Choose the best insurance exchange to make online shopping easier

Looking for individual major medical insurance on a commercial health insurance exchange that is up and running now? Try Members Smart Health Insurance Exchange for coverage options in all 50 states and D.C. Looking for guaranteed issue, supplemental individual insurance or short term coverage? Try FreedomBenefits.net for listings of the most popular commercial plans on a state-by-state basis. Small business coverage? Try the HealthCare.gov site for insurance and FreedomBenefits.org for low cost HRAs, HSAs and other flexible benefit design options.

OnlineNavigator health insurance exchange Q&As

GENERAL TOPICS

What is a health insurance exchange?

“Exchange” in this context simply means “marketplace.” We exclusively support online exchanges and are not involved with in-person community based enrollment.

Each state will have at least one insurance exchange serving individual residents and small businesses who buy their health insurance directly. Some health insurance exchanges will be operated by insurance companies, other commercial businesses and non-profit entities. Employers may opt to have employees use an exchange to find insurance to replace their current health benefit plans in order to allow employees access to more insurance choices. Consumers will likely notice a wide difference in the products and services available among different insurance exchanges, however any specific insurance policy will be priced identically regardless of which insurance exchange is selected.

What is OnlineNavigator?

OnlineNavigator is a personal financial planning service that helps individuals and businesses understand their health insurance options, especially when considering the options available under the new health reform law. OnlineNavigator is designed as an easy-to-use, one-on-one personal service the supplements the automated online consumer health exchange resources offered by the U.S. Department of Health and Human Services, state governments and other commercial sources. Our focus is to help expand understanding of health insurance options in connection with the federal health insurance clearinghouse and state health insurance exchanges.

OnlineNavigator is a privately operated business not affiliated with any government entity, health plan or insurance company.

What is a navigator?

A navigator is the term used by the Affordable Care Act to refer to a health insurance adviser paid by the government, a government-funded entity, or an insurance exchange to provide advice to individuals and businesses. The navigator's role will be further defined by the U.S. Department of Health and Human Services, the state governments and the commercial health insurance exchanges in the future.

There is no expectation our OnlineNavigator service will resemble other navigator services. Ours is expected to remain an independent and unaffiliated service operating outside of the norms of any other navigator service.

How is a navigator different from an agent or broker?

The primary difference is in the form of compensation. The agent or broker is paid a commission by the heath plan. A navigator is paid a fee by the government or insurance exchange. Agents and brokers are generally required to maintain higher levels of training, licensing and continuing education than navigators but that training might not focus on qualified health plans. Each state may modify the rules for its own insurance exchange navigators.

Do navigators work for non-government insurance exchangers? If so how are they paid?

These details are not yet available so we do not know. For now, we presume that insurance navigators on non-governmental exchanges are treated the same as agents or brokers.

What is the advantage of using a navigator?

A health insurance navigator provides assistance with qualified health insurance plans that are typically not available through insurance agents. These include public insurance plans and non-commissionable insurance options.

When is a health insurance navigator better than an insurance agent?

If you want personal help finding insurance to cover a pre-existing medical condition, are seeking entry in to a public health plan like Medicare or Medicaid, child-only coverage, COBRA or HIPAA conversion plan or want assistance completing an insurance application form then a navigator can typically provide more useful assistance than an insurance agent.

When is it not useful to use a health insurance navigator?

We are not qualified for nor prepared to assist with enrollment in Medicaid plans or similar plans meant for low income individuals.

How do I become a navigator?

States or their contracted lead agencies will hire in-person assistors later in 2013. The details are not available at this time.

Who provides OnlineNavigator service?

OnlineNavigator service is provided primarily by the principal Tony Novak. Other advisers provide support and respond to routine inquiries. Neither OnlineNavigator nor Tony Novak is affiliated with on a candidate for any state agency navigator contract but we may provide service to or join with another entity that intends to provide this service to a state exchange.

Tony Novak is an accountant and licensed health insurance agent in all states with more than 25 years experience as a health reform advocate. He is trained as a compensation planner and has worked as a benefits accountant and adviser for the various companies that make up the Freedom Benefits network. His articles and recordings about health reform and health insurance planning are reproduced in dozens of traditional and online media publications. Contact information is available on this site and a more detailed biography and list of credentials is available at www.tonynovak.com.

