There have been a few letters printed recently complaining about the Affordable Care Act otherwise known as “Obamacare”. Where others see socialist or evil conspiracies I simply see bureaucratic ineptitude. Where some are not willing to admit any problems, I see many. My insurance agency, HIQS Group located in Bethel, has placed around 400 people in the exchange. The fact is many of my clients have saved a huge amount of money. I have one client who was paying $2,100 monthly and is now paying about $100.
Fact. During open enrollment Access Health CT and the 3 participating carriers did not make it clear that the network for exchange plans was smaller. One carrier, Connecticare, sent out a memo to agents near the end of open enrollment saying that the search tool for looking up providers was not accurate and that clients should call providers directly to check. This information was NOT posted on the exchange for those who did not use a broker. I have quite a few clients who signed up for Connecticare who cannot use their doctors.
This is my perception of what is currently happening at Access Health. Access Health has about 40 employees, and they are in charge of sales, marketing and technology. They outsource most of their work to 2 other organizations namely Maximus & Zerox. Maximus is responsible for most customer support and help desk activity. Xerox is responsible for verification of documents, proving such things as income, citizenship, and special enrollment events like marriage, divorce, loss of jobs, etc.. Even though Access Health hires them, they don’t control everything that they do. When the agents in our agency call customer service on behalf of our clients for updates or help, we are told often that we are not authorized to talk to them because they cannot verify that we are the agent! When the system was designed it was simply never included on the screens that these customer service reps can view. Eventually we can talk to them, but how long this takes and how much hassle it takes, sometimes transferring to a supervisor, varies with each call. We are falling way behind in solving of clients issues because of this and Access Health, I am sure, pays for this help by the hour. The longer it takes the more costly it is. Access Health does not have control of this process even though they are paying for it. Maximus defends their actions by saying that their legal team blocks them from disclosing customer information until they can prove who we are. There is currently no simple system in place to accomplish this.
The other actor on this stage is the company who verifies income. I will refer to them as Xerox. When agents were trained we were told that during open enrollment we could sign clients up, they would estimate their 2014 income and if they qualified for a subsidy they would sign up for an exchange plan. As agents we were asked to provide the most recent income tax return for the client as sufficient income documentation. However in the spring of 2014 Xerox has looked at updated “clarification” rules from the federal government and has said that tax returns are not enough. They are now requiring 1 month of payroll stubs or, if someone is self-employed, a profit and loss statement for the first quarter signed by an accountant. About half of my clients (200 or so) now have their subsidies in jeopardy because of this change, and many have been given a window of 90 days to comply. It is not always clear exactly what documentation is acceptable, and if they submit an inadequate document, the 90 day window could close and then it is too late. This is happening to so many clients that the turnaround time to process all of this paperwork only to find out if they qualify for their subsidy is putting many of them at risk of losing both their subsidy. Our agency is overwhelmed in trying to keep up and so is Access Health. If half of our clients have this happening I would estimate that statewide there must be about 20,000 people affected. The fact is many of my clients don’t use an accountant during the year, or sometimes ever. Many are simple, honest people who work and do their taxes in the spring using their own business records, and they need the subsidy to be able to afford insurance, since the average policy premium has now doubled since the passage of the Affordable Care Act. This system of income verification also does not account for those who have seasonal work where most of their income is made between April and September. Those who fail income verification in the spring lose their subsidy because Access Health forces them to be on husky or pay full price for insurance until they can “prove” they are now making enough income to get a subsidy. (If you earn at or below the Federal Poverty level, then you must enroll in the State Medicaid plan or purchase a full priced health plan). This can interrupt continuity of health care for clients because their doctor network can suddenly change. This verification is a time consuming process and what constitutes “proof” has not been clearly defined. Even though Access Health pays Xerox they can’t control how they do it, as Xerox “interprets” the government regulation on their own terms. The more work they do the more they can bill Access Health. Ultimately either the State or the consumer pays for this.
