Insurance Claims Workshop

We know what you don't want to think about.

We know you don't want to think about ever having an accident, or a lot of medical bills, or a flood or fire. But it happens, and we know just what you need to do. It will take some careful planning, but if you're prepared for it, you'll be a lot better off.


A three part interactive event, that takes you through the claims process from start to finish.

Part 1- Understanding Your Coverage

Part 2- Managing the Project

Part 3- Securing Settlement Dollars


Location and Details:

3205 Old Conejo Rd, Newbury Park, CA 91320

Saturday January 20th, 4-7pm

4-5pm, Cocktail hour

4:30 -6p workshop presentation

6p to 7p Dinner and FAQ

Please RSVP

800 860 8835

Hayek Insurance

3205 Old Conejo Rd, 2nd Floor

Newbury Park, CA 91320

(805) 496-8835

Fax (805) 496-8572

info @ hayekinsurance.com

California Department of Insurance 0F09609

Anthem Blue Cross is canceling all individual health insurance policies effective 12/31/17, with the exception of grandfathered plans. Yours may be one of them! Contact Hayek Insurance today, so you can plan and prepare for your new health coverage in 2018.

10/10/2017

Covered California announced today in a press release that health plans will include a surcharge on the Silver-tier plans for the 2018 coverage year due to the ongoing uncertainty at the federal level.The average Cost-Sharing Reduction (CSR) surcharge increase on rates for 2018 is 12.4 percent, although the surcharge will vary for each health insurance company and will range from 8 percent to 27 percent. Most Covered California consumers who receive financial help in the form of an Advanced Premium Tax Credit (APTC), will not see a significant change in what they pay for their insurance in 2018, and many will actually end up paying less because the subsidy amount will increase more than the surcharge.

Renewal period begins today, October 11, 2017. Covered California has now updated its Shop and Compare Tool with 2018 rates. Existing consumers have the opportunity to see their expected rates, financial help available to them and can begin renewing into coverage for 2018. The next Open enrollment period will run from November 1, 2017 through January 31, 2018 for those consumers who do not have coverage and do not meet Special Enrollment conditions.

How do I Enroll in Health Coverage?

You can attempt to enroll on your own by visiting www.coveredca.com. However, there is no cost to have Hayek Insurance process the enrollment for you! Costs of coverage and benefits are the same, whether you enroll on your own, or contact us to help you.

What is an HSA Account?

HSA stands for Health Savings Account. Choosing an HSA compatible insurance plan means that you may deposit funds into a special health savings account, to be used for medical services. Contact your tax professional to find out how funding this special account may reduce your tax liability

What is Premium Assistance, and how do I get it?

Premium Assistance, also know as Federal Tax Credits may be awarded to those that fall within the right income bracket. When we enroll you for coverage, we'll discuss where you fit in, and how you can optimize your assistance, for the lowest costs.

What is a PPO?

A PPO stands for Preferred Provider Organization. It means that you have better benefits when you use a Preferred Provider (In Network), than when you use one that is out of network with your insurance company.

What is an EPO?

An EPO stands for Exclusive Provider Organization. Coverage applies only when you use providers that are in your insurance company network. No out of network benefits apply.

What is an HMO?

An HMO stands for Health Maintenance Organization. Benefits apply only when you use network providers. The insurance company has more control over covered services, and you must have your primary care provider refer you, in order to see a specialist.

What is a Co-Pay?

A co-pay refers to the amount you might pay for a specific medical service, before you have to satisfy your deductible. As an example, the Silver 70 PPO has a $35 co-pay, to see a primary care physician, and a $15 do-pay to fill a generic prescription

What's the difference between a deductible and an out of pocket maximum?

With some health insurance policies, once you satisfy your deductible, you'll be paying a percentage of the remaining balance, until you reach your out of pocket maximum. See the example below:

Suppose you have the Silver 70 plan, and undergo a surgery. The hospital bill is $14,000. The Silver 70 Plan has a deductible of $2,500, and a 20% Co-Insurance. In this situation, you would pay the $2,500 deductible, then 20% of the remaining $11,500 balance, or $2,250. Added together, your responsibility for this surgery would be $4,750.

What is an Out of Pocket Maximum?

In a given year, this is the maximum amount you would have to pay for all medical services. The Gold plan has an out of pocket maximum of $6,750. Even if you have a $1,000,000 hospital bill, your cost will be $6,750.

What are Essential Benefits?

Affordable Care Act Compliant plans must include the 10 essential health benefits:

  • Ambulatory patient services (outpatient services)
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

Will my brand name prescriptions be covered?

Yes. All plans will cover necessary brand name medications, but they will be subject to meeting the policy or pharmacy deductible, depending on the plan you choose. As an example, the Silver 87 plan has a $50 pharmacy deductible, then a minimum of $20 per prescription

When can I enroll in coverage for 2018?

Open enrollment starts on 11/01/2017. However, the 2018 coverage and rates will be released the second week of October 2017. Call us to review and discuss your options.

Call Hayek Insurance Now! (800) 860-8835

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Silver Tier Surcharge