ELIGIBILITY AND AVAILABILITY

Who is eligible to use OnlineNavigator service?

Any English-speaking resident or visitor to the United States can use OnlineNavigator service. The navigator reserves the sole right to determine whether service will be offered. (Sorry we do not have service available to non-English speaking individuals).

While only legal residents of the United States can get government-provided financial subsidies for insurance premiums, OnlineNavigator provides assistance with insurance designed for immigrants and visitors regardless of their legal status.

What is required to use OnlineNavigator service?

Users must have the ability to use a personal computer and have a personal e-mail account. We support enrollment in online insurance exchanges only; paper enrollment is not available.

Please note that while OnlineNavigator service can be provided to a person using a mobile Internet device like a Blackberry, IPhone or IPads, most insurance enrollment Web sites do not support these devices. For this reason we recommend that you use OnlineAdviser service when you are at a personal computer.

Since the insurance and if applicable, the OnlineNavigator service must be paid for through an electronic transaction, a bank account or credit card account is also required.

How is OnlineNavigator service delivered?

At this time, only e-mail service is available.

When is OnlineNavigator service available?

Services are offered on a limited "first come, first served" basis during east coast business hours. Requests for service outside these hours will be granted based on availability of a navigator.

Availability of a navigator service varies but is generally expected to be available within one business day of the date of payment or other time requested, if later. You can request a specific appointment time or call without an appointment. Busiest times are the last day of the month and the first two days of the month. Mondays and Fridays are busier than other days.

What is the cost of OnlineNavigator service?

OnlineNavigator is offered at no cost to the user for members of specific participating benefit plans. Others may access the service by enrolling in the subscription service.

Basic service: OnlineNavigator basic service is offered at a flat rate of $10 for up to 10 minutes of in-person or telephone support plus e-mail follow-up.

Extended Service: The price of extended service is determined by the navigator based on the individual circumstances of each request. As a guideline, the price of OnlineNavigator service will typically be less than one month's insurance premium and less that the fee amount the adviser would otherwise charge for one hour's work for a client not enrolled in the OnlineNavigator service. We may elect to accept payment in full or in part from an insurance exchange, insurance company or directly by the government.

When is the OnlineNavigator fee waived?

At this time there is no fee for OnlineNavigator support.

Why are some services offered without payment from any source?

We may elect to provide some services without any expectation of payment in order to strengthen our position to prepare to provide similar services under a contract with a government or insurance exchange in the future.

We may also provide free service to some low income individuals as a charitable act. If you are unable to pay for service we encourage you to make a request to the adviser based on financial need.

What if I'm not eligible for OnlineNavigator service?

Other support options are expected to be available for health insurance enrollment in 2013. Also, traditional insurance agents and social assistance programs are available that provide similar services without a fee outside of the insurance exchange.

OnlineAdviser is a service similar to OnlineNavigator that offers consumer support by telephone and email for online transactions for products and services other than health insurance. See www.onlineadviser.org for details on this service.

INSURANCE ENROLLMENT

How do I enroll in coverage?

All of the health plans supported through this service can be accessed through the online insurance exchanges. Enrollment may be completed online on your own or with the assistance of the navigator.

What information do I need to provide?

The only information absolutely required by the navigator is your name, date of birth, address, social security number, email address and telephone number. Additional information like health history, household or business budget, income tax data and preferred medical provider is not mandatory but is likely to result in better recommendations.

Information for businesses is different and varies depending on the size, legal structure and location of operations of the firm. The primary data needed is employee census, including salary data and the firm's benefit strategy (the intent, if any, to fund part or all of health benefits through employer contributions or voluntary salary deductions).

Information required on an insurance application varies widely for 2012 and 2013 but is expected to become standardized in 2014. Some required details on medical history and a few may request that you provide a copy of your medical records. Other insurance companies simply request basic identity information. Until 2014 an insurance company may decline to issue coverage based on your medical history.

None of the health insurance companies require a medical exam or laboratory test as a requirement in the insurance application process.

What about privacy?

