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About Caffrey Insurance Solutions
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Best Broker in the
East Bay
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| Health Care Study: Ouch! | |
A recent study by the Institute of Medicine claims the US health care system squanders $750 billion a year. It also is falling short on quality, outcomes, costs and equity. It draws the following analogies.
"If banking worked like health care, ATM transactions would take days".
"If home builders were like health care, carpenters, electricians and plumbers would work from different blueprints and hardly talk to each other."
"If shopping were like healthcare, prices would not be posted and could vary widely within the same store, depending on who was paying".
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Review us on Yelp!
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Thanks to your great reviews, we now have a five star rating on Yelp. If you have received good service from Caffrey Insurance Solutions over the years, please drop by and let prospective customers know about your experience. We really appreciate your time! Thank you.
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Group Coverage Could Help Your Next Tax Day
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If you are currently considering small group coverage for your employees, you may not know that in addition to tax-deductibility of premiums, there are also tax credits available to groups of 2-50 employees.
One of our clients, a group of six people, said, "Can you believe we saved $1,500 last year because you let us know about it?" For more information, please feel free to check out the provisions of the act.
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Free CA Prescription Drug Discount Card
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 As a resident of California, you and your family have access to a FREE Prescription Drug Card program.
Simply download your Prescription Drug Card and receive savings of up to 75% at more than 50,000 national and regional pharmacies. You may create as many cards as you need.
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| Do You Like This Newsletter? | |
Some of you may be receiving this newsletter for the first time. We have been expanding our outreach efforts, but by all means, if you are not interested in receiving future newsletters, please click the unsubscribe link at the bottom of the page. If we haven't spoken in a while and you have concerns about health insurance that we can help you with, please let us know.
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| New Associates | |
If you would like quotes for your group or individual investment plans, we recommend Frank Pare of PF Wealth Management.
If you are seeking individual homeowners' or auto insurance, we recommend Jain Williams of State Farm Insurance.
If you are seeking some small-business operations coaching or career change guidance, we recommend Susan Urquhart-Brown of Career Steps Consulting Services.
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| As You Grow, We Grow With You | |
Please ask about additional services and value-added products such as HR administration and online policy management tools.
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| Testimonials | |
"You are different from any image I have had of an insurance broker. I simply enjoy being with you. I experience a combination of efficiency, care, honesty, commitment, and flexibility. I couldn't ask for better." --Miki Kashtan
"It's been a while since I encountered such superb client service in any area of business or life. Lynn is incredibly patient, super responsive, AND can translate insurance lingo.
She is also friendly and genuine without being intrusive, overly chatty or fake, navigating the sometimes challenging boundary between professionalism and human interest with natural ease."
--Yelp.com Review
"I'm glad there are individuals like Gabriel who can break it down so the average joe can understand the ins and outs of each plan, and make better-informed decisions." --Kerwin K.
"Thank you! Thank you! Thank you! I would probably still be on the phone with my insurer if it wasn't for you. Thanks so much, you're a life saver." --Michelle Ruiz "If any friends out there are heading toward navigating the path to Medicare...call Lynn at Caffrey Insurance Solutions in Oakland. She's great. --Elisabeth Schlessinger |
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Greetings!
The leaves are changing and the world looks clearer in the autumn. To help you understand your benefits better, our issue this month will focus on the newly required Summary of Benefits and Coverages forms, which are meant to provide more comprehensive and clearer understanding of your benefits.
The Summary of Benefits and Coverages requirement went into effect for new plans, renewals and individual plans on September 23, 2012. Believe it or not, the purpose of this rule is to clearly explain benefits - or else! So here's our attempt.
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New Requirements for
Summary of Benefits and Coverage
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Effective September 23 and being implemented with anniversaries after that date, the final Summary of Benefits and Coverage (SBC)
Needs to be implemented. This is part of health care reform.
It requires that all insurance carriers, employers and self-insured health plans provide individuals with a uniform summary of their benefits and coverage (SBC). The intent of the rule is to provide consumers and customers with an easy way to understand their coverage, as well as a way to help them make "apples-to-apples" comparisons when purchasing new coverage. You can be fined heavily for non-compliance.
