Hello, Utah Kids families! My name is Brandee Garvoille, I have a son
that’s almost 15, and a daughter, 10 years-old; both are on the Autism
Spectrum, have other learning disabilities, and severe ADHD, so things can be a
little crazy at our house! Not to
mention, I also work full-time! I began
my career in the insurance industry by working on the carrier side. I worked with IHC Health Plans (which later
became SelectHealth) for almost 6 years.
The Insurance Exchange recognized my talent, and hired me to start
working with them in 2005. I have an
extensive understanding of all aspects of placing and servicing insurance
policies that I learned while working on the carrier side. In 2007, I obtained my insurance license,
which allowed me to expand my roll with The Insurance Exchange even more. I love my job! As crazy as it sounds, I’m passionate about
insurance! However, I know how extremely
frustrating it is; the denials, the benefits, the customer service, and to now
throw “Obamacare” in to the mix. I love
when I can answer questions, and help people with their insurance needs!
On November 15th the
second Open Enrollment for individual healthcare through the Federally Funded
Marketplace, or directly with the carrier of your choice, begins. For most of us, there are still a lot of
questions, and some confusion, in regards to HealthCare Reform, aka Obamacare,
aka PPACA, aka ACA. In this post, I’ll
do my best, to break it down and explain it in laymen’s terms.
The biggest thing that came about
with the implementation of the Affordable Care Act, that especially affects our
special needs kids, is that everyone is now guarantee issue. You cannot be denied or rated up on an
individual policy for health conditions.
Waiting Periods and Exclusions for Pre-Existing Conditions have also
been eliminated. This was huge for our
kids!
One of the biggest confusions has
been when an individual can apply for coverage; you are no longer able to apply
for an individual policy whenever you want.
Open Enrollment is November 15, 2014 through February 15, 2015. Outside of Open Enrollment, you are only able
to enroll in a plan if you qualify for a Special Enrollment Period. A few examples of qualifying life events
include:
·
Marriage or divorce
·
Having a baby, adopting a child, or placing a
child for adoption or foster care
·
Moving your residence, gaining citizenship,
leaving incarceration
·
Losing other health coverage due to losing
job-based coverage, COBRA expiration, aging off a parent’s plan, losing
eligible for Medicaid or CHIP, and similar circumstances.
An important thing to remember is
that voluntarily ending coverage doesn’t qualify your for a Special Enrollment
Period.
In order to make health insurance
more affordable to you and your family, it is possible to have help from the
Federal Government in paying your premiums.
This assistance is called Advanced Premium Tax Credits aka Subsidies. In order to obtain a subsidy, you must apply
through the Federal Marketplace, several carriers (Altius, Humana,
SelectHealth), allow you to go through their website, as it is connected to
healthcare.gov, to see if you qualify for a subsidy. These subsidies are generally available for
the following people:
·
Individuals who are not offered insurance
through their work
·
Those who are not eligible for a public plan
like Medicare, Medicaid, or CHIP
·
Those with annual income between 100 and 400
percent of the Federal Poverty Level.
These subsides are based on
certain criteria such as family size, age, and income. To qualify for a subsidy, you must:
·
Be a citizen or legal resident of the U.S.
·
Have a family income between 100 to 400 percent
of the Federal Poverty Level based on Modified Gross Income.
·
Not have access to a qualified
employer-sponsored health plan that provides minimum value (actuarial value of
at least 60 percent) and that is affordable (does not cost you more than 9.5
percent of your income)
·
Not eligible for public coverage-including
Medicaid, CHIP, Medicare, or military coverage
·
Use your subsidy to purchase insurance.
Many of you may be on a
“grandfathered” or “grandmothered” plan; this is part of ACA that says you can
keep your current coverage without changing.
Many employers, and some individuals, have chosen to remain on their old
plan, and not change to a plan that complies with ACA. However, if you ever want to change this plan
in any way, i.e., your deducible, co-pays, or co-insurance, etc., you would
have to move to a new plan.
There is a tremendous amount of
information that is available, a tremendous amount of regulation, and
requirements in regards to PPACA. The
information above is only meant to be a summary of the more pressing issues
dealt with on a daily basis. The good
news is you never have to try and navigate this alone! Please don’t hesitate to contact me, Brandee
Garvoille, with questions on your specific situation. My office number is (801) 262-2691, or email
me at
brandee@ieutah.com.
On October 25, 2007 the
Nelson’s welcomed twins Carter and Hunter Nelson to the family at 8:55 a.m., 11
weeks early. Carter weighed in at 2 pounds 13 ounces and Hunter weighed in at 2
pounds 15 ounces. They were born early due to a phenomenon called
twin-to-twin transfusion, where one twin gives the other twin all the blood and
doesn’t get any back. Carter was the donor in their case, while Hunter
was the recipient. It was also determined that Carter suffered from Stage 3 and
Stage 4 brain bleeds which could potentially cause Cerebral Palsy. Only
time would tell though what the damage would do to his body. 
