Anthem Enrollment in Identity Protection Services for Current & Former Members Starts Today

Today, Anthem provided information on how to immediately enroll in credit protection services to all members who are potentially impacted by the Cyber Attack. Starting today at 11 a.m. PT, current and former Anthem members can visit to learn more about credit monitoring and identity theft repair services provided by AllClear ID, a leading and trusted identity protection provider. All services are available for two years. Details of the services and instructions on how to enroll are included in the press release below.

If your company was or is an Anthem client, you may wish to share this information with your employees. We will continue to monitor and provide updates as we receive further guidance so you and your employees can stay informed.

Anthem Press Release – How Members Can Access Identity Protection Services
Please feel free to contact us if you have any questions.

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Important Update and Guidance Regarding Anthem Data Breach

As we communicated last week, Anthem suffered a significant cyber-attack during which the personal information of Anthem members was compromised. Gray & Troy Insurance has been closely monitoring the situation to keep you informed. Below is the latest information we have received from Anthem. If your company was or is an Anthem client, you may wish to share this information with your employees. We will continue to monitor and provide updates as we receive further guidance so you and your employees can stay informed.

Cyber Attack Communications Update

Anthem Cyber FAQ

Please feel free to contact us if you have any questions.

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Anthem Data Breach Impacting Members

We want to let you know that we have just become aware that Anthem, Inc., the parent company of Anthem Blue Cross, is the victim of a highly-sophisticated cyber attack. Anthem has informed us that its member data was accessed, and information about our clients could be among the data.
We are working closely with Anthem to better understand the impact on its members. Here is what we do know:

  • Once Anthem determined it was the victim of a sophisticated cyber attack, it immediately notified federal law enforcement officials and shared the indicators of compromise with the HITRUST C3 (Cyber Threat Intelligence and Incident Coordination Center).
  • Anthem’s Information Security has worked to eliminate any further vulnerability and continues to secure all of its data.
  • Anthem immediately began a forensic Information Technology (IT) investigation to determine the number of impacted consumers and to identify the type of information accessed. The investigation is still taking place.
  • The information accessed includes member names, member health ID numbers/Social Security numbers, dates of birth, addresses, phone numbers, email addresses and employment information, including income data. Social Security numbers were included in only a subset of the universe of consumers that were impacted.
  • Anthem is still working to determine which members’ Social Security numbers were accessed.
  • Anthem’s investigation to date shows that no credit card or confidential health information was accessed.
  • Anthem has advised us there is no indication at this time that any of our clients’ personal information has been misused.
  • All impacted Anthem members will be enrolled in identity repair services. In addition, impacted members will be provided information on how to enroll in free credit monitoring.

We are continuing to work closely with Anthem to better understand the cyber attack and the impact on our clients. Anthem has created a website –, and a hotline, 1-877-263-7995, for its members to call for more information.
We will continue to monitor this situation and will provide you updates as they become available along with suggestions on how to take action.

Please click on the following link to review a memo we have prepared for you to distribute to employees. Employee Memo

Please feel free to contact us if you have any questions.

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Understanding Preventive vs. Diagnostic Services


Seeing your provider for regular checkups and exams is an important part of staying healthy. Under health care reform, many preventive care services and screenings are covered at no cost to you when you visit a doctor in your health insurance network. Diagnostic services, on the other hand, may be subject to your plan’s deductible, copayment or coinsurance, and will usually apply to your annual out-of-pocket maximum.

Preventive Services Keep You Healthy

No-cost preventive services such as routine screening tests, immunizations, well-woman visits and children’s well-check exams are intended to maintain your health and identify potential health issues before they become serious. During your preventive care visit your doctor will determine which tests or screenings may be beneficial based on your age, gender, general health and family health history.

Diagnostic Services Diagnose, Treat or Manage Health Conditions

Diagnostic services are intended to treat ongoing or already identified health conditions or issues. For example, lab services may be ordered due to current symptoms that require further diagnosis, or to clarify previous abnormal test results.

Examples of When Services May be Billed as Diagnostic

If you visit your physician for a routine physical exam (preventive) but mention during the appointment that you have been experiencing abdominal pain, your appointment and resulting services may be billed as diagnostic and applied to your deductible, increasing your percentage of the cost.

If you receive a screening test that is sometimes covered as a preventive benefit, such as a colonoscopy, but your physician ordered it because of ongoing symptoms you have experienced, it may be billed as diagnostic.