Looking ahead to 2015 I would like to talk about the next open enrollment. First of all many people I talk to are unaware that they cannot purchase a health insurance plan that will take effect before 1/1/2015. Open enrollment for 2014 ended on March 31st, and the only way to purchase a health plan outside of open enrollment is through having a qualifying event. This is referred to as a Special Enrollment Periods (SEP), for people whose situations change through a life event such as marriage, divorce, birth, moving from one state to another or losing insurance from a job. Many people are also unaware that they do not have to purchase health insurance through an exchange. There are actually more companies to choose from off of the exchange, and the only reason to purchase on the exchange, since their networks are smaller, is if you qualify for a subsidy. The third thing that people are unaware of is that all of the individual Affordable Care Act (ACA) compatible policies end on Dec 31, 2014. There is an open enrollment period starting Nov 15, during which you can choose a new plan for Jan 1. Our agency is particularly concerned that the carriers will wait to release pricing until that date, thus blocking brokers and policyholders from doing their homework ahead of time to see which policy is the best value for next year. All policyholders can switch to any plan from any company for January 1, 2015. If you do nothing you keep the same plan at whatever the new price is set at. If a policyholder finds out after Jan 1 that they want to be enrolled in another plan they can change plans through the end of open enrollment on February 15, 2015.
This bring us to the final topic. Non-grandfathered plans. When the ACA was passed all individual health policies purchased before that date (3/23/2010) were considered grandfathered plans. These are the ones which president Obama so famously told us we could keep. As we now know this was only partially true. The State of Connecticut, with the Federal Governments blessing, let each carrier decide whether to allow policyholders currently enrolled in grandfathered plans to keep them. Anthem, Celtic and Cigna cancelled all their grandfathered plans, while United Health One/ Golden Rule, Connecticare and Aetna allowed policyholders to keep them. I would like to note that the largest carrier, Anthem, with almost 30,000 grandfathered policyholders, was solely blamed by the public for cancelling these plans. One of the main reasons they did this is that for a few years prior to 2014, the state insurance department scaled back or did not allow requested price increases for these grandfathered plans, often due to public outcry that they were becoming unaffordable. Perhaps Anthem did not trust the insurance regulators to allow them to charge a fair rate and took advantage of the new rules to walk away from these policyholders.
Many policyholders, when faced with a huge increase in premium starting 1/1/2014, purchased non-grandfathered plans before the end of 2013. These were less expensive plans because they could be only purchased by healthy policyholders. All of these plans, plus all other non-grandfathered plans, are ending this year; most of them on Dec 31. The Federal government announced that they would allow non-grandfathered policyholders to keep these policies for another 2 years; however, they also said that they were leaving it up to the States and the insurance carriers to decide if they would allow this. In Ct, officials, lobbied or “advised” by the carriers decided NOT to allow this. I have seen no articles or public mention of this decision, but if means that all of these policyholders will be faced with either paying more for their insurance, paying the same for a worse policy, or getting a subsidized plan (if they qualify) . Our agency has almost 700 policyholders who fit into this category. We will be hard pressed, as all advisors and brokers will be, to truly spend the time our policyholders deserve in reviewing and recommending new policies. One more note about this process. Each carrier has different rules about when polices will end. Last year for January 1st, the two largest insurers, Aetna and Anthem, “mapped” their policyholders onto their ACA compatible plan which most closely resembled their existing plan. This meant that those who did nothing would still be insured, even though most of the time the premium skyrocketed. There were lots of problems related to this because communication about plans and prices along with the billing were often severely delayed.
As plans begin to end in 2014, at least one carrier, Aetna, is not mapping their policyholders to a new plan. Our agency has 50 policies which are ending between August 1 and Sept 1. Although our agency will be proactive in working with our clients, there are many other policyholders who may not be so lucky and will find themselves uninsured. Aetna has sent one letter so far. I don’t know how diligent they will be to follow up, even though it represents potential preservation of existing business for them.

