2013 CIS Logo
July 7th, 2015
Guiding You Through the Insurance Labyrinth
Caffrey Insurance Solutions Expanded Services

As your broker, we are constantly searching for value-added services that may assist you in running your business. To that end, we have partnered with HR360 to deliver a state-of-the-art human resources library. 


 

In many ways, HR360 acts as an 'online HR department', providing your company with the most current, attorney-reviewed federal and state employment laws as well as a complete range of downloadable forms, posters, interactive HR tools and a lawyer-vetted sample employee handbook. 


 

If you are one of our group clients and want to know more about HR360 or any of our value-added free services, please let us know!

 


 

We are stepping up our client outreach efforts and want to hear from you how we can continue to serve you best. If you have any additional needs or questions, please contact us by email at [email protected] or call 510-444-5447.
 

U.S. Supreme Court Rules That Premium Tax Credits
Can Continue Nationwide in 6-3 Ruling

The U.S. Supreme Court has ruled that the Affordable Care Act premium tax credits will continue to be available for eligible individuals enrolling in qualified health plans through any Health Insurance Exchange (Marketplace) regardless of whether the exchange is state-based or using a federally-facilitated Exchange.

 

The premium tax credit helps eligible individuals and families with low or moderate income afford health insurance purchased through the Marketplace. 

 

Large employers subject to the ACA's employer shared responsibility provisions (pay or play) may be liable for penalties if any of their full-time employees receive premium tax credits.
 

The U.S. Supreme Court decision comes in response to conflicting lower court rulings which considered whether the ACA's premium tax credits are limited under the law only to individuals who enroll in qualified health plans through state-based Health Insurance Exchanges. The opinion upholds the availability of premium tax credits in every state. Individuals and families enrolled in Exchange plans do not need to make any changes at this time as nothing has changed in the law and tax credits are still available.

 

For the curious, the official transcript of the case, King et al. v. Burwell is available here. 

U.S. Supreme Court Rules 
Same-Sex Marriages Legal Nationwide

As you will likely have heard, same-sex marriages are now legal throughout the United States. This is momentous news with wide-ranging social consequences. It also has some interesting implications concerning health insurance and employee benefits. Many employers do not offer benefits to same-sex domestic partners but do offer to spouses, regardless of gender. We expect to see a significant uptick in adding same-sex spouses as covered dependents under group plans in the near future.

For more context, we recommend reading a bit more in this article from Kaiser Health News.
2015 Benefits Notes for Employers from HR360

2015 Benefits Notices for Employers is an easy-to-understand chart that simplifies and clarifies which benefits notices apply to companies with 1-19 employees, including:

  • Live links to downloadable Model Notices and other agency resources
  • Who must receive such notices
  • When notices are due

Click on the image below to view and download the full chart in PDF format.
 

What Would Caffrey Insurance Solutions Do?

Question Mark  

Scenario

A client came to us with about $90,000 in unpaid claims. The insurance company had declined them, mostly because they were out of network. The client had paid about $10,000 out of pocket but decided it was getting out of hand. The vendors were getting anxious. What could the client do?

 

Possible Responses

  • A. This is justification for declaring medical bankruptcy. The actual claims were close to one million dollars.
  • B. Try to negotiate with the providers. They would prefer to get something rather than nothing.
  • C. Keep arguing with the insurance company and escalate to the Department of Insurance.
  • D. Get a good lawyer and sue.
  • E. None of the above. 

Solution

What they really needed to do was enlist our help. Once they called us, we learned that almost all of the services were covered by a retroactive authorization. The insurance company had to be reminded, many times, that they were responsible for the claims. It is surprising how often a wide range of practitioners do not communicate with the insurance companies for payment once a claim is denied.

 

It took a lot of persistence and insistence to speak to supervisors, but we eventually got everything paid by the insurance company. This doesn't always work, but in this case, our efforts paid off big time for our client.
 

Getting Ready for Fourth Quarter Rates

Many of our group clients will be renewing at the same time in December this year, and will be required to switch from older "grandmothered" plans to Affordable Care Act compliant plans at that time. 


 
This will be an immense change that will affect your rates and plan designs, so we are being as proactive as we can be to help you review your options before that point. We expect to have October-December rates from most insurance carriers by mid-July and will be working to help you make informed choices so we can all get ahead of an extremely busy season.


About Caffrey Insurance Solutions 



yelptag



405 14th Street, Suite 711

Oakland, CA 94612

Phone: 510-444-5447

Fax: 866-530-7365
Email: [email protected]

Caffrey Insurance Solutions is a family business that provides insurance brokerage expertise for small companies (fewer than 100 employees) and individuals seeking individual or family coverage. We also provide Medicare assistance.  

Caffrey Insurance Solutions works with you to find the best insurance benefits that provide the best value, all tailored to the unique needs of you or your company. 

 

Lynn Profile

Lynn Caffrey, PrincipalGabriel Caffrey, Broker
CA License 0557451, Agency License 0G80281CA License 0H66348, Agency License 0G80281

Testimonials

"These guys rock. Period. Gabriel Caffrey has helped my startup navigate the complexities of health, dental, and vision insurance options. He is technically sound, and at the same time able to describe my insurance options in layman's terms. Additionally, he is timely in taking or responding to my calls and requests. I actually switched from Zenefits to Caffrey Insurance Solutions, as Zenefits did not have the technical expertise that I was looking for. Their "one size fits all" model did not work for me. I had a unique situation with my employees, and Gabriel was able to help me find the optimal solution, which was unavailable with Zenefits. Simply put, Caffrey Insurance Solutions makes your life easier when it comes to your insurance needs." 
-- Andrew Kitirattragarn, Dang Foods

"Lynn and Gabriel have both been amazing advocates and every single interaction has been professional, knowledgeable and thorough. I would trust them to guide the people I love most dearly into the right plan for their needs. If they painted houses, I would have them paint my house. If they ran a restaurant, I would eat there all the time. They are good people and they do great work. You can't go wrong in choosing Caffrey Insurance Solutions." 
--Megan Delgleize, The Nature of Hair

"The medical insurance sector is complicated to navigate at the best of times and...with the whole ACA thing...it became almost impossible for me.  Luckily, I crossed paths with Gabriel Caffrey of Caffrey Insurance Solutions and that was a fantastic break. Not only was Gabriel able to explain the tangled web of medical insurance in a manner that I was able to comprehend, but he implemented the insurance solutions for myself and my employees in such a manner that I barely had to do anything. 

It was an incredibly easy and painless process and since then, Caffrey Insurance Solutions has taken care of any and all the issues that did crop up. If you want medical insurance, get a broker, and if you want the best, I really recommend you visit the Caffrey family!" 

--Andrew Gregor, Blue Dog Construction

 

"Lynn really helped me in dealing with a declined insurance claim by guiding me through the appeal process and communicating with the insurance provider. She offered continued support until the claim was reviewed and finally resolved. I truly believe that Caffrey Insurance Solutions' dedication in providing insurance as well as exceptional care and support to clients is invaluable." 

--Current Individual Client

 

"Caffrey Insurance Solutions walked us through every state and step of a quite complex system, and we were successful! Without their help I do not believe we would have managed...I would refer anyone with insurance questions to Caffrey Insurance Solutions, and to Lynn Caffrey in particular."

--Alan B.

 

"Your expert advice is always appreciated. I literally don't know what I would do without you. You give me the most valuable gift of all: time."

--Scott Gordon

 

"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.


"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