Although health insurance carriers use the same guidelines for preventive care coverage, they may be explained differently in your benefits summary. See below for examples of preventive care guidelines.

Anthem Blue Cross Guide to Preventive Care

Blue Shield Guide to Preventive Care


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Employer Reimbursements and the IRS

In a recently published Frequently Asked Questions (FAQs), the IRS addressed the deductibility of employer-sponsored reimbursements for individual health insurance premium policies. Read the full Q&A here.

What does it mean?
Beginning January 1, 2014, employers are no longer permitted to reimburse employees for insurance premiums for the purchase of an individual policy – whether the policy is purchased on- or off-exchange – as a tax-free benefit. Instead, any employer-reimbursed insurance premiums for individual health insurance policies are subject to all applicable federal and state income and payroll taxes that would otherwise apply.

The IRS does not prohibit employers from increasing employees’ salaries to contribute to the cost of purchasing individual policies. However, pre-tax reimbursements to employees for individual policies are no longer allowed. Reimbursements now must be treated as taxable compensation for the receiving employee and included in all income reporting.

What is the penalty for providing tax-free reimbursements for individual health insurance plans?
Per the IRS: “such an arrangement fails to satisfy the market reforms and may be subject to a $100/day excise tax per applicable employee (which is $36,500 per year, per employee) under section 4980D of the Internal Revenue Code.”
Read the full IRS Notice 2013-54 notice here.


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Term Life Insurance – What Happens When Your Policy Expires?

Boy and Grandfather
Term life insurance provides coverage for a predetermined amount of time to fit your needs. But what happens when your term nears its expiration date? You have a few options to consider.

1. Pay the new premiums. Don’t assume that your term policy will cancel automatically when the term ends. Depending on your policy, it may continue at a significantly higher premium. This is especially important to note if you have the premiums automatically drafted from your bank account. Premiums may continue to increase annually until you reach 95 or 100 years of age. This is not a feasible option for many individuals due to the high cost. However, it may be a viable option for an individual who needs to continue coverage and is no longer insurable due to health conditions.

2. Purchase a new policy. If you determine that your loved ones would still benefit from financial assistance, you may consider purchasing a new term policy or a permanent policy.

3. Convert your term policy to a permanent policy. Some term life insurance policies include an option to convert to a permanent policy – universal life or whole life – without having to answer health questions or undergo a medical examination. This may be helpful to those with health conditions that would make obtaining a new policy impossible or prohibitively expensive.

4. Let the policy expire/cancel the policy. If you’ve determined that your need for life insurance has passed – due to personal savings, grown children or a spouse who no longer needs financial support in the event of your death – you may decide that the best option is to allow your policy to expire (or cancel it when the term ends).

Need guidance on your life insurance policy options?


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Covered California Announces Special Enrollment Period for COBRA Enrollees


Covered California today announced a special enrollment period for individuals with Federal COBRA or Cal-COBRA coverage who would like to switch to an individual health insurance plan purchased through the Covered California exchange.

Those who currently have COBRA (Consolidated Omnibus Budget Reconciliation Act) healthcare coverage can shop for and buy coverage on the Covered California website during a two-month special-enrollment window, beginning May 15, 2014 and ending July 15, 2014. Gray & Troy Insurance has a team of certified Covered California agents ready to assist you should you have any questions regarding your health insurance coverage options.

Click here for the full article from Covered California.


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IRS Sets 2015 Health Savings Account Contribution Limits

Recently, the IRS released the 2015 inflation adjusted annual contribution amounts for Health Savings Accounts (HSAs).

This applies to individuals with high deductible health plans (HDHPs).

Annual HDHP Minimum Deductibles and Out-of-Pocket Maximums
In 2015…
The minimum HDHP deductible for an individual with self-only coverage will be $1,300, up from $1,250 in 2014.
The minimum HDHP deductible for an individual with family coverage will be $2,600, up from $2,500 in 2014.
The HDHP out-of-pocket maximum for an individual with self-only coverage will be $6,450, up from $6,350.
The HDHP out-of-pocket maximum for an individual with family coverage will be $12,900, up from $12,700.

Annual HSA Limits
In 2015…
The amount for an individual with self-only coverage will be $3,350, up from $3,300 in 2014.
The amount for an individual with family coverage will be $6,650, up from $6,550 in 2014.