Author: Suzanne Candee, CT Agent
We may be enjoying the lazy, hazy days of summer. However … Let us pause and remember that Fall is approaching, and with it, the flurry of activity (and for many, the confusing quagmire) associated with Affordable Care Act (“Obamacare”) Open Enrollment.
In our experience, we find that what people do not understand generally upsets them. People also tend to get upset when they feel they are being told what to do, or not given a choice. Dealing with the rules, requirements and regulations of the Affordable Care Act (and the CT Healthcare exchange, Access Health CT / AHCT) definitely seems to apply here for many.
Need help?? Here some important tips that may assist you in navigating these murky ACA waters –
Our Top 7 Essentials re. The ACA and AHCT
7 “Obamacare” = The Affordable Care Act, Period.
“Obamacare” is the moniker most often given to health plans designed in accordance with the Affordable Care Act (ACA) — all of the new health plans offered since January 2014. The ACA allows for states to offer Health Insurance plans to consumers through healthcare exchanges, where applicants, if eligible, may receive federal tax credits and/or other reductions to lower their healthcare costs, or join the state Medicaid program. CT has its own healthcare exchange, Access Health CT (AHCT). Obviously, we refer to applying on AHCT as purchasing a plan “on the exchange”.
The ACA also allows for Health Insurance carriers (companies like Aetna, Anthem BCBS, CIGNA, Connecticare, Healthy CT or United Healthcare) to offer Health Insurance plans directly to consumers, at full-price. There are no tax credits or reductions offered in this case. We refer to this as purchasing a plan “off the exchange”.
There are many that have erroneously referred to “Obamacare” as plans purchased “on the exchange”.
However, whether one is purchasing a health insurance policy “on the exchange” (applying through AHCT), or “off the exchange” (directly from a Health Insurance carrier) one is purchasing an ACA health plan; participating in “Obamacare”.
6 Enrollment Periods – The Good, the Bad & the Ugly
Rules, rules, rules. The ACA has a distinct set of rules regarding when we may and may not apply for health plans during the calendar year.
Open Enrollment happens annually, and is the opportunity to buy a new plan for the coming benefit year. This year’s Open Enrollment will be November 1, 2015 thru January 31, 2016 for 2016 health plans.
When Open Enrollment is over, there are only certain life circumstances (“qualifying events”) that will allow one to be able to purchase a new health plan during the rest of the year, including marriage, divorce, having or adopting a baby, moving into the state, or losing essential coverage. These qualifying events may allow one to purchase a new health plan thru a Special Enrollment Period (SEP).
It is in the “losing essential coverage” scenarios where the bad & ugly aspects can raise their heads. For example, losing coverage from your employer is a valid qualifying event for a Special Enrollment Period. However, losing your employer-based coverage, choosing to go on COBRA, and later deciding you cannot afford COBRA does notconstitute a SEP.
In addition, Health Insurance carriers are now very strict with regards to premium payment, and strongly enforce payment grace periods. In other words, please pay your premium as billed on time, or you risk your plan being cancelled. Losing existing individual coverage due to non-payment of premiums also does not constitute a SEP.
5 Let’s Talk About Income Projection
Hmmm … Income Projection may include tax filings, profit-and-loss statements, unemployment compensation, family gifts, sheer estimation and “crystal-balling” regarding the future.
The first step we take when approaching ACA plans is one’s Adjusted Gross Income (AGI) – starting with, “Line 37 on your 1040 Form”. Modified Adjusted Gross Income per size of household is the measure that AHCT utilizes to determine eligibility for Medicaid, or for federal tax credits/subsidies to lower health insurance premiums & costs, or for full-price health plans.
If one’s household AGI has them eligible for Medicaid or federal tax credits/subsidies, we explore the process and outcomes of applying for health plans “on the exchange”, unless one is opposed (philosophically or politically) to utilizing AHCT.
If one’s household AGI has them eligible for a full-price health plan, we can look at plans thru AHCT (“on the exchange”), but we often find there are far more choices and competitive pricing for full-price health plans “off the exchange”.
Whether or not one’s household AGI would allow eligibility for Medicaid or federal tax credit/subsidy, anyone may purchase a full-price health plan, on or off the exchange.
4 Verification Documentation, Whether We Like It or Not
So, you’ve completed your AHCT application, you’ve seen your eligibility determination, you’ve chosen a plan, you’ve seen and confirmed your plan summary, you are complete, and can go on your merry way …
Not. So. Fast. AHCT is asking you to provide some sort of Verification Documentation (Proof of Identity, Proof of Income or Employment, etc.) within the next 90 days … or else.
This exercise of finding the appropriate Verification Documentation and sending it to AHCT has its very own good, bad and ugly aspects. For example, if one is self-employed, or does not have “traditional” methods of documenting Income (pay stubs, W-2, 1099, etc.), this process can prove quite challenging.
Additional administrative complications, missed communications, misunderstandings, and inaccuracies can complicate this process significantly, and cause frustration all around.
3 Verification Documentation – They Mean It, They Really Mean It
These requests for additional Verification Documentation to AHCT often appear as a flurry of annoyance; something we’d rather ignore, avoid or even forget … However, it is real, and not responding in the timing requested, or providing documents which do not match the information on the AHCT application, has real consequences.
“Failing Verification” and/or not getting information to AHCT in the 90-days-from-application window may trigger a “90-Day Determination Letter” to the insured from AHCT. This letter (difficult for many to understand) is alerting the insured that because they did not comply with the request for additional Verification Documentation (for any number of reasons), it has changed their eligibility determination, and essentially voided whatever “deal” they originally had with AHCT when they applied for coverage for that year. In some cases, a federal tax credit/subsidy is taken away (the insured remains on their chosen plan, at full-price, and may now owe additional premium to the carrier from the plan’s inception). In other cases, a cost-reduction plan may be taken away.
These new determinations from AHCT can be appealed, though require timeliness, tenacity, clarity, and often the help of a knowledgeable broker/advocate to succeed. There is a time frame for appeals, and if one waits too long to respond to a 90-Day Determination Letter, they may be left uninsured.
2 “The Point of No Return” – What Can I Do??
Are you still with us, Dear Reader?? There is light at the end of the tunnel …
If you find yourself uninsured at this point – either because you missed Open Enrollment entirely, or you fell victim to an AHCT complication … There are still Health Insurance options available for you.
The options available are not compliant with ACA (does not prevent you from paying the tax penalty for being uninsured). They do not cover pre-existing conditions or preventive (annual wellness) visits, but are designed to cover any new illness or injury, and fill the insurance gap in which you may find yourself.
1 Stop, Drop and Call a Broker
No matter where you are in your Health Insurance search or situation, the most important thing to do is to align yourself with a knowledgeable, licensed agent/broker.
You have nothing to lose, and everything to gain.
We are experts — trained, certified and experienced in Health Insurance matters, on and off the exchange.
And – Bonus — It does not cost you anything to work with a broker!
We are experts at dealing with AHCT applications, correspondence and appeals.
We work consultatively with you to find the right solution for you – your situation and circumstances. We are even trained and experienced regarding other lines of Insurance: Life, Disability, Long-Term Care, retirement plans and Medicare.
We can become your broker at any time!
Stop, drop and contact us!
Call 203-730-8304 or email [email protected]

