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Catherine Giles, Independent Insurance Agent

Catherine Giles, An Independent Insurance Agent, Blog

See If You May Qualify for a Special Enrollment Period for Health Insurance Outside of Open Enrollment

by Catherine Giles on 02/24/17

See If You May Qualify for a Special Enrollment Period for Health Insurance

Contact Independent Insurance Agent Catherine Giles at 940-597-4757 or [email protected] to see if you may qualify for a Special Enrollment Period for Health Insurance outside of Open Enrollment

Life changes that can qualify you for a Special Enrollment Period, as listed from the Marketplace.

Loss of health insurance

You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days.

Coverage losses that may qualify you for a Special Enrollment Period:

Losing job-based coverage

You may qualify for a Special Enrollment Period if you lose health coverage through your employer or the employer of a family member, including if:

· Your employer stops offering coverage.

· You leave a job where you had health coverage (even if you left your job by choice or were fired).

· You have a reduction in work hours that causes you to lose your job-based plan.

· Your job-based plan doesn’t offer qualifying health coverage and as a result you become newly eligible for a premium tax credit. Most job-based plans count as qualifying health coverage. To find out if your employer’s coverage meets the standards, ask your employer to complete the Employer Coverage Tool (PDF).

· Your job-based health plan is ending for the year and you choose not to renew it. Note: If the plan is affordable and meets minimum value standards, you can buy Marketplace insurance but won’t qualify for a premium tax credit or other savings.

· Your former employer stops contributing to your retirement coverage, requiring you to pay full cost.

Note: You DON’T qualify for a Special Enrollment Period if:

· You voluntarily drop your job-based coverage during your coverage year while still working for your employer.

· You lose your job-based coverage because you didn’t pay your premium.

Losing COBRA coverage

Some special rules apply if you’re losing COBRA continuation coverage.

You DO qualify for a Special Enrollment Period if:

· Your COBRA coverage runs out.

· Your former employer stops contributing to your COBRA coverage, requiring you to pay the full cost.

You DON’T qualify for a Special Enrollment Period if:

· You decide to end COBRA early (and are paying the full cost yourself).

· You lose your COBRA coverage because you didn’t pay your premiums.

Note: You don’t need a Special Enrollment Period if you voluntarily end COBRA early during a Marketplace Open Enrollment Period. You can drop your COBRA plan and enroll in a Marketplace plan at that time.

Losing individual health coverage for a plan or policy you bought yourself

You may qualify for a Special Enrollment Period if you lose individual health coverage, including if:

· Your individual plan or your Marketplace plan is discontinued (no longer exists).

· You lose eligibility for a student health plan.

· You lose eligibility for a plan because you no longer live in the plan’s service area.

· Your individual or group health plan coverage year is ending in the middle of the calendar year and you choose not to renew it.

Important: Losing individual coverage doesn’t qualify for a Special Enrollment Period if you voluntarily drop coverage, if you lose coverage because you didn’t pay your premiums, or if you lose Marketplace coverage because you didn’t provide required documentation when the Marketplace asked for more information.

Losing eligibility for Medicaid or CHIP

You may qualify for a Special Enrollment Period if you lose Medicaid or the Children’s Health Insurance Program (CHIP) because:

· You lose your eligibility. For example, you may have a change in household income that makes you ineligible for Medicaid, or you may become ineligible for pregnancy-related or medically needy Medicaid.

· Your child ages off CHIP.

Losing eligibility for Medicare

You may qualify for a Special Enrollment Period if you become no longer eligible for premium-free Medicare Part A.

You don’t qualify for a Special Enrollment Period if:

· You lose Medicare Part A because you didn’t pay your Medicare premium.

· You lose Medicare Parts B, C, or D only.

Losing coverage through a family member

You may qualify for a Special Enrollment Period if you lose qualifying health coverage you had through a parent, spouse, or other family member. This might happen if:

· You turn 26 (or the maximum dependent age allowed in your state) and can no longer be on a parent’s health plan.

· You lose job-based health coverage through a family member’s employer because that family member loses health coverage or coverage for dependents.

· You lose health coverage through a spouse due to a divorce or legal separation.

· You lose health coverage due to the death of a family member.

· You lose health coverage through a parent or guardian because you’re no longer a dependent.

Important: Losing coverage you have as a dependent doesn’t qualify for a Special Enrollment Period if you voluntarily drop the coverage. You also don’t qualify if you or your family member lose coverage because you don’t pay your premium.

Changes in household size

You may qualify for a Special Enrollment Period if you or anyone in your household in the past 60 days:

· Got married. Pick a plan by the last day of the month and your coverage can start the first day of the next month.

· Had a baby, adopted a child, or placed a child for foster care. Your coverage can start the day of the event — even if you enroll in the plan up to 60 days afterward, and even if the event happened late in 2016.

o Example: You had a baby December 17, 2016 and enroll in a 2016 plan February 8, 2017. The coverage applies to medical services from December 17 through December 31, 2016. Your 2017 plan would cover your expenses from January 1, 2017 on. Note: If the event happened in 2016, contact me to enroll in 2016 coverage.

· Got divorced or legally separated and lost health insurance. Note: Divorce or legal separation without losing coverage doesn’t qualify you for a Special Enrollment Period.

· Death. You’ll be eligible for a Special Enrollment Period if someone on your Marketplace plan dies and as a result you’re no longer eligible for your current health plan.

Changes in residence

Household moves that qualify you for a Special Enrollment Period:

· Moving to a new home in a new ZIP code or county

· Moving to the U.S. from a foreign country or United States territory

· A student moving to or from the place they attend school

· A seasonal worker moving to or from the place they both live and work

· Moving to or from a shelter or other transitional housing

Note: Moving only for medical treatment or staying somewhere for vacation doesn’t qualify you for an SEP.