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Individual Open Enrollment Has Ended. Can You Still Obtain Coverage?


The individual open enrollment period for 2014 is over, but in some circumstances you may still be able to obtain health insurance coverage without having to wait until 2015.

1. You start a new job.
If you start a new job, you may be eligible to enroll on your company’s group plan during the initial enrollment period. This will depend on your work status (full-time versus part-time, for example) and your employer’s waiting period. If you choose not to enroll at the time benefits become available to you, you will have to wait until your employer’s next open enrollment period, unless you have a qualifying event.

2. You have a qualifying event.
Qualifying life events may include:

  • Change in marital status (for example, marriage, establishment of a domestic partnership, divorce, death)
  • The birth or adoption of a child
  • Loss of Medi-Cal or Healthy Families coverage
  • Termination of employment
  • Your group-sponsored coverage is terminated
  • Your COBRA benefits are exhausted
  • Other involuntary loss of group coverage or governmental insurance coverage

Check with your benefits administrator for details on how to enroll if you believe you have had a qualifying life event, and to determine the eligibility period for the event.

3. You are eligible for Medi-Cal.
You can enroll in Medi-Cal at any time.

4. You are an employer.
Businesses can implement group-sponsored health and wellness plans year-round.

5. Covered California Exemptions and Special Enrollment Periods
In some circumstances you may be eligible for a special enrollment period for Covered California plans.

If you do not qualify for enrollment under any of the circumstances listed above, the next open enrollment period for individual policies purchased “off-exchange” and Covered California plans will be in the fall of 2014. If you are eligible for insurance through your employer, check with your benefits provider to confirm when the next open enrollment period will begin.

If you did not purchase individual coverage or enroll on a group plan, and you do not qualify for an exemption, you may have to pay a tax penalty when filing your next federal income tax return in April 2015.


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Long-Term Care Insurance: Can You Afford It? Can You Afford Not to Have It?

For the vast majority of baby boomers, the question isn’t if you’ll need long-term care, but when.

About 70 percent of individuals ages 65 and older will need long-term care at some point, according to the Wall Street Journal. And the costs of obtaining such care are significant – as seen in the chart below. (You can plug in your own parameters and see the results here.)

Cost of Care Example

Those with sufficient savings most likely won’t need assistance paying for long-term care. Those with very limited resources can receive some assistance from Medicaid (Medi-Cal in California). But what about the individuals who fall somewhere in between? The out-of-pocket costs of long-term care can quickly deplete their available resources.

Those who cannot afford long-term care insurance (referred to as LTC or LTCI) may have to rely on family to help care for them. Sometimes this situation isn’t ideal or feasible, especially for extended time periods. Programs such as Medicare and Medicaid/Medi-Cal do not pay for assisted living or home care services.

Long-term care insurance provides some breathing room by paying for care not covered by health insurance, Medicare or Medicaid.

Timing Is Everything
Knowing when to purchase LTCI can be challenging. If you purchase a policy too soon, you may end up paying for premiums long before your health declines to the point of needing care. If you wait too long to purchase a policy, the cost of obtaining a policy may have drastically increased based on your age, or you may be declined altogether due to your health condition. Up to 25 percent of applicants in their 60s may find they cannot obtain LTCI, or they face premiums up to 40 percent higher, according to the American Association for Long-Term Care Insurance. For this reason, it’s often recommended that individuals consider buying LTCI while they are still in their 50s.

What should my policy include?
You may want to consider the following needs:

  • Personal at-home care, if you need assistance with activities of daily living (ADLs) – bathing, dressing, walking, toileting, eating, etc.
  • Adult day care
  • Assisted living
  • Nursing home

Other Considerations

  • Don’t purchase based on price alone – be sure the carrier is a reliable one with a good rating.
  • Couples may want to purchase a rider that allows them to share benefits as opposed to two separate policies.
  • You may want to consider inflation protection, although it can add 50 percent or more to the cost of the premium.
  • Can you afford to pay the premiums over time? Premiums often increase, and if you are unable to continue paying for the policy, you may be left empty-handed.

Where can I get a LTC plan?
While some employers may offer a LTCI policy as an employee benefit, most LTCI is purchased by individuals outside of the workplace.

Gray & Troy Insurance Services can help you determine whether LTCI is right for you.

Helpful Calculators
You can calculate the average cost of long-term care in your specific region here:
Will you be able to afford nursing home care?


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