Andy and Ben are partners in a company called Vanilla Inc. Both men are married 30-year-olds in excellent health. They are not currently planning to sell the business so the question of the current “value” of the business is not one they have fully addressed. Each partner makes $100,000 yearly. The IRS would use a simple formula of 10 times net income to place a value on the business, which would be $2 million (10 x $100,000per year income each). Thus, for this case study we will assume the value of their business is $2 million. The fixed overhead of Vanilla Inc is $60,000 per year in rent, advertising, office, etc. Andy and Ben expect their business to last for at least 30 years. Of the two primary aspects of Vanilla Inc, Andy is the manager of the business and Ben is the salesman for their product.
To Summarize:

• 50% ownership
• Income: $100,000 each
• Business Value: $2 million
• Fixed Overhead: $60,000

Things are going well for Andy and Ben. However, neither can truly enjoy his success until he knows that an unexpected devastation will not be the ruin of either partner’s family. There are several scenarios that haunt the men as they are business-related risks that have not yet been addressed. The right insurance plans will allow the business, and the partners and their families to avoid major financial losses.
Risk #1: Ben or Andy dies. Andy or Ben is now in business with their deceased partner’s wife. Neither of them has the experience, nor the interest in filling their husbands position.
A Buy-Sell Agreement funded by life insurance would be appropriate. If one of the partners should die, the money from the life insurance policy would provide the capital for the remaining partner to purchase the deceased’s wife’s portion of the company. The wife wouldn’t have to go through the process of finding a buyer for her newly inherited share of the business and a purchase price would have already been established. There are clear cut tax reasons for the policies not to be owned by Vanilla Inc. See page 3 for detailed explanation. This policy works best when the partners own life insurance on each other.
There is a second often overlooked aspect of the buy-sell transaction. It is possible that Andy (or Ben) inherits Ben’s (or Andy’s) half of the company after one of these events and is now the sole owner but does not have enough operating capital to make it through the crisis.
A Key Man Life Insurance Policy provides the operating capital to keep the business functioning for a period of time. Perhaps the remaining partner would need to hire someone new to take the place of the former partner to keep the business running. The remaining partner might decide to sell the business. , may find a new partner, or something else. No matter what, it doesn’t make sense for him to own the business without a survival plan and the cash to carry it out. The policy is owned by the business. The premium is a business expense. It pays a lump sum to the business if the insured dies.

