.

 

[HealthGuy]

Sam, I know its easy for me to say this, but I wouldn't worry about it...according to healthcare.gov there are NO enrollments outside of an open enrollment without an SEP...how are they doing this by the way? And if you were to elect to enroll outside of an open enrollment, when could you first get into the compliant ACA plan? The first of the next month, or how long would you have to wait? What jerks these guys are. By the way, their brochure provides NO details on the ACA compliant plan option that you can "buy into" anytime during the year, if necessary, there is not ONE detail on that plan. I think this is such BS.

 

[WCMason]

What a childish response. "I'm gonna tell on you!" Probably ran to his mommy. So unless you're his brother who might have to go to bed without dessert, you're fine.

 

[Yagents]

It's one of the typical side effects of the cool aid.

 

[wingateexpress]

You should be more careful what you discuss on an open forum. You will likely get a letter from an attorney asking you to retract your statements.

 

[Yagents]

This is NOT ACA compliant, it is a fixed indemnity plan. The rider they are speaking about allows them to upgrade to a higher level non ACA compliant INDEMNITY plan. In fact, they have a full disclaimer that states they will also have to pay the penalty if they own this plan. They use the words "essential health benefits", but it is not related to the ACA EHB's. Misleading to consumers and fraudulent in my opinion. The agents who sell this should be getting a cease and desist from HHS. Or, they will be shut out once they finalize regulations that products like this can NOT be sold separately, but must be sold as a SUPPLEMENT to an ACA qualified plan.

Here is the brochure to the SecureCare Plus plan (Read page 11):
USHEALTH Group | Brochures

From page 6 disclaimer:

The individual mandate under the Affordable Care Act (“ACA”) generally requires individuals to maintain “minimum essential coverage” in 2014 and beyond, or be subject to
payment of the annual shared responsibility payment, the amount of which is based, in part, upon the individual’s household income each year (See page 14 of this brochure
for details). The SecureCare Plus plans are fixed indemnity insurance plans, which provide pre-determined fixed dollar benefits on a periodic basis (e.g. daily/monthly) for
covered services and are neither “essential health benefit plans” under the ACA, traditional major medical insurance plans, nor Workers Compensation plans under state law.
Fixed indemnity plans are “excepted benefit plans” under the ACA, but are not considered “minimum essential coverage” under it. Therefore, unless an insured under one of
our SecureCare Plus fixed indemnity plans has an exemption from the ACA’s individual mandate or maintains “minimum essential coverage” under the ACA the insured will be
subject to the ACA’s “shared responsibility payment” (See page 14 of this brochure for details).



From page 14:

ACA Individual Mandate & Shared Responsibility Payment
The individual mandate under the ACA generally requires individuals to have “minimum essential coverage” in 2014 and beyond, or be subject
to payment of an annual “shared responsibility payment”, the amount of which is based, in part, upon the individual’s household income
each year. The ACA’s “shared responsibility payment” has also been referred to from time to time as a tax and as a penalty, and is payable
to the federal government. Fixed indemnity plans are exempt from the coverage and rating mandates of the ACA, and therefore are not
considered “minimum essential coverage” under the ACA. If an individual (a) does not receive an ACA exemption annually from the federal
government for the individual mandate, or (b) does not maintain “minimum essential coverage” under the ACA for 9 or more consecutive
months during each year, (including coverage under one of the following types of plans (i) an employer sponsored group health plan, (ii) a
grandfathered health plan, (iii) a non-grandfathered health plan for which the government has granted a waiver of the individual mandate,
or (iv) an ACA essential health benefits plan), he will be subject to the ACA’s annual “shared responsibility payment”, even if covered under
one of the SecureCare Plus fixed indemnity plans. For additional information on the individual mandate, “shared responsibility payment”,
exemptions from the mandate and other matters concerning the ACA, please visit www.healthcare.gov, the federal government’s website.

And just look at some of their exclusions on page 12-13:

• Prescription Drugs that are classified as psychotherapeutic drugs,
including antidepressants;
• except for Complications of Pregnancy, routine maternity related to
childbirth, including routine nursery services and well-baby care except
as specified in the MATERNITY DAILY FIXED INDEMNITY BENEFITS section;
• Outpatient Prescription Drugs that are dispensed by a Provider, Hospital
or other state-licensed facility;

----------

Well it turns out he is correct they have a rider on their fixed indemity plan you can purchase at application that you can buy into one of their ACA compliant plans throughout the year. The plan is securecare plus.

Here is your answer, show me where and how this is ACA compliant. It states anything but that.

 

[SamIam]

Yagent where did you see that " The rider they are speaking about allows them to upgrade to a higher level non ACA compliant INDEMNITY plan."

I didn't see that in their brochure?