Pocono Springs News at home with nature . . .
Pocono Springs Civic Association
PSCA Annual Meeting
Votes are in; the Winners are: President’s Message 3 Dominick Demaio 3 Martin Guerra 3 Carol Slowik
Announcing the 2013/2014 Pocono Springs Civic Association Board: Mary Ann Arciprete....... President Edward Geisler............... Vice President; Liaison to OWL Committee Thomas Bonikowski....... Treasurer Carol Slovick.................. Secretary; Liaison to Recreation Committee Jason Trabalka................ Liaison to Security Committee Domnick DeMaeo.......... Liaison to Buildings & Grounds Martin Guerra................ Liaison to Buildings & Grounds
Building and Burn Permits
Downloadable documents to apply for building permits has been added to the Pocono Springs Website. Please visit the Members Rules, Regulations, Permits and Maps section to download the permit application. Requests for a burn permit must be applied for via email. Visit our Members Rules, Regulations, Permits and Maps page, click the email link to apply, or send a request with Burn Permit Request in the Subject line to firstname.lastname@example.org There will be more documents to come for your convenience.
By Mary Ann Arciprete Good afternoon and welcome to the Pocono Springs Civic Association’s Annual Meeting. As we gather here today, we start a new beginning by greeting our General Manager Donna Mowrer. Donna comes to us with great enthusiasm to take on the challenge of managing our Community. We look forward to a long working relationship. The staff at Pocono Springs needs to be acknowledged, as they continue to do a great job. They are dedicated and hard working. There are many volunteers who must also be thanked; including members serving on PSCA committees -- recreation, security, owl, budget, buildings and grounds, who work unselfishly for us. The process will now begin to prepare the PSCA budget for 2014/2014. Much time and care is taken, as this is the backbone of our Community. It has been my pleasure working with our Board of Directors this past year. Many extra meetings had to be scheduled to go through resumes and interviews, for the new GM hire and each and every Board member made every effort to attend. Thank you: Dom, Tom, Betty, Eddie, Carol and Jason for all your hard work. On a sad note we lost one of our Director’s, Carol Swetz and several of our residents. One, I feel I must mention, is Margie Nawrocki, who served in many different capacities over the years in Pocono Springs, a place that she loved. The Pocono Springs Board of Directors looks forward to another year and we are ready to take on the challenges and decisions that make our Community one of the best in the Poconos. Any questions, or concerns, you can e-mail me at email@example.com
General Manager’s Report
By Donna Mowrer Time has been just flying by and it is already autumn with all its glorious colors. Pocono Springs couldn’t be more magnificent with the flaming colors surrounding Crystal Lake which soon give way to the white frosting of winter. I have been researching and familiarizing myself with all that is relevant and important to Pocono Springs and have many creative thoughts and plans. As time passes, I will come to realize which of these ideas will most benefit the community and with everyone’s help, I look forward to continued success. I would like to place a suggestion and idea box for those of you whom either don’t wish to come in to the office or simply can’t get here during our operating hours. I have an open door policy and welcome everyone to come and introduce yourselves and tell me your thoughts and ideas. Our maintenance men have been sprucing up the community. They are also working on several of the roads in an effort to prevent icy conditions that were prevalent in previous years by improving the drainage from these areas. This will considerably cut the cost of salt and anti-skid and make the passage in these areas much safer. If you are a resident of one of these roads, we thank you for your consideration during their efforts to rectify the situation.
The speed limit on ALL Pocono Springs roads is 25 MPH, except where otherwise posted.