• Andy owns a $1million policy on Ben to fund the Buy-Sell. Cost: $890 Annually (30 year term)
• Ben owns a $1million policy on Andy to fund the Buy-Sell. Cost: $890 Annually (30 year term)
• Buy-Sell agreement requires using the proceeds to buy the partner’s share of the business.
• Business owns a $500,000 Key man Policy on Ben. Cost: $490 Annually (30 year term)
• Business owns a $500,000 Key man Policy on Andy. Cost: $490 Annually (30 year term)

Risk #2: Ben or Andy or one of their spouses is catastrophically injured. In either position, as the injured spouse or the caretaker, the partner involved can no longer fulfill his duties at Vanilla Inc.
A Catastrophic Disability Insurance policy would provide funds to survive financially. Because they are very young, this type of plan is very inexpensive- $825 each year per couple, or just $517 a year for Ben or Andy. Premiums are tax deductible and benefits are not taxable.
Ben and Andy could also consider a lump sum buy-out. The Classic Disability Buy-Out insurance provides funds for the financial survival of the disabled partner. That takes care of the business, but what about the partner who is no longer employable? He and his wife will need some form of income; the funds from the company will eventually run out. Here, Disability Income Insurance is recommended. This plan provides a monthly benefit that pays up until retirement age.
Risk #3: Ben or Andy is moderately disabled. He will be able to return to work eventually, but is unavailable in the meantime. The company is severely hampered in its ability to earn money yet the overhead costs will continue.
A Disability Business Overhead Expense insurance plan provides the income to pay business expenses if one partner is disabled. Owned and paid for by the company, the company would receive benefits. Vanilla Inc. would be granted an income of $5,000 per month for two years.
In Conclusion
Andy and Ben knew all along that their families and future are a top priority. Ultimately they realized that owning insurance was essential to them as it secured the financial futures of their families and their company.
Purpose of Private Ownership of Policies in Buy-Sell:
Ben and Andy want Vanilla Inc to own the life insurance policies as a business expense. If one of them died, the business would buy the shares from the deceased partner’s spouse. This sounds great in theory but has a fatal flaw. When the remaining partner eventually sells the business he will pay capital gains on the $1million since the company assets grew by receiving a $1 million tax-free insurance payment. It is much better for each partner to own a policy on the other paid for with tax dollars. In practice, many companies pay for these policies with company funds. The accountants make sure these payments are expensed as income to the partners.

In anticipation of upcoming drastic changes to the individual health insurance market brought about by Health Care Reform, HIQS Group has already begun assisting Connecticut based small businesses with fewer than 50 employees in significantly reducing their current health insurance costs.
Current un-insured’s will be required to own a health insurance policy either through their employer, or purchased as an individual as of January 1st, 2014. Connecticut residents will have the option to either procure health coverage through private companies, or through the Connecticut health insurance exchange, which is on schedule to be up and running by the fall of 2013. The exchanges will provide a mechanism for those who currently can’t afford coverage to receive a subsidy in order to obtain a health plan.
As of this release, companies with 50 or fewer employees not offering health care to their employees will not face a tax. This, coupled with the fact that all individual and group market health insurance policies will be guaranteed issue regardless of health status, now provides the ability for small employers to significantly reduce their premium costs by enrolling their employees in individual market plans. Implementing this strategy for 2013 will provide the most premium savings for these companies, and here is why.
In Connecticut, the individual market based health insurance premiums are still 30% to 40% less expensive than their group market counterparts. This is due to the fact that until 2014, these plans are still underwritten based upon health status. Companies can still deny, rider, amend, or rate up applicants upon underwriting review. Further, group market plans tend to offer certain benefits not offered in the individual market plans, with the most significant in Connecticut being maternity.
For 2013, companies can give serious consideration to moving current enrollees who qualify to individual market plan, leave those who do not qualify on the group plan through 2013, and then they can move to the exchange or private insurance based guaranteed issue plan for January 1st, 2014. Companies will have a mechanism which will allow them to pay individual premiums, and fund potential deductible expenses for employees without increasing their gross income.
Our most recent case study is a Connecticut based group with 8 employees on a group health plan. 6 are enrolling in an individual plan, while 2 are remaining on the group plan. Overall savings for this company beginning on October 1st, 2012 will be 24%. Interestingly, the individual based policy will feature both lower deductibles and maximum out of pocket costs relative to the group based plan.
All of us at HIQS Group are excited about this strategy as we are constantly seeking out ways to provide premium relief for our clients, while still offering quality health benefits for employees.
For more information please contact our office at 203-730-8304, or Kevin Murray directly at
203-243-4277. [email protected]

