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Top 10 things Individuals need to know...

  1. If you do not sign up for an individual policy during open enrollment and go more than 90 days without Qualified Health Coverage, you will be subject to a TAX Penalty at the time of filing; see below.

    • 2014 - $95 per adult, $47.50 per child, $285 per family, or 1% of family income
    • 2015 - $325 per adult, $162.50 per child, $975 per family, or 2% of family income
    • 2016 - $695 per adult, $347.50 per child, $2,085 per family, or 2.5% of family income
  2. Short Term Medical insurance is NOT Qualified Health coverage under the law.

  3. If you lose group coverage for any reason (downsized, quit, hours cut and no longer full time employee eligible for benefits), you have a 30-60 day window to enroll in continuation or shop for an individual policy (on or off the marketplace.)

  4. If you get divorced, you have a Special Election to: 1) take COBRA continuation for up to 36 months (may differ for an Employer Group plan with less than 20 Employees) or 2) buy an individual policy.

  5. If your income changes (up or down) to where you 1) no longer qualify for a subsidy; 2) now qualify for a subsidy or might qualify for a larger subsidy, you can call the marketplace and update your application to reflect the change mid-year.

  6. If you have a lapse in coverage of less than 90 days (you left one company because of a better job offer elsewhere and had coverage through the end of the month, but had a 90 day wait for coverage with the new employer (NOTE: The waiting period for group health coverage CANNOT exceed 90 days under the law), you can purchase a short term medical policy to fill the gap. If you go beyond 90 days for this 'temporary' type of coverage, you will be deemed as NOT having an ACA - compliant plan and will face a penalty at tax time.

  7. If you are doing your taxes for last year and determine that you would have qualified for a tax credit because your income was lower than expected, it is too late to apply. You must apply at the beginning of each year for the upcoming tax year, based on your estimated income.

  8. If you are not enrolled in a Qualified H.S.A.-type medical plan, you cannot open up a Health Savings Account at a bank and make tax-deductible contributions. The H.S.A qualified medical plans must meet certain guidelines including but not limited to having a High Deductible. If your plan has a Dr. copay benefit or drug card, it is not an H.S.A. qualified medical plan.

  9. When applying for an individual policy on or off the exchange, you must apply by the 15th of the month to get an effective date of coverage that begins the first of the month following your application. You cannot get a "middle of the month" effective date or "back-date" your coverage to the first of last month. Applying on the 16th of the month will result in your coverage starting the 1st of the second month after applying, so about 45 days out.

  10. Failing to pay your premium on time is not a Qualifying Event that allows you a special enrollment to sign up for your plan again or a new plan. If you lapse your insurance coverage, you will have to wait until the next open enrollment to apply again. So best to pay your premiums on time! (NOTE: Most companies allow a 30 day grace period to pay the premium, which should you give you adequate time to make a payment.)
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      • Read This First
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    • APPLY for Blue Cross Plans
    • Critical Illness
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    • Individual Dental
    • Individual Vision
    • Short Term Medical
    • Telemedicine


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CB Health Insurance
188 Industrial Drive, Suite 226
Elmhurst, IL 60126
630-279-1739

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