OVERVIEW
- The Summary of Benefits and Coverage (SBC) rule, part of the Affordable Care Act (ACA), requires all health insurers and group health plans to provide individuals with a uniform summary of their benefits and coverage.
- The purpose of the SBC is to ensure that benefits and coverage information is presented in clear language and a consistent format to help consumers understand the coverage they already have or to help them make comparisons of available options when purchasing new coverage.
- The law for providing SBCs became effective September 23, 2012.
- It applies to all groups and individual plans and to Cobra and Cal-Cobra beneficiaries.
WHO IS IN CHARGE OF REQUIREMENTS?
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Generate the Summaries of Benefits and Coverages
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Carrier
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Distribution
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Carrier or Broker in Case of New Business
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Getting documents to employees
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Employer
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Cobra Beneficiary Notification
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Employer
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Cal-Cobra Beneficiary Notification
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Carrier
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WHAT IS THE REQUIREMENT?
Summary of Benefits and Coverage (SBC) in hard copy or electronic format
Uniform Glossary of Health Coverage and Medical Terms
WHEN MUST SBC DOCUMENTS BE DISTRIBUTED?
Within 7 days of request, regardless of enrollment status
With initial enrollment for new groups and for new hires or newly eligible employees.
Within 90 days of a special enrollment event.
At renewal.
Within 60 days of a material modification
HOW ARE SBC DOCUMENTS DISTRIBUTED?
Electronically if members have a computer
In paper format if requested
Consent forms are required.
PENALTIES FOR FAILURE TO DELIVER SBC'S
Failure to deliver SBCs to subscribers within the required time frame may result in a fine of $1,000 per each covered individual.
Additionally, a fine of $100 per day per person may be imposed until the SBC is issued.
Temporary Enforcement Safe Harbor: For coverage that begins prior to January 1, 2014, the federal agencies will not impose penalties on groups and insurers that are working diligently and in good faith to comply with the SBC requirement.
We have linked to a sample SBC document above. The US Department of Labor has many more relevant documents, including templates for the requirements.
Each carrier has links to their plans. At each renewal we discuss with you going forward, we will provide links for your specific plans so you can forward them to your employees. If you want us to find your plan now, please send us an email and we're happy to do so.
Thank you and we promise our next issue will be all about turkeys and pumpkin pie!
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What Would Lynn Do?
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 Q: We have a very small company, only five employees. We were planning to start benefits some time soon but now we have had a crisis. Our President is being admitted to the hospital. What can we do?
- Nothing. You can start coverage next month but will have to pay for this claim out of pocket.
- Try backdating all the forms and blaming the US Post Office.
- Hope Medi-Cal will kick in for this one claim.
- None of the above.
None of the above.
In a similar case we dealt with, a client was admitted on the 9th of the month. The deadline for getting materials to the insurance carriers was the 7th, which was a Friday. However, because of our relationship with the agencies that work directly with the insurance carriers, we were able to add this company's name to a "late list".
Within 3 days we got all we needed to add the group. They were approved a day later effective retroactive back to the first of the month, in time to cover the claim. This isn't always possible but a broker will know when to try.
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How Long Will You Live?
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This is a repeat feature as people still seem to be enjoying it!
They try to predict how long you're likely to live. It does say that it won't work if you have a long term health issue, but generally it works well. Barring long-term health problems, we're going to live a long time, most of us into our late 80's or 90's.
How will we ever pay for the insurance to cover such long lives? Smarter folks than us are working on these issues. When they figure it out, we'll be here to explain it to you. We promise.
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About Caffrey Insurance Solutions
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Lynn Caffrey and Caffrey Insurance Solutions is a family business employee benefits brokerage firm that provides insurance expertise for small companies (fewer than 50 employees) and individuals seeking Individual coverage.
Caffrey Insurance works with you to find the best insurance benefits that provide the best value, tailored to the unique needs of your company.
California License Information
Individual: 0557451 Corporate: OG80281
336 Lenox Avenue, Oakland, CA, 94610
510-444-5447
Email: lcaffrey@caffreyinsurance.com
 Gabriel Caffrey (CA License: 0H66348) is interested in hearing from small groups, particularly innovative tech companies just getting started in the world. He is technically savvy with data management and is glad to help with infrastructure projects as well as ensuring efficient HR and benefits management for you.
Email: gabriel@caffreyinsurance.com
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