Important: You must prove you had qualifying health coverage for one or more days during the 60 days before your move. You don’t need to provide proof if you’re moving from a foreign country or United States territory.

More qualifying changes

Other life circumstances that may qualify you for a Special Enrollment Period:

· Changes that make you no longer eligible for Medicaid or the Children’s Health Insurance Program (CHIP)

· Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder

· Becoming newly eligible for Marketplace coverage because you became a U.S. citizen

· Leaving incarceration

· AmeriCorps VISTA members starting or ending their service

· Other complicated cases that may qualify you for a Special Enrollment Period

Special Enrollment Periods for complex issues

Outside the Open Enrollment Period, you can enroll in a private health plan through the Marketplace only if you qualify for a Special Enrollment Period.

You can qualify for a Special Enrollment Period if either of the following applies to you:

You have a qualifying life event like having a baby, getting married, or losing minimal essential coverage. Learn more about Special Enrollment Periods and other coverage options outside Open Enrollment.

You have other complicated situations, as described on this page.

Below are cases and examples that may also qualify you for a Special Enrollment Period:

Exceptional circumstance

You faced a serious medical condition or natural disaster that kept you from enrolling. For example:

· An unexpected hospitalization or temporary cognitive disability, or were otherwise incapacitated

· A natural disaster, such as an earthquake, massive flooding, or hurricane

Enrollment or plan information display errors

· Misinformation, misrepresentation, misconduct, or inaction of someone working in an official capacity to help you enroll (like an insurance company, navigator, certified application counselor, or agent or broker) kept you from:

o Enrolling in a plan

o Enrolling in the right plan

o Getting the premium tax credit or cost-sharing reduction you were eligible for

· A technical error occurred when you applied on HealthCare.gov -- you probably saw an error message when completing your application – that prevented:

o You from enrolling in a plan, or

o Your health insurance company from receiving your enrollment information

· The wrong plan data was displayed on HealthCare.gov at the time that you selected your health plan, such as benefit or cost-sharing information.

Previously lived in a state that hasn’t expanded Medicaid and you become newly eligible for help paying for a Marketplace insurance plan because of an increase in household income or move

You previously lived in a state that hasn’t expanded Medicaid and weren’t eligible for Medicaid or advance payments of the premium tax credit (APTC) because your income was too low. But in the last 60 days, you had an increase in household income or moved, making you newly eligible for premium tax credits.

Being determined ineligible for Medicaid or CHIP

You applied for Medicaid or CHIP during the Marketplace Open Enrollment Period and your state Medicaid or CHIP agency determined that you weren’t eligible for Medicaid or CHIP after Open Enrollment ended. You may qualify for a Special Enrollment Period regardless of whether you applied through:

· The Marketplace and your information was sent to your state Medicaid or CHIP agency, or

· Your state Medicaid or CHIP agency directly

Gain or become a dependent due to a child support or other court order

You gained a new dependent or became a dependent of someone else due to a court order. Your coverage would start the effective date of the court order – even if you enroll in the plan up to 60 days afterward.

Experience domestic abuse/violence or spousal abandonment

You're a survivor of domestic abuse/violence or spousal abandonment and want to enroll in your own health plan separate from your abuser or abandoner. You can enroll by contacting the Marketplace Call Center. Your dependents may be eligible too.

If you’re married to your abuser/abandoner, you can answer on your Marketplace application that you’re unmarried, without fear of penalty for mis-stating your marital status. You then become eligible for a premium tax credit and other savings on a Marketplace plan, if you qualify based on your income.

If you qualify for this SEP, you'll have 60 days to enroll in a Marketplace plan.

Prevail on Appeal

You believe you received an incorrect eligibility determination or an incorrect coverage effective date and file an appeal with the Marketplace. If the ruling goes in your favor, you’ll be given the option to enroll in or change plans either retroactively or prospectively.

If you think you qualify for a Special Enrollment Period

If you think you qualify for a Special Enrollment Period for one of the situations listed on this page, contact me at 940-5974757.

If you’re already enrolled in a plan and you get a Special Enrollment Period, you can stay in your current plan in most cases, or you can switch plans. In some limited cases, you may qualify for an earlier effective date of coverage. Remember, you must make the first premium payment before your coverage becomes effective.

Filing an appeal

If your request for a Special Enrollment Period is denied, you can file an appeal. If the denial is found incorrect, you can get coverage back to the date your Special Enrollment Period was denied.

How to file an appeal:

· Select your state’s appeal form, download it, and fill it out

· Mail your appeal to:

Health Insurance Marketplace

Attn: Appeals

465 Industrial Blvd.

London, KY 40750-0061

When possible, include a copy of any eligibility determination notice or other official notice you received. This isn’t required, but will help us process your appeal.

When mailing the appeal request to the Health Insurance Marketplace, be sure to include the last 4 digits of the London, KY ZIP code (40750-0061). This will help your appeal arrive faster.

Deadline to Furnish Employer Health Insurance IRS Forms Delayed to March 31, 2016

by Catherine Giles on 01/06/16

On December 28th, 2015, the IRS released Notice 2016-4, in which a two-month delay in the employer deadline for furnishing Forms 1095-B & 1095-C.  The original February 1st deadline to issue forms to employees has now been extended to March 31st.  In addition to the delay in employee notification, subsequent notification to the IRS has also been pushed back to May 31st for those filing by mail or June 30th, 2016 for those filing electronically. 

