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Health Insurance Information

What is the Affordable Care Act (ACA)?


The Affordable Care Act (ACA) was signed into law by President Obama in 2010.  The law makes preventive care (including family planning and related services) more accessible and affordable for many Americans.  While some provisions of the law have already taken effect, many more provisions will be implemented in the coming years.  Enrollment for ACA began October 1, 2013 for the coverage beginning January 1, 2014.


What does it do?

  • Improves the quality of care by providing better preventative and wellness services and raises the standards of the quality of basic health care coverage
  • Eliminates pre-existing conditions and gender discrimination, meaning no one can be charged more or be dropped from their health insurance coverage for health or gender related reasons
  • Gives low and middle-income families access to quality health care by providing discounts through the Health Insurance Marketplace (also known as a Health Insurance Exchange)
  • It’s reforms roll out year by year until 2022, with the biggest reforms in 2014
  • Helps to ensure that health care coverage is available to any legal U.S. resident
  • Gives employers with over 50 full-time employees the choice between providing insurance that meets the standards of ACA or paying a penalty. This penalty helps to offset the cost of employees who aren't covered through their employer to purchase insurance through the public health insurance exchanges instead of using emergency services
  • Employers with less than 25 full-time employees may qualify for tax credits, tax breaks and other assistance for insuring employees through the Health Insurance Marketplace
  • Increases consumer protections that help to protect individuals from being dropped while sick, denied care due to lifetime limits, denied care for pre-existing conditions, and offers a better legal standing against health insurance companies
  • Unless you make over $200k individual / $250k as a family or small business you are exempt from almost every tax ObamaCare levies
  • Requires that all Americans have health insurance either through a private provider or through a state or federally assisted program If you don't have insurance you must pay a tax equal to 1% of your income in 2014 and 2.5% in 2016
  • Expands Medicaid to over 15 million uninsured low-income Americans
  • Aims to reform the health care industry by cutting out waste, reallocating where government funding goes, fixing what doesn't work, and most of all ensuring health care for Americans


What are the benefits?


Personal and Family

  • Outpatient  services, such as doctor visits or tests done outside of a hospital
  • Emergency services
  • Hospital stays
  • Pregnancy and baby care
  • Mental health and substance abuse services, including behavioral health treatment
  • Prescription drugs, including  generic and certain brand-name drugs
  • Rehab and facilitative services, those that help people recover from an accident or injury and those that help people with developmental issues
  • Lab tests
  • Preventive and wellness services, along with those that help people manage chronic conditions, including chiropractic care
  • Dental and vision services (for children only)



  • The smaller the businesses the better the tax breaks.
  • Businesses with over 50 full-time equivalent employees are exempt from the fee on their first 30 full-time workers, greatly reducing the negative affect the law could have on businesses who just barely qualify as a large firm.
  • The Employer mandate isn't meant to hurt small businesses; it's to ensure that companies like Walmart take a Shared Responsibility in providing healthcare access to more Americans.
  • Small employers can offer better quality benefits due to the increased benefits, rights and protections offered by ObamaCare.
  • Due to small businesses being able to shop for group health plans on their State's Health Insurance Marketplace via the SHOP, AKA the Small Business Health Options Program, small businesses now have the same buying power as larger firms. Along with tax credits, increased buying power helps small businesses afford to provide benefits to their employees.

 Other Benefits for Everyone

  • Easier to understand explanations of insurance coverage
  • No limits on total annual or lifetime benefits. If you get seriously ill and need expensive treatment you won’t have to worry about running out of insurance coverage
  • Guaranteed acceptance with no exclusions for pre-existing conditions
  • Premiums will not vary with health or gender
  • Free Preventative Care
  • Many more benefits, rights and protections will apply to you and your health insurance plan. Certain exclusions apply to health plans with grandfathered status.


 Contact us now to learn how ACA can benefit you.

What kinds of health insurance are there?

There are essentially two kinds of heath insurance: Fee-for-Service and Managed Care. Although these plans differ, they both cover an array of medical, surgical and hospital expenses. Most cover prescription drugs and some also offer dental coverage.

  1. Fee-for-Service
    These plans generally assume that the medical professional will be paid a fee for each service provided to the patient. Patients are seen by a doctor of their choice and the claim is filed by either the medical provider or the patient.
  2. Managed Care
    More than half of all Americans have some kind of managed-care plan1. Various plans work differently and can include: health maintenance organizations (HM0s), preferred provider organizations (PPOs) and point-of-service (POS) plans. These plans provide comprehensive health services to their members and offer financial incentives to patients who use the providers in the plan.

What is 'long-term care'?
Because of old age, mental or physical illness, or injury, some people find themselves in need of help with eating, bathing, dressing, toileting or continence, and/or transferring (e.g., getting out of a chair or out of bed). These six actions are called Activities of Daily Living–sometimes referred to as ADLs. In general, if you can’t do two or more of these activities, or if you have a cognitive impairment, you are said to need “long-term care.”

Long-term care isn’t a very helpful name for this type of situation because, for one thing, it might not last for a long time. Some people who need ADL services might need them only for a few months or less.

Many people think that long-term care is provided exclusively in a nursing home. It can be, but it can also be provided in an adult day care center, an assisted living facility, or at home.

Assistance with ADLs, called “custodial care,” may be provided in the same place as (and therefore is sometimes confused with) “skilled care.” Skilled care means medical, nursing, or rehabilitative services, including help taking medicine, undergoing testing (e.g. blood pressure), or other similar services. This distinction is important because generally Medicare and most private health insurance pays only for skilled care–not custodial care.

What are the types of disability insurance?
There are two types of disability policies: Short-Term Disability (STD) and Long-Term Disability (LTD):

  1. Short-Term Disability policies (STD) have a waiting period of 0 to 14 days with a maximum benefit period of no longer than two years.
  2. Long-Term Disability policies (LTD) have a waiting period of several weeks to several months with a maximum benefit period ranging from a few years to the rest of your life.

Disability policies have two different protection features that are important to understand.

  1. Non-cancelable means the policy cannot be canceled by the insurance company, except for nonpayment of premiums. This gives you the right to renew the policy every year without an increase in the premium or a reduction in benefits.
  2. Guaranteed renewable gives you the right to renew the policy with the same benefits and not have the policy canceled by the company. However, your insurer has the right to increase your premiums as long as it does so for all other policyholders in the same rating class as you.

In addition to the traditional disability policies, there are several options you should consider when purchasing a policy:

  • Additional purchase options
    Your insurance company gives you the right to buy additional insurance at a later time for an additional cost.
  • Coordination of benefits
    The amount of benefits you receive from your insurance company is dependent on other benefits you receive because of your disability. Your policy specifies a target amount you will receive from all the policies combined, so this policy will make up the difference not paid by other policies.
  • Cost of living adjustment (COLA)
    The COLA increases your disability benefits over time based on the increased cost of living measured by the Consumer Price Index. You will pay a higher premium if you select the COLA.
  • Residual or partial disability rider
    This provision allows you to return to work part-time, collect part of your salary and receive a partial disability payment if you are still partially disabled.
  • Return of premium
    This provision requires the insurance company to refund part of your premium if no claims are made for a specific period of time declared in the policy.
  • Waiver of premium provision
    This clause means that you do not have to pay premiums on the policy after you’re disabled for 90 days.




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