OPEN ENROLLMENT RESOURCES

Please keep in mind that Open Enrollment is a very short period of time – November 1st-December 15th. If you do need to change your appointment, we will do our best to find another available time, but this may affect your health insurance start date.

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INDIVIDUAL

Online Applications: 11/1 — 1/1/2017

MEDICARE

Online Applications: 10/15 — 12/7

MEETING DOCUMENTS

Thank you for choosing Summit Insurance as your guide through 2017 Health Open Enrollment! Here are the forms to fill out ahead of time and speed up your enrollment process.

INDIVIDUAL

We’re here to walk you through the steps and find the best solutions for you and your family. Because the insurance companies compensate us, our services cost you nothing.

If you’ve never had health insurance, we make it easy to get started. If you have, we help you compare your current plan to see if there’s a better fit for you.
Here are some common Questions & Answers:

  • When can I change plans for 2017?

    By December 15 for plans starting January 1, by January 15 for plans starting February 1, and by January 31 for plans starting March 1. Thereafter, only if you have a qualifying event.

  • Will my pre-existing condition be covered?

    Yes.

  • Do I need to pay for preventative care?

    No. There is an extensive list of no-cost preventative care including labs, x-rays, screenings, and immunizations for adults and children.

  • How do I determine estimated tax credit, then apply?

    This link will show if you qualify for an Advanced Premium Tax Credit. Health & Welfare will confirm the amount.

  • I still don’t think I can afford the cost of my prescriptions and treatments.

    You may qualify for a subsidy to reduce your cost of care. Please contact us to find out!

  • Can my child receive unlimited orthodontic and dental care?

    Yes, if medically necessary. Some insurers automatically include this coverage, while others require purchase of a separate dental plan.

  • Can I earn an advanced premium tax credit or subsidy for 2017 after the January 31, 2017 deadline?

    Yes, when you complete your taxes in 2018 for 2017 and are insured with YHI eligible companies. Or if you have a qualifying event during the year.

  • What happens if I am on Medicare or become newly eligible this year?

    You are NOT eligible to enroll in individual plans that receive a tax credit or subsidy after you turn 65. If you turn 65 in 2017 you will need to replace coverage and dis-enroll from a tax credit or subsidized plan.

EMPLOYER

We provide small businesses with some big advantages, especially one-stop shopping. With Summit Insurance, you can compare and purchase coverage and receive no-cost consulting to design and manage your benefit plan.

If you have 25 or fewer employees, chances are you also qualify for tax credits! Here's what Summit Insurance can do for you:

  • Help you understand how this law applies to your business
  • Explain all your options for coverage
  • Walk you through a Compliance checklist (many rules apply, even if you do not have 50 full time employees)
  • Help determine your Full Time Employee (FTE) calculation
  • Help you determine penalties, if any
  • Determine the value of group vs private exchange for group coverage
  • Determine the contribution and participation levels for your plan
  • Design and secure group coverage
  • Estimate your Small business tax credit
  • Provide alternative-funding options such as Health Reimbursement Arrangements
  • Establish Wellness programs
  • We are willing to educate your workforce

WHAT'S NEW IN HEALTH INSURANCE

The Changing Health Insurance Landscape

No matter your thoughts on the Patient Protection and Affordable Care Act (PPACA or ACA), it has set the stage for profound changes in the American healthcare and insurance landscape.

Coverage has improved under ACA

The act sets the stage for minimum benefits, referred to as essential health benefits, which must be offered by all private and public health insurance plans. These benefits include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care, mental health and substance abuse disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Pediatric services, including oral and vision care

No cost care:

Preventative and wellness services and chronic disease management

Under the Act:

  • Insurance coverage must be offered to all applicants regardless of pre-existing medical conditions. It means that no one can be turned away without coverage.
  • Children may remain on their parent’s plan until age 26.
  • You cannot be dropped or rates increased if you become ill or injured.
  • Lifetime benefit ceilings have been removed.

Available Assistance

The Act provides assistance in the forms of advance premium tax credits and subsidies to lower the cost of care significantly. Households earning up to 400% of the Federal Poverty Level may be eligible for the tax credit, which is applied directly to the premium to reduce their cost of insurance. The subsidy is used to reduce the deductibles, coinsurance, co-payments and out-of-pocket expenses.

Carrot and the Stick

The law requires that everyone must obtain health insurance coverage. For 2016 and 2017, the penalty for not having insurance is $695 per adult, $347,50 per child, up to $2085 per family or 2.5% of the gross adjusted income for the household, whichever is greater!

For many, the cost of great coverage is less than the penalty or cost of self-insuring medical and prescription costs.

Impact on Medicare

The Affordable Care Act focuses on individual and family private insurance and small company employee coverage, but it has also had a far ranging impact on other types of health insurance as well.

Medicare insurance, which is the cornerstone of health insurance coverage for citizens over 65, has been impacted. Insurance coverage under Medicare has incorporated many of the innovations introduced by ACA including an expansion of essential health benefits and the discontinuation of any pre-existing condition as well as other changes.

Even if you have had your Medicare coverage for a number of years, it is worthwhile to review your plan with our staff of certified professionals. Together, we can identify any and all changes for your present plan; new benefits features that may be available for you; and ways to further reduce your costs associated with healthcare and insurance.

2017 INDIVIDUAL COVERAGE TIMELINE

  • NOVEMBER 1, 2016

    Open enrollment begins
    Time to newly enroll
    Time to change plans

  • DECEMBER 15, 2016

    Last day to secure coverage effective January 1, 2017

  • JANUARY 15, 2017

    Last day to secure coverage effective February 1, 2017

  • JANUARY 31, 2017

    Last day to secure coverage effective March 1, 2017

  • APRIL 1, 2017

    Penalties accrue to $695 per person, $347.50 per child up to $2085 per family max or 2.5% of Adjusted Gross Income, whichever is greater!