1095-C & 1094-C

Form 1095-C is to be used by employers with 50 or more full-time employees (including full-time equivalent employees) known as applicable large employer (ALE) to report information required under section 6055 and 6056 to the IRS. Form 1095-C must also be furnished to covered employees. (Form 1095-C is transmitted to the IRS using Form 1094-C.) This form is required to be used by ALEs for the combined reporting of Minimum Essential Coverage (MEC) under section 6055 and the offer of coverage under section 6056 to the IRS. The form will be used by:

  • Large Employers that sponsor a self-funded plan: The employer completes Parts I and III of the 1095-C for any employee that enrolls in the health coverage, whether or not the employee is a full-time employee. If the employee is a full-time employee, the employer must also complete Part II. Part II of the form includes information about the offer of coverage that was made to the employee, the employee’s share of the lowest cost monthly premium, and other employer responsibility information.
  • Large Employers that provide fully insured coverage: The employer completes Parts I and II of Form 1095-C, but does not complete Part III of the form. Part III of the form reports information about the MEC and will be separately reported to the IRS by the entity providing the coverage (the fully insured carrier)
  • The 1094-C is the cover page that is sent to the IRS along with the 1095-C

 1095-B & 1094-B

Form 1095-B is the return used for reporting MEC (Minimum Essential Coverage) under section 6055 to the IRS and for furnishing coverage information to covered individuals. (Form 1095-B is transmitted to the IRS using Form 1094-B.) Insurance companies that issue policies in the small group market are responsible for filing the 1095-B (this means that small employers that are self-funded must issue the 1095-B.

 Who sends what:

  • Small Employer that is FULLY INSURED with less than 50 full time equivalents:
    • the insurance company will provide the 1095-B to enrolled employees. 
    • The employer does not need to report or file anything.

 Small employer that is SELF FUNDED with less than 50 full time equivalents:          

    • Employer will send form 1095-B to both the IRS and the Employee
    • Employer will transmit the 1095-B to the IRS using the form 1094-B

 Large Employers that is FULLY INSURED:      

    • Insurance Company will supply the 1095-B to both the IRS and the enrolled employee
    • Employer will send form 1095-C (but only complete sections I & II) to both the IRS and the Employee that was deemed eligible for benefits
    • Employer will transmit the 1095-C to the IRS using the form 1094-C

 Large Employer that is SELF FUNDED:        

    • There is NO 1095-B form for self-funded large employers
    • Employer will send form 1095-C (complete ALL sections) to both the IRS and all benefit eligible employees
    • Employer will transmit the 1095-C to the IRS using form 1094-C

Top Reasons Why a Life Application May Be Declined and How to Address Being Declined

by Catherine Giles on 11/23/15

Have you ever wondered some of the reasons why someone who applied for life insurance may have been declined coverage with an insurance company?  Life insurance coverage options as well as underwriting guidelines differ among insurance carriers.  Underwriting guidelines are the guidelines in which investigation of the facts contained in life applications are used to determine if coverage will be offered or declined.

 

Below is a list, in no particular order, of some reasons why an applicant might be declined for life insurance with some insurance carriers:

1. Previous Declines on Life Insurance Applications

Insurance carriers can utilize the Medical Information Bureau, a not-for-profit company through which life insurance companies can assess an individual’s risk and eligibility during the underwriting of life insurance.

Often, depending on insurance carrier, if an applicant was declined life coverage within the past five years and if the reason was due to a serious medical condition that it still in existence, it can make it more difficult to qualify for life insurance with some carriers.  However, just because an applicant has been declined life insurance coverage in the past doesn’t mean he or she can’t qualify for life insurance coverage now or in the future

2. Your Driving Record

A history of driving offenses, accidents, and claims can indicate that you live a dangerous lifestyle, as auto accidents are one of the leading causes of death, and especially prevalent among young adults.  Some carriers may charge an increased rate if coverage is offered.

A history of multiple accidents or tickets, or DUI/DWI episodes cause concern for insurance carriers. You may find it impossible to get life insurance until you can demonstrate a history of safe driving.

3.  Height and Weight Ratios

When applicants are obese or morbidly obese, some insurance carriers may decline life insurance coverage because often obesity or morbidity obesity lead to severe health complications, such as cardiovascular disease, diabetes, and can increase cancer risks.


If an applicant is obese without many other health issues, some carriers may charge an increased rate if coverage is offered.


4. Elevated Cholesterol, Lipids and Triglycerides

Research has shown that the relationship between high LDL cholesterol, and low HDL cholesterol puts a person at higher risk for heart disease and stroke. If a life insurance applicant has high cholesterol, lipids, and triglycerides without many other health issues, some carriers may charge an increased rate if coverage is offered.

 

5.  Elevated Liver Function

 

Elevated liver function can indicate inflammation or damage to the liver cells. This can cause the cells to leak above-normal levels of certain chemicals into the bloodstream. Typically, the elevation is mild, and the condition is temporary. But sometimes it can be an indication of more serious liver problems, and that's a concern to life insurance companies.

One of the challenges for an applicant, is that they may become aware of the elevated liver function only after taking a life insurance medical exam. However, there is no medical documentation to indicate if the condition is temporary or something more serious, since you haven't had the opportunity to get follow-up medical attention. A life insurance company however may assume the worst and deny your application.


6. High Levels of Glucose or Blood Sugar

 

High levels of glucose or blood sugar can be an indication of diabetes, and that opens up the possibility for a host of other medical consequences, such as increased risk of heart attack, stroke, cancer, kidney damage, and circulatory issues that many life insurance companies prefer to avoid.  Some carriers, if coverage is offered, may charge an increased rate if there is medical documentation that currently and for an extended period of time glucose levels are well-controlled by diet and/or medication.

