Individual Market Resources in Response to COVID-19
Be prepared to help your individual clients if they lose health insurance coverage from their employer.
Due to recent events regarding COVID-19, the individual market is expected to skyrocket. To help you provide quick solutions to your clients, the Flex General Agency wanted to provide you a quick list of options for those individuals in the case that they lose coverage from their employer at this time.
4 options for individuals who lose coverage outside of OEP:
- Apply On-Exchange at www.healthcare.gov to see if they qualify for a subsidy
- Short Term Medical (STM) plans can be purchased for up to 6 months per carrier. They are often less costly. Flex offers three STM carriers that can help your clients.
- Off-Exchange Individual plans: If the individual cannot medically qualify for a Short Term Plan, or if COBRA is not available to the client.
- If the individual is age 65 or older, they can apply for Medicare. The individual must apply for both Medicare parts A and B (even if electing COBRA) and purchase a Medicare Plan (Medicare Supplement, Medicare Advantage, Prescription Drug Plan)
3 Things You Can Do to Be Prepared to Help Your Individual Clients
- If selling ON Exchange [Marketplace] at Healthcare.gov, it is mandatory that you complete the FFM Marketplace Certification to place business.
You must complete the Special Enrollment Period (SEP) Training to receive commissions during a SEP.
- Get contracted with at least two STM carriers that FLEX offers:
- Get contracted with Medicare carriers:
Individual Ancillary Resources with UnitedHealthcare
Hospital SafeGuard and Health ProtectorGuard
Other important options to discuss with clients are the Ancillary line of products through the UnitedHealthOne brand.
These ancillary plans do not coordinate benefits with the existing health carrier and pay claims directly to your client. Claim reimbursements can be used by the client in whatever fashion they choose. The funds can be used to help subsidize out-of-pocket expenses on health plans or to shore up other personal expenses while ill or injured.
Not for Consumer Use.
UnitedHealthOne is the brand name of the UnitedHealthcare family of companies that offer personal health insurance products. Golden Rule Insurance Company, a UnitedHealthcare Company, is the underwriter and administrator of the Hospital SafeGuard and Health ProtectorGuard Plans.
CMS guidance on Payment and Grace Period Flexibilities for Issuers Offering Coverage on the Federally-facilitated Exchanges and State-based Exchanges on the Federal Platform can be found here: https://www.cms.gov/files/document/faqs-payment-and-grace-period-covid-19.pdf
The FAQs on Availability and Usage of Telehealth Services Through Private Health Insurance Coverage can be found here: https://www.cms.gov/files/document/faqs-telehealth-covid-19.pdf
The FAQs on Prescription Drugs and the Coronavirus Disease 2019 (COVID-19) for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets can be found here: https://www.cms.gov/files/document/faqs-rx-covid-19.pdf
CCIIO now has a landing area on our website for all COVID-related guidance, which can be accessed at:
These FAQs, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White
House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 visit www.coronavirus.gov.
For information specific to CMS, please visit the Current Emergencies Website.
Flex is Here to Help!
Whether you're a seasoned agent working in the individual market or a group agent looking to assist your clients who've lost group coverage due to the pandemic, Flex is here to help you succeed. Contact us to get appointed and start selling today!
This information is intended for agent/broker use only.
Flexible Benefit Service LLC | www.flexiblebenefit.com | 888-353-9178 | email@example.com