POCONO SPRINGS CIVIC ASSOC. 331 South Turnpike Road Newfoundland PA 18445
Stroudsburg, PA 18360 PERMIT NO. 418
PRSRT STD U.S. POSTAGE
Summer Fishing Season is Over
By Karen Lesmeister Summer Fishing is over. Fall fishing is underway and soon it will be time for ice fishing. The fishing club had a busy season on the lake. Thanks to everyone for a nice Fish Fry on Labor Day weekend. We appreciate all the volunteers who made the event enjoyable and we thank all the community members who came hungry and purchased food and drinks. The weather was very nice. It was a nice way to end the summer with good friends and at least one or two fish stories. The season long contests ended Labor Day weekend. The winners for the adult Bass were First Place - Jason Kummerer Second Place – Jim Harvey and third place – Pete Tagliavia. The First Place Pickerel went to Jim Harvey. Second Place – Jason Kummerer and Third place went to Tom Bonikowski. The first place trout was caught by Jim Harvey Second Place – Adam Lippman and third place went to Jim Tome. Congratulations to all of the winners. For the Junior division the first place bass was caught by Jonathon Rizzo, the second place bass was caught by Tyler Galatro and the third place bass was caught by Marc Rizzo. The first place pickerel was caught by Abigail Tokar, her brother Andrew Tokar caught the second place pickerel and the third place pickerel was caught by Jonathon Rizzo. The first place trout was caught by Jonathon Rizzo and his brother Marc Rizzo caught the second place trout. Congratulations to all our Youth winners! In addition to the season long contest there were 4 evening bass contests. The first week winner was Pate Tagliavia. The second and third week winner was Jason Kummerer. And the fourth week winner was the Bass. None of the fishermen caught a bass so all the money collected was returned to the participants. Since the last newsletter there have been two children’s fishing contests. The July 6th contest had 38 children participating. The first place winning fish was caught by Peter Zunno Jr with a fish weighing 1.08 pounds. Second place went to Marc Rizzo with a fish weighing 1.03 pounds and Andrew Tokar came in third place. On Saturday August 31st we had our last children’s contest of the summer. We had 30 children participate. The first place fish was caught by Donny Lessing. The second place fish was caught by Patrick Macchiarola and the third place fish was caught by Thomas Lofaso. Congratulations to all of our children!
2013 Road Maintenance Report
Approximately seven miles of roads were paved at the cost of $126,000 dollars. There has also been seven roads that were tarred and chipped at the cost of $49,578 dollars. The following roads were patched instead of paved at substantial savings. Fountain Dr. & Pocono Dr. were patched at a cost of $3,700 dollars. Cost savings for Fountain Dr. approx. $100,000 dollars. Spot patching of other roads cost $3,700 dollars. A new tar emulsion was used on various roads on an experimental basis, it seems to be a success because of less stones being kicked up when vehicles ride on it and also less dust.
Pocono Springs News Official publication of the Pocono Springs Civic Association 331 South Turnpike Rd, Newfoundland PA 18445 (570) 676-9259 • firstname.lastname@example.org
Editor......................................................................... Mary Ann Arciprete Contributing Staff............ Elaine McMahon, George Laszlo, Karen Lesmeister Office Liasion........................................................................ Alice Pinnock Security Liasion...................................................................... Captain Bob ADVERTISING INFORMATION:
Community Newspaper Publishers 237 Phyllis Ct, Stroudsburg PA 18360 570.476.3103 • email@example.com • www.cnpnet.com The Pocono Springs News, Pocono Springs Civic Association and Community Newspaper Publishers, Inc. disclaim any liability for any advertisements published herein and in no way endorse or guarantee these ads. They also reserve the right to reject any ads submitted.
Pocono Springs News
November 16, 2013 R.E. OBAMA CARE & COMPLIANCE Pocono Springs Civic Association values the health and welfare of all of its residents and employees. This Individual Mandate of the Affordable Care Act is compelling all Americans to have health insurance. The Patient Protection and Affordable Care Act will accomplish a fundamental transformation of health insurance in the United States through shared responsibility. Noncompliance: Penalties will be applied to tax returns on a graduated scale. Shared responsibility is one of the foundations to the success of the new law. Penalties for not purchasing coverage in 2014 are $95 per adult and $47.50 per child. Up to the greater of $285 or 1% of family income. 2015 penalties are $325 per adult and $162.50 per child, up to 2% of income. We at Pocono Springs urge you get health insurance if you do not already have it. We will have our health insurance advisor, Paul Nentwig, speaking at the community meeting on November 16th, 2013 at 11am. He will answer questions and assist residents in attaining health insurance coverage.
O.W.L. Committee Annual Report – 2013
The O.W.L. Committee had another active year. The septic tank cleaning program in conjunction with Koberlein, had 25 participants. The wildlife education program conducted by Kathy and Eric Uhler of the Pocono Wildlife Rehabilitation Center was attended by more than 150 people. They also had another program “Human Conflict with Wildlife” which was very informative. The committee and volunteers, performed litter pickup, sponsored by Penn Dot’s Adopt-A-Highway program on Route 507 and the back gate road. Many thanks to our dedicated members for another active year. They are: Mike Sexton, Chairman, Erika Geisler, Harry Hedglin, Bob Kakareka, Frank Kopyta, Alice McAfee and Larry Tobin. Respectfully Submitted, Betty Knapp, Liaison
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Pocono Springs News
By Tom Bonikowski After many years of volunteered service, Betty Knapp has stepped aside as Treasurer of PSCA. I, Tom Bonikowski, have been appointed your new Treasurer. I don’t need to tell you that these will be big shoes to fill. As you read this issue of the Pocono Springs News, we are in the process of formulating the 2014 budget. Betty Knapp will be sitting on the budget committee and will continue to provide us with her knowledge and expertise. We will be working closely with Donna Mowrer, our new Manager, in order to address the operational and capital needs of our development for the coming year. We will also be looking at ways to improve on efficiency and service. We have the best community in the Poconos and will strive to maintain the beauty, safety and amenities that you have become accustomed to.