 


7. Blood or Protein in the Urine

 

The existence of blood or protein in the urine could be an indication of kidney disease. It can also be caused by extreme physical exercise. One of the challenges for an applicant, is that they may become aware of blood or protein in the urine only after taking a life insurance medical exam. However, there is no medical documentation to indicate if the condition is temporary or something more serious, since you haven't had the opportunity to get follow-up medical attention. A life insurance company however may assume the worst and deny your application or may decide to gather additional medical information and may charge an increased rate, if coverage is offered.

 

 

8. Alcoholism

 

If alcohol use is indicated on the application, in medical records, and also if regular alcohol abuse is indicated when liver functions are high, most insurance companies will deny coverage; the reasons being liver function, along with damage to health that occurs from alcoholism, as well as the potential for engaging in life-threatening activity.

If alcoholism is a current problem, a denial of coverage would most likely occur, but the best strategy if applying for life insurance would be to delay your application until you have ceased drinking completely, and enough time has passed that medical evidence of sobriety can be substantiated.


9. Drug Use

 

Confirmed use of illicit drugs are typically an automatic decline when you apply for life insurance.

Just as is the case with alcoholism, if you have a drug habit or drug use disorder, the best strategy is to completely get off the drugs under a physician’s care and to document a medical history of being drug-free for an extended period of time.


10. Hepatitis

 

Hepatitis B or C already diagnosed and treated is typically not a reason for denial once treatment is complete. But it can be a problem with a life insurance application if the condition has only been recently diagnosed, or if it is revealed by the life insurance medical exam itself.

In order to get life insurance, you'll first need to begin and complete medical treatment. 


11. AIDS or HIV

 

Even though AIDS and HIV are better understood and treated now than in the past, and even though survival rates have improved dramatically, most insurance carriers will deny coverage.

 

 

12.  Occupation

 

Some occupations carry a higher degree of danger than others. This can make life insurance companies reluctant to approve policies if you are working in an occupation that is considered hazardous.

Some of the most hazardous occupations are:

  • Logging workers

  • Fishers and related fishing workers

  • Airline pilots and flight engineers

  • Roofers

  • Structural iron and steel workers

  • Refuse and recyclable material collectors

  • Electrical power-line installers and repairers

  • Drivers/sales workers and truck drivers

  • Farmers, ranchers, and other agricultural managers

  • Construction laborers                  



13. Hazardous Extra-Curricular Activities

For some people, it's not what they do for a living that causes increased risks, but rather what they do when not working. Some extracurricular activities are considered hazardous, and carry a higher risk of premature death. If you participate in any the following activities, many insurance carriers will decline coverage:

Skydiving

Scuba diving

Flying Aircraft (recreational pilot)

Base jumping.

Bungee Jumping

Mountain Climbing



14. A History or Family History of Heart Attack, Stroke, and/or Cancer

Even though cardiovascular and cancer outcomes have been improving dramatically in recent years, heart attack, stroke, and cancer are high risk medical events and the cause of many premature deaths.

Less serious forms of cardiovascular disease or cancer, such as hypertension or murmur that is well-controlled or skin cancer, may be approved by insurance carriers with an increased rate.


Steps to Take if You Have Been Denied Life Insurance Coverage:

1. Write the insurance company and request that they disclose to you in a written explanation all of the specific reasons why you were denied life coverage and request any medical information that was used in determining the denial.



2.  Order copies of any medical records that were used by the life insurance company in declining your application.

 

3.  Get copies of your complete medical records.

 

4.  Carefully check the medical records used in determining that your life application would be declined to make sure that they do not contain false or questionable information. Should you come across any, you'll need to make sure that the information is corrected, as it will appear in the database that virtually all insurance companies have access to.

5.  Work with an Independent Insurance Agent or Broker appointed with many insurance carriers.  One life insurance carrier may decline coverage, but another carrier may approve your life application as is or with an increased rate. 


Life insurance coverage options vary among insurance carriers as well as underwriting guidelines differ among carriers.  The best advice is to utilize an independent insurance agent appointed with many insurance carriers and who is also experienced in order to receive the best advice, recommendations, and options for coverage.

The Truth is: Most Deaths are Unintentional and Unplanned; your Life Insurance Needs Shouldn’t Be

by Catherine Giles on 10/19/15

 

     Often adults may think that having life insurance is optional, and only if and when they can afford it.  Often adults may think that having life insurance is not important to safeguarding their and their family’s financial needs and futures as a direct result of an unplanned-for or an under-planned-for death. 

 

     But the truth is many of us have seen first-hand, and many of us have seen over and over, the life lessons of loved ones and our family or of people we may know and their families who, as direct consequences of an unplanned-for or an under-planned-for death, have not had their final medical and final burial expenses needs met and/or their surviving loved ones’ ongoing mortgage or rent with on-going living expenses such as car payments, electricity, and food, and their loss of income needs met.

 

     In a 2015 Insurance Barometer study from LIMRA, an association that provides research, consulting, and other services about insurance and financial services, the study found that more than 43% of Americans say they would feel a financial impact within six months if a primary wage-earner died.  However, 43% of Americans have no life insurance at all.  Of the 57% of Americans who have at least one life insurance policy: 

 

  • 1/3 of the 57% have group life insurance through their employer, which means that the employer owns the policy and the employees while working there hold a certificate to coverage, never owning their own policy and in most cases never being able to take their life insurance with them when they terminate employment or retire. 

 

  • 1/3 of the 57% believe they need more life insurance.

 

  • 1/4 of the 57% actually own their own individual life insurance policy.