Few people like to think about the possibility of the need for long term care coverage. Most think in terms of “nursing home” insurance, when in fact it is important to be educated on what types of long term care insurances are available, and how they differ in payout dispersal when claims are triggered.


All long term care contracts pay out on not being able to perform certain aspects of daily living. These include but are not limited to needing assistance with eating, dressing & cognitive impairment. A traditional Long Term Care contract is a reimbursement arrangement whereby the carrier will coordinate with the facility and pay them based upon the terms of the contract up to benefit amount that was purchased. The premium for a $7500 monthly benefit with a pool of $540,000 for a 61 yr old male and 55 yr old female couple would be approx. $4200 per year. Insurance carriers pay providers directly as claims are filed, and reimburse only what was spent.


A second approach would be to purchase a product that is identical to the above with one exception. Upon claim, the carrier would pay the chosen monthly benefit directly to client. This provides the unique opportunity to do with these monies what you will, such as providers, bills, food, or to build a ramp up to the house for accessibility, etc. Comparing to the above benefit example, the premium for a $500,000 pool of money for the same 61 yr old male and 55 yr old female couple at $7500 per month, would be approximately $4600 per year.


A third and perhaps the most compelling option would be a single premium product that provides two benefits to the policy holder. For those who are approaching retirement age who have not yet planned for long term care expense, and have monies in CD’s that are earning paltry returns, or perhaps a sum of money dedicated specifically for long term care, a single premium long term care/life insurance product can be an opportunity to leverage these assets. For a 61 yr old male, a $100,000 one time premium payment provides a guaranteed death benefit of $160,000 and a long term care benefit of $480,000. This would provide a monthly benefit of $6682 paying out a total of 6 years. This product has unique flexibility as the client can withdrawal the original single premium payment at any time throughout the life of the contract with no surrender charges. Clients could deposit $100,000, be covered by this two for one policy for a number of years, and then be able to rescind the contract and receive the $100,000 back without penalty.


Any of the above examples prevent the rapid depletion of assets built over the course of a lifetime. The important point is to have this discussion with your financial advisor, accountant, and your own peer group who have already chosen to complete this process. It is also advisable to work with a licensed agent to determine what coverage fits your needs and budget.

Providing sufficient disability insurance for self-employed people can be challenging. This is especially true of the blue collar professionals who are in industries that are considered high risk to insurers.


We assist many clients who fit this category, and find that the traditional disability market does not adequately service them. This is true throughout the industry where certain vocations see higher potential for filing claims. Carriers who offer disability insurance want to know how much money you earn annually, how long you have been in the business, along with reviewing your current health status. This process takes a long time, and the end result is twofold. The amount of monthly benefit offered is not sufficient, and the premium is disproportionately high. One recent example was an offer of $4000 monthly benefit, for $6000 per year. Further, the premiums paid out for the policy are all post tax dollars.
​

Purchasing a catastrophic disability plan makes much more sense, especially for the trade professions noted above. This product does not care what you do, how much you earn, and medical underwriting is limited. Benefit qualifications are less likely as they are based upon not being able to perform certain activities of daily living. This results in affordable premiums, and rich monthly benefits. A $7500 benefit for an employee and his/her spouse in their 40′s quotes out at $1600 per year. Portions of the premium are tax deductible, while the benefit is tax free. Another advantage is that the monthly benefit, when triggered, comes directly to the beneficiary, and can be used for any expenses.

Our office can write these policies nationwide.