By Karen Lesmeister Bingo has ended for the year. Bingo will return to Friday evenings beginning in April. Watch the weekly flyers for the exact date. We are in need of an additional caller for next year. We are looking to have each caller call one week a month. Please consider calling and training will be provided. Thank you to all our volunteers this year. We appreciate everyone who collected money, bought supplies, called the numbers, verified our winners, and brought or baked desserts. Thank you for a successful season. We look forward to seeing everyone next season. Also watch for a couple of Saturday afternoon Bingos this winter. They will be a nice way to see everyone over the winter.
Security Committee Year End Report
Joe Slowik (Chairman) Karen Shirhall (Secretary) Frank Kopyta Alice McAfee Annette White Bob Muscolina Barbara Muscolina Barbara Casey
Topics of discussion: Having clubhouse open during lengthy power outages so residents can get water, snacks, use bathrooms and to charge phones. We will have volunteers staying at the clubhouse while it is open. All houses must have their 911 numbers posted where it is clearly visible from the road day and night. Put no trespassing signs along the border of ranchettes property and Pocono Springs property. This has been done. Start a community watch, we will have volunteers while they are out driving go some extra streets and keep an eye on the area if they see anything suspicious they are to call the front gate security and report it. Signs will be made to place on vehicles. I would like to thank everyone who has volunteered for the worthwhile committee, and look forward working with everyone in the future. I would also like to thank Mike Slowik and his family for donating the magnetic signs that will be placed on our vehicles. Our next meeting will be November 6th at 6:30 PM at the clubhouse. Respectfully Submitted Jason Trabalka, Board Liaison
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Dealing With Medical Bills
By George Laszlo No matter how you feel about Obamacare, we can probably agree that there is nothing scarier than the possibility of going broke because of medical bills. Even a nice nest egg can be wiped out if some major uncovered medical condition comes your way. So, how can you keep your cool when the bills arrive while still worrying about yourself or your loved ones? The first thing to remember is that playing ostrich by sticking your head in the sand is the worst thing you can do. The bills will continue to pile up and your doctors and hospitals will not wait forever for payment. So, keep on top of things and handle each medical transaction as they happen. In other words, don’t let them pile up. Next, there are some practical rules that you must follow to avoid paying too early or too much. I say this because your healthcare providers will start to bill you immediately after you see them. So, pay attention to the following: RULE #1: A BILL that comes from your doctor or hospital SHOUD NEVER BE PAID UNTIL YOU HAVE AN INSURANCE COMPANY STATEMENT TO COMPARE IT TO! By all means, look at the bill and check that you agree that whatever it says was done indeed took place. Of course, you may not be able to tell what all those codes and medical terms are. At least, you will be able to verify that the dates are correct and which doctors you saw. After you check things out, just put the bill aside and WAIT for the insurance statement. RULE #2: When the INSURANCE STATEMENT shows up, look at it closely and COMPARE IT to the BILL sent by your provider. Be patient and suspicious until all items line up properly. Believe it or not, your providers and the insurance companies make mistakes; lots of them. Many of these will be at your expense unless you are vigilant. RULE #3: FOLLOW THE NUMBERS especially the CPT codes and amounts billed. CPT stands for Current Procedural Terminology. A procedure is whatever is being done to you and is then given a unique number based on a list maintained by the American Medical Association (AMA). For example, if they take your blood, the procedure is called Venipuncture and has the code of 36415. The code is more important than the terms since your provider may use a different term than the insurance company. So try to match the codes on the bill and the insurance company statement. Then see if the amounts charged match up. If they do, you are in luck. If they don’t, you have more homework to do. If the CPT codes don’t match, the next best thing is to match the amounts charged. For example, if the Venipunture is charged at $26 on the bill and the insurance company shows a $26 charge on the same date, you have most likely found the correct match. If you are curious, you may want to look up the CPT codes themselves. To do that, just open your internet browser (e.g. Google) and in the search bar enter: “CPT #####” where ##### is the five digit code. You will get a long list of hits and will need to figure out which one to choose. When in doubt, go with the Medicare (www.cms.gov) listing. RULE #4: See what your insurance company DENIED, PAID or LEFT FOR YOU TO PAY Get ready for the shock of your life! When you see what your provider charged and what your insurance company agreed to pay for a given procedure, you will realize what’s wrong with our medical system. Think of the provider charge as the “suggested list price” and the insurance company covered charge as the “sale price.” The list price becomes irrelevant since the provider will never get nor expects it to be paid.