 

  • 1/10 of the 57% have both group life through their employer and have individual life, which they actually own.

 

     Also the study found that procrastination is a common reason Americans give for either not taking life insurance at all or, if they do, for being underinsured.  Another common reason most Americans give for not having life insurance is its perceived cost.  Yet 80% percent of American consumers misjudge the actual price for term life insurance, with Millennials, those born between the early 1980s to the early 2000s, overestimating the actual cost of life insurance by 213%.  29% of Millennials cited saving for vacation as a priority over purchasing some or more life insurance.  60% of Millennials cited paying for expenses such as Internet, cable, and cell phones as a priority over purchasing some or more life insurance.  Yet as a permanent consequence to and a direct result of not having any or adequate life insurance, the decision means not having one’s own medical and final expense needs met as well as not having ongoing auto payments, mortgage or rent, and living expenses needs met for our loved ones.  From the study results, it may appear that temporary consequences of going on a vacation, or not, and having a certain level of Internet, cable, and cell phones, or not, may appear to outweigh the permanent consequences to ourselves and to our loved ones of not having any or of not having adequate life insurance coverage.

 

    The LIMRA study found that Gen Xers, those born in the early 1960s to the early 1980s, overestimated the actual cost of life insurance by 119%.  23% of Gen Xers said paying for recreational activities, such as going out to eat, to the movies, or shopping was a priority over purchasing some or more life insurance.  Again as a permanent consequence to and a direct result of not having any or adequate life insurance, the decision means not having one’s own medical and final expense needs met as well as not having ongoing auto payments, mortgage or rent, and living expenses needs met for our loved ones.  From the study results, it may appear that temporary consequences of going out to eat, or not, and to the movies or shopping, or not, may appear to outweigh the permanent consequences to ourselves and to our loved ones of not having any or of not having adequate life insurance coverage.

 

    The study found that 49% of those 65 and older cited paying for expenses such as Internet, cable, and cell phones as a priority over purchasing some or more life insurance.  Again as a permanent consequence to and a direct result of not having any or adequate life insurance, the decision means not having one’s own medical and final expense needs met as well as not having ongoing auto payments, mortgage or rent, and living expenses needs met for our loved ones.  From the study, with older Americans it may appear that temporary consequences of having a certain level of Internet, cable, and cell phones, or not, may appear to outweigh the permanent consequences to ourselves and to our loved ones of not having any or of not having adequate life insurance coverage.

  

     The LIMRA study found that many Americans have an inaccurate perception that life insurance policies are expensive and are a hardship to one’s budget.  (Depending on insurance carrier and on age, term life insurance policies can be as inexpensive as $1.54 per week and up, less than a cup of coffee, and can help one’s family pay for final medical and final burial expenses, the mortgage or rent and ongoing living expenses, and for the family’s loss of earning power, all directly caused by an unplanned-for or under-planned for death.  Also insurance policy options can be whole life, universal life, or variable life.  Please see your insurance agent for more details on the types of insurance coverage and for recommendations on what would best fit your needs and of any surviving family members’ needs.) 

 

     Many Americans simply have an inaccurate perception that having at least one life insurance policy that you own can wait until later, even though we know that death happens to us at any age and in any circumstance.  The leading causes of death across age groups in the U.S., according to the Centers for Disease Control, are unintentional injury and sickness/condition; being an unintended victim of homicide; and suicide; only suicide is intentional.  The LIMRA study found that of the 57% of Americans who have at least one life insurance policy:

 

  • 1 in 4 of the 57% only initiated taking life coverage directly because an insurance agent asked them about their life insurance needs. 

 

  • 2 in 3 of the 57% say they trust their insurance agent and their insurance company.
  •  

     From the LIMRA study, we find that having life insurance is critical.  It is important to have at least one or more life insurance policies that you own and that will fit both your current needs and your future needs.  From the study we find that there are many options for types of life insurance and for affordable premium options.  As life insurance is designed to safeguard our and our family’s financial needs and our surviving family members’ futures, life insurance can only provide these protections and security if actually taken and remaining in force, whether or not one terminates employment or retires.  From the CDC study, we find that 2 of 3 deaths are unintentional, happen at any age, and in any circumstance. 

 

     The truth is many of us have seen first-hand, and many of us have seen over and over, the life lessons of loved ones and our family or of people we may know and their families who, as direct consequences of an unplanned-for or an under-planned-for death, have not had their final medical and final burial expenses needs met and/or their surviving loved ones’ ongoing mortgage or rent with on-going living expenses, such as car payments, electricity, and food, and their loss of income needs met.  The truth also is, most deaths are unintentional and unplanned, but your life insurance needs shouldn't be.

 

     For a free life insurance needs consultation and for free quotes, please feel contact your agent, Catherine Giles, by phone at:  940.597.457, by email at:  [email protected], or by auto-schedule appointment on her website:  www.giles4insurance.com or her mobile site:  m.giles4insurance.com.

 


The 2015 Insurance Barometer Study was fielded in January 2015 using an online panel, which surveyed 2,032 U.S. adults age 18-75. The data were weighted by age, gender, education, race, region, and income to be representative of the general population. A propensity score adjustment was added to correct for biases inherent in Internet panels. The margin of error in this study is 3 percentage points.