The health insurance navigator does not release your private information to anyone in the course of providing this service. Private information that you provide to the navigator is used only for the purpose of making recommendations. During the process of making an application for insurance the navigator may assist you in releasing information as specifically intended to a health insurance company.

Health insurance companies have their own privacy policies and are subject to the federal health information privacy law known as HIPAA.

The navigator does not retain or store protected health information as defined by HIPAA law, does not have access to insurance company records and does not meet the requirements of a covered entity under the law.

See our privacy policy for more information.

BENEFITS

What benefits are available?

Four basic health standardized health insurance plans are authorized by federal health reform law to begin in 2014 although the details of the standardized coverage are not available at this time.

For 2012 and 2013 the benefits vary widely from state-to-state and from month-to-month. Some health plans may have income limitations and health eligibility requirements prior to 2014.

PREMIUM PAYMENTS

Who pays for the insurance coverage?

Beginning in 2014 Individuals who earn less than the income amounts determined by state guidelines qualify for government-subsidized health insurance. Individuals pay the remainder of the cost for their own coverage. For 2012 and 2013 individuals pay the entire cost.

Businesses may pay for the cost of health insurance coverage for their own employees, or they can split the cost with the employee. Businesses that pay for coverage may be eligible for a tax credit.

How do I know if I qualify for an insurance subsidy?

The exchange will verify your residency status and the income you report at the time you apply for coverage and then confirm the amount of the subsidy. Subsidies are only available for certain types of basic health insurance coverage. Subsidies are not available for limited benefit insurance, mini-med plans and supplemental insurance. OnlineNavigator can help you estimate the amount of the subsidy before you actually apply for coverage.

How much is the insurance subsidy?

The subsidy is based on a sliding-scale subsidies determined by income for individuals and families who earn up to four times the federal poverty level (about $44,700 for singles or $92,200 for a family of four). If your income exceeds these amounts, there is no subsidy.

The government’s subsidy is based on the premium cost for the second-lowest-cost insurance plan at the "silver" coverage level that is available in your area. You may select a higher or lower cost insurance and the difference in cost does not change the amount of the subsidy.

A family of four headed by a 40-year-old making $35,000 will get a $10,742 subsidy towards the annual premium cost of $12,130. They’d have to pay $1,388, about 4 percent of their income, or about $115 a month. If the insurance they select costs more, then their expense will be higher.

A similar family making $90,000 will get a $3,580 subsidy. They would have to pay $8,550 of the same $12,130 policy premium. That works out to more than 9 percent of their income, or about $710 a month. If the insurance they select costs more, then their expense will be higher.

OnlineNavigator can help you estimate the amount of the subsidy before you apply for coverage.

Who pays for OnlineNavigator service?

For 2012 and 2013 the cost of navigator service is usually paid by various governments, private funding and the individual user. In some cases payment may be made by a third party payer like an employer, church or government agency.

Beginning in 2014 the state insurance exchange is expected to pay the navigator directly. There are not expected to be any fees paid by the individual user, the employer or the health insurance company at that time. Details of payment are not available at this time.

CLAIMS AND ASSISTANCE

How do I file a claim for benefits in an insurance plan?

OnlineNavigator is not authorized to provide policyholder service or assist with a claim. We will provide the contact information of the member service resources for your health plan.

LIMITATIONS AND REFUNDS

What are the limitations of OnlineNavigator service?

Services are limited to the specific functions described in the terms of service. The navigator can offer only the options available on the health insurance clearinghouse or exchange and cannot modify any offer of a health plan provider. The navigator cannot act on behalf of the health plan or provide customer services to health plan members.

OnlineNavigator service is limited in both scope and availability. The adviser incorporates reference to these limits on an individual or case-by-case basis in the course of providing service.

What is the satisfaction guarantee and refund policy?

No refund or satisfaction guarantee is offered for the basic navigator service. Refund is available for the paid enhanced enrollment service if you are not satisfied with the service.

Choose the best insurance exchange to make online shopping easier

OnlineNavigator health insurance exchange Q&As

CONTENTS

General Q&As

Eligibility

Enrollment

Benefits

Payment

Claims

Limitations and Warranty