 

5 Tips for an Informed, Smooth, and Painless Health Insurance Open Enrollment

by Catherine Giles on 09/19/15

 

5 Tips for Your Informed, Smooth, and Painless 2016 Health Insurance Open Enrollment

 

     The 2016 Health Insurance Open Enrollment Period is approaching, from November 1, 2015 to January 31, 2016, with a January 1, 2016 effective date if your application is submitted no later than December 14, 2015.  Take the time now to prepare your open enrollment game plan: 

 

1.  Work with an Expert Health Insurance Agent Certified for Both On and Off the Health Insurance Marketplace; for Individual/Family and Group, or SHOP; who Represents Many Insurance Carriers

 

     Unless you’re a health insurance expert both on the Health Insurance Marketplace, or healthcare.gov site, and off the site with Non-Marketplace insurance carriers, and unless you're an expert in Individual/Family options and also for Group, or SHOP, and unless you represent many insurance carriers, work with an expert who is. Work with a health insurance agent who is certified both on and off the Health Insurance Marketplace, for both Individual/Family as well as Group, or SHOP, and who represents many insurance carriers.  This should be the core of your game plan:  working with a true expert in all types of health insurance, in all markets, and who represents many insurance carriers.  More experience, more sources of coverage, from more carriers.

 

     With on the Marketplace options, work with a certified agent who gives you the same choices, same premiums, and same options for help with paying for your monthly premiums, called a premium subsidy, as with going it alone directly on the health.gov site.  This choice allows your agent to work with you for Individual/Family options; or for questions about possible SHOP coverage being offered by your employer.  Tt allows your agent the opportunity to contact your employer to request a free consultation about the possibility of Group, or SHOP, insurance being offered through your employer.  

 

2.  Work with an Expert Health Insurance Agent for Personalized Help, Enrollment, and Servicing Vs. Directly with Healthcare.gov Call Center or Directly with Your Insurance Carrier

 

     Unless you prefer to go it alone and work directly with the healthcare.gov site or directly with your Off-Marketplace insurance carrier, make it your game plan to work with an expert health insurance agent certified for all types, all sources, and who represents many insurance carriers.  This choice in your game plan gives you personalized help with selection, enrollment, and servicing; same options, same prices, same subsidy eligibility.

 

          If you work with one expert agent who is your designated agent on your Individual/Family original application or on your Employer's Group or SHOP account, your agent is not only your one designated agent, but your contact, versus, when going it alone directly on the healthcare.gov site, the government is your agent of record and your contact with its call center, which randomly assigns each new call to a new customer service representative, or each new email to their email help center, which auto-emails you back that they will contact you within two business days.

 

3.  Take Stock of Your Sources for Health Insurance

 

     An expert health insurance agent for all types of insurance, from all sources, and with many insurance carriers can best advise you on this, but make it your game plan to take stock of your sources for health insurance:

 

A. employer-sponsored group plan off the Healthcare Marketplace or on the Marketplace, called SHOP.  Both places have employee eligibility requirements.

 

B. individual or family plans, either on or off the Marketplace

 

C.  Medicaid, if you or your family qualifies

 

D.  CHIPS for children, if your child or children qualifies

 

E.   Tri-Care for military veterans and families, per eligibility requirements

 

F.  Veteran’s Administration Health Care Program

 

G.  Peace Corps Health Care Program

 

4.  Gather the Necessary Documents NOW Needed for Health Insurance Open Enrollment

 

   Again, your expert health insurance agent for all types and all sources of insurance, who represents many insurance carriers, can best assist you on this, but make it your game plan to gather NOW all the required documents necessary for your upcoming consultation and Open Enrollment:

 

For each person in your household and for each tax dependent who is out of your household but whom you claim on your income taxes, their:

 

A.  Full legal name

 

B. Residential address

           

C. Birthdate

 

D.  Social security number

 

E.  Whether or not any form of tobacco use or tobacco delivery use, such as e-cigs, within the past consecutive 12-month period

 

F.  For off the Health Insurance Marketplace options, the height and weight of each person.

           

G.  If you are married

           

H.  If you and your spouse have filed jointly for 2014 income taxes and if you plan to file jointly for 2015’s income taxes.

           

I.  If a legal U.S. resident but not a U.S. citizen, your immigration papers, called your Green Card.

 

J.  All Household Income Sources from each person, such as:

 

1.  Wages and salaries, as reported on your W-2 form

 

2. Your latest pay stubs

 

3.  If in any job, you receive tips, your total tip amount

 

4.  If you are self-employed or have a business, your net income from any self-employment or     business

 

5.  If you are or have been unemployed within 2015, your Unemployment compensation

 

6.  If you receive Social Security payments, including disability payments (but not Supplemental Security Income (SSI), your compensation

 

7.  If you receive or pay Alimony, your compensation

 

K.  If you are retired, your retirement or pension income, including most IRA or 401k withdrawals

 

L.  If you have investments, your investment income, like dividends or interest

 

M.  If you own rental property, your rental income

 

N.  Other taxable income

 

O.  Your 2014 Income Tax Return

 

P.  Your best estimate of your household income for the 2015 tax year and for 2016.

 

Q. Existing Health Insurance policy numbers, only if anyone in your household currently has a health insurance plan, even if an Employer-Sponsored Group or SHOP plan

 

R. Employer information for each person in your household, even if their employer doesn’t offer an Employer-Sponsored Group of SHOP plan

 

5.  Schedule NOW with your Expert Health Insurance Agent Certified for all Types and from all Sources of Insurance, Who Represents Many Insurance Carriers

 

     Unless you plan to go it alone directly on the Marketplace with the government as your designated insurance agent and contact or to go it alone directly with your insurance carrier for off the Marketplace  options with your insurance company as your designated insurance agent and contact, make it part of your game plan to contact and schedule your upcoming consultation and Open Enrollment NOW with your expert health insurance agent certified for all types and from all sources of insurance, who represents many insurance carriers. 

 

     Please note that not all insurance agents are licensed for health insurance.  Not all licensed health insurance agents are certified for both Individual/Family and Group, or SHOP.  Not all Individual/Family and Group, or SHOP, agents are certified for on and off the Marketplace.  Not all on and off the Marketplace agents are appointed with many health insurance carriers.  The expert health insurance agents who are certified for Individual/Family and for Group, or SHOP; who are certified on and off the Health Insurance Marketplace; and who represent many health insurance carriers, are in very high demand throughout the year, and are in extremely high demand during every Open Enrollment Period. 

 

    When scheduling NOW for your health insurance consultation and also for your Open Enrollment with your expert health insurance agent for all types and all sources of insurance, who represents many carriers, please remember you may have your consultation and enrollment which best fits your preferences, needs, and schedule:  either a face-to-face appointment, by phone, Skype, GoToMeeting, etc.  It is critical before the time of your appointment(s) for application that you have already gathered and already have on-hand all the required documents listed above.  If your consultation appointment and/or your Open Enrollment appointment are not face-to-face, it is also critical that you have computer and internet access already on-hand and connected.

 

     It is also critical at the time of your upcoming Health Insurance Open Enrollment application appointment that you designate your health insurance expert on that original application.  If not, this cannot be added later.   Your expert agent should give you the following information that must be on your original application: 

 

1. Your agent’s full name

 

2.  Your agent’s Business name

 

3.  Your Marketplace ID for on the Marketplace application or your agent’s ID and Producer Number with your chosen insurance carrier for off the Marketplace application

 

4. Your agent’s National Producer Number, which is different from his or her Marketplace ID or Producer Number.  Your agent's National Producer Number is critical to be on your Marketplace or your non-Marketplace application.

 

 

     The 2016 Health Insurance Open Enrollment Period for consultation and open enrollment is fast approaching.  Make it your #1 top priority in your game plan to take the time NOW to schedule with your expert health insurance agent who is certified for all types of insurance, from all sources, and who represents many insurance carriers. Make it your #2 priority in your game plan to prepare NOW for your consultation and Open Enrollment application appointment(s) by gathering all the required documents and keeping them in one place and on-hand.

 

 

     Catherine is an experienced insurance agent who is licensed for life, home, auto, business, health  and dental insurance.  She is certified for both Individual/Family and for Group, or SHOP.  She is certified both on and off the Health Insurance Marketplace, or the healthcare.gov site, as well as for supplemental health insurance.  She also represents many insurance carriers, both on and off the Health Insurance Marketplace, which give you more types and more sources of health insurance, from many insurance carriers.

     To schedule your free consultation and your upcoming Health Insurance Open Enrollment application appointment, please contact her:

1.  By phone or text message at:  940-597-4757

2.  By email at:  [email protected]

3. By private message on Skype, Facebook, Twitter, or LinkedIn through her ID:  giles4insurance

4.  By private email through her auto-schedule appointment tabs on her website:  www.giles4insurance.com

5.  By public posting on Skype, Facebook, Twitter, Linkedin, or Instagram through her handle: giles4insurance.  Please remember not to post any confidential information and please don't post any information you don't want everyone seeing.

 

 

 

 

5 Easy Tips to Prevent Water Damage

by Catherine Giles on 09/19/15

Most Homeowners insurance policies cover basic water damage claims up to the purchased limit.

 Check out these five suggestions for preventing water damage:

 1. Grease isn't the word...

 You’ve probably heard this before, but you should definitely avoid pouring grease down your kitchen sink. Whether you flush your drain with hot water or use soap to try and break up the grease, it can still congeal, cling to your pipes, causing pipe damage, back-up, and water damage. The safest thing to do is just to pour your grease in an empty can, and either let it sit or put it in the refrigerator. Once it hardens you can toss it in the trash and get rid of it.

 2. Snake your pipe clogs

 Drain clogs happen. As convenient as caustic drain cleaners may be, the caustic chemicals are also eating away at pipes. If you rely on them a lot, you could be setting yourself up for water leaks. Owning and using a drain snake is a good solution to clear away clogs. They’re inexpensive, you can get them at your local hardware store, and they can cut through most any clog you’ll have without damaging pipes or making your eyes red and teary from chemical fumes.

 3. Root out clogs from your roof gutters

 Schedule on a calendar for four times per year to safely get up on a ladder and inspect your roof gutter, if you are able. Plan for rain before a rainy day to ensure that your gutters are clean and can handle the water flow. Clogged gutters can send water spilling into your home’s foundation, through the roof, or down to your basement, if you have one. Water damage, especially water damage caused by neglect, can be costly. If your gutters are too high, be safe and get a professional to inspect them.

 4. Eagle-Eye your water usage and bill

With so many water pipes hidden behind walls and in the floors in your house, you might not know there’s a leak until the damage is already done. That’s why it’s a good idea to keep a close eye on your monthly water usage contained in your water bill . If you see it starting to creep up, or get one that’s uncommonly high, it’s an indication you may have a water leak somewhere.

 5. Plan before you plant

 Some plants and trees, like weeping willows, have pretty invasive roots. If you’re not careful, they’ll grow right into your sprinkler system, drainage field, pipes, and septic tanks. Know where your water and sprinkler lines are and plan to allow for invasive root growth before you plant.

 Free Review and Quote

For a free review of your water damage coverage in your homeowner's policy or for free, competitive quotes for homeowner's or renter's insurance, call me today at 940-597-4757 or email me at [email protected].

3 Simple Auto Insurance Add-ons and 12 Simple Items to Help You in Accident, Emergency, or Breakdown

by Catherine Giles on 09/19/15

 

 

     We should all prepare for the unexpected in life; with our finances, with our homes, and with our autos. Some simple auto insurance add-on coverage can help you with the unexpected, such as having towing/roadside assistance, auto rental reimbursement, and mechanical breakdown coverage, added to your auto policy, if available for your type of auto policy. These coverages are usually inexpensive and can save you time and out-of-pocket expenses when life happens. For a free consultation, policy review, and competitive quotes for auto coverage, please feel free to contact me at: 940-597-4757 or [email protected]

     Some suggestions for simple items you can keep in your vehicle to prepare for the unexpected can also help protect you or someone else.


1.  Fire Extinguisher Safely Secured Under Your Car Seat or in Your Trunk

     When you’re in an accident, or even if you’re not, and there’s a small fire, having quick access to a fire extinguisher can help stop your car, or something else, from turning into a true disaster. If a five-pound fire extinguisher, or smaller, can be safely secured under your car seat, such as with a strap and clip to your car seat’s frame, it can be at an arm’s reach and available when needed. Having one securely strapped under your car seat can help lessen the chance of it becoming a projectile during an auto accident. If a fire extinguisher cannot safely be secured under your car seat, consider keeping on safely secured in your trunk.


2.  Window Shattering Tool/Seatbelt Cutter in Your Glove Compartment or Safely Secured Under Your Car Seat

     When you need to exit your vehicle immediately and can’t open your seatbelt, have access to exiting through doors, using power windows, or manually rolling down windows, having a window shattering/seatbelt cutting tool in your glove compartment, if it will fit, or safely secured with a strap and clip under your car seat can give you quick access to breaking a window, if necessary, to exit your vehicle. It can help you to save valuable time in such cases as having an accident and having your vehicle land in a creek, lake, or other body of water, for example.


3.  First Aid Kit and First Aid Manual in Your Glove Compartment or Safely Secured Under Your Car Seat

     When you’re in an accident or have a medical emergency, having quick access to a First Aid Kit and a First Aid Manual in your glove compartment, if it will fit, or safely secured with a strap and clip under your car seat, is vital. Slowing down or stopping bleeding, as one example, may help prevent a person from going into shock or may help prevent one from bleeding to death.

 
4.  Blanket in Your Trunk

     Even if the weather is nice, having a blanket in your truck can help you or someone else keep covered or warm in an accident, medical emergency, or during an extended stay in your vehicle.


5.   Fully Charged Cell Phone, if You Have One, with Auto Adapter Charger

     Having a fully charged cell phone, if you have one, with a charger adapter for either your car’s cigarette lighter or a USB port, if you have one, can make getting help faster and easier, particularly if you need to call 911 for an emergency, to call your insurance carrier for roadside assistance or towing, or call a loved one in an emergency. Make sure you are not operating your vehicle and are in a safe area if you need to make a call. Auto adapters are usually about $20 or less and can help you stay in touch during an emergency or the unexpected.


6.  Owner’s Manual in your Glove Compartment

     The Owner’s Manual provides useful information that can help get you back on the road, such as detailed images of how to change a tire, etc., if you don’t have roadside assistance added to your auto policy.


7.   Flashlight (and Extra Batteries) in your Glove Compartment 

     A flashlight and extra batteries in your glove compartment is essential at night to see and to be seen when the unexpected happens.

 
8.  Road Flares in Your Trunk

     Road flares in your truck are invaluable, especially at night, so that others can see you if you need help or if you need to exit your vehicle, such as to change a tire, etc., if you don’t have towing/roadside assistance or mechanical breakdown coverage.


9.  Two Cans of Fix-a-Flat in Your Trunk

      If your tire has a rapid leak, Fix-a-flat can often provide just enough help for you to get to a tire repair station. If your tire is flat, it can often provide just enough help for you to get to a tire repair or tire sales business. Having two cans on hand can help you, if you run over an object with both your front and back tires, for example.


10.  Tire Gauge in Your Glove Compartment

     Having a tire gauge is essential for helping you to keep your tires fully inflated, and it is essential for preventive maintenance. Keeping your tires fully inflated at the proper air levels indicated in your Owner’s Manual can not only improve your gas mileage, but can help you reduce your risk of tire blow-outs. To verify how much air your tires require, consult your Owner’s Manual.


11.  Booster (Or Jumper) Cables in Your Trunk

      If you don’t have roadside assistance, having jumper cables in your trunk can help you get your car started when it has a dead battery (if a Good Samaritan comes along). Having a set of jumper cables on hand can also enable you to help someone out if they have a dead battery.


12.  Bottled Water and High Energy Snacks in Your Trunk

     Having bottled water and high energy snacks in your trunk can help you if you are in your car for an extended period of time due to an accident, mechanical breakdown, etc.


      Having some simple auto insurance add-on coverage, such as towing/roadside assistance, auto rental reimbursement, and mechanical breakdown coverage, added to your auto policy, if available for your type of auto policy, can help you prepare for the unexpected and can help you save out-of-pocket expenses. Also having these 12 suggested items on-hand in your car can help you in a time of accident, emergency, or mechanical break-down. For a free consultation, policy review, and competitive quotes for auto coverage, please feel free to contact me at: 940-597-4757 or
[email protected].

 

 

Blog, Humbug!

by Catherine Giles on 09/19/15

  

      This is my first foray in to the world of blogging for business.  I'm no slouch in the world of technology; I use Facebook, LinkedIn, Twitter, Instagram, and Skype, all with the handle "giles4insurance" to keep it simple.  I maintain this website and try to keep it simple.

       So, I’m off in to the land of the Blogs.  Wish me luck!  Blog, Humbug!