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Pocono Springs News
NOTE: If you do not have insurance coverage, the provider will almost always bill you at the list price. This is why uninsured patients often go broke or are simply not able to pay. The key lesson from this is that IF YOU HAVE NO INSURANCE, YOU SHOULD NEVER AGREE TO PAY THE BILLED AMOUNT! YOU MUST NEGOTIATE as if you were the insurance company. [See Rule #7 below.] EXAMPLE: Recently, a friend of mine told me that his mom received hospital bills totaling $21,000. The whole family was in shock. After negotiating with the hospital, their bill was reduced to $165. Once the insurance company states what the acceptable amount is for a given procedure, they will decide what they will pay and what remains your responsibility. Let’s say, for example, that you had a small skin tumor removed. The doctor charged $1,000 for this and the insurance company agreed that only $800 was reasonable. Unfortunately, you still had $300 left on your deductible for the year and the coverage was only at 80% (i.e. 20% was your responsibility). The calculation then is $800 * .8 - 300 = $340. This means that your insurance company paid the doctor $340, leaving you with a balance of $460. Here is a summary: - List Price: $1,000 - Sale Price: 800 - Insurance Paid: 340 - Your 20% Share: 160 - Your Deductible: 300 RULE #5: Only pay what your insurance company told you to pay This is a corollary to Rule #1. NEVER pay a bill until the provider bills have been reconciled with the insurance company statements. Also keep in mind that not all of the charges for procedures done on the same day will be processed together. In other words, you may need to wait until several statements arrive before you will see all of the procedures properly processed. This DOES NOT mean that you should hold off on any and all payments. If you have done the reconciliation and the numbers look right for a given procedure, go ahead and pay the bill for that procedure. RULE #6: If it does not look right, it probably isn’t. Question any charge that you don’t understand or don’t agree with. In some cases, you will see things that don’t make sense. This may be the inability to match up a line item between the provider bill and the insurance statement. Or, the amount charged by the provider is a different amount than shown on the insurance company statement. Or, a procedure being billed is not one that you remember having been done. In such cases, call either the provider or the insurance company to get clarification. Example: A few months ago, I could not match the price charged by a hospital with the amount showing on the insurance statement. After a few phone calls, it became evident that the hospital is allowed to charge 10% more than their normally allowed charge since they are in the New York metropolitan area where the cost of everything is higher. The six rules above apply when you do have insurance coverage. But, what do you do if you don’t have any medical insurance? In this case, pay attention to Rule #7. RULE #7: NEVER PAY LIST PRICE! ALWAYS NEGOTIATE! As stated earlier, your provider will bill you at their list price even if that figure is ridiculous. Your position should always be that you will not accept that figure. But, how will you know what is a fair and reasonable number? Medicare to the rescue! Since Medicare sets prices for just about every conceivable procedure, you can easily find out how much they would pay your provider if the bill went to them rather than you. Of course, Medicare is known to pay the least of any insurance provider. In other words, when you find the Medicare covered charge, you have a minimum number below which you should not try to negotiate. The Medicare number, in other words, is the floor or minimum cost. OK, but how will you find the Medicare covered amount? You guessed it: It’s done by visiting their web site and using the CPT code to find that number. Here is what you need to do: 1. Go to: http://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx 2. Scroll to the bottom and click on ACCEPT 3. Scroll down to the HCPCS Code field and enter the CPT code from your bill 4. Pull down the Modifier field and select “All Modifiers” 5. Click the SUBMIT button Depending on what CPT code you entered, the display will change. You will need to do some homework to determine the right way to read the tables that pop up. Unfortunately, there is not enough space in this newsletter to go into this in detail. As they say, ‘No Pain, No Gain.” The bottom line is that when you have determined the Medicare floor cost, you are in a good position to negotiate a fair payment amount with your provider. Remember, medicine is a business too and you have every right to received and pay a fair price.
Pocono Springs News
Order Your New 911 Street Signs Property owners may now purchase 911 Address Signs through the main office. The $20 fee for each sign must be paid at the time the order is placed with the office. This fee includes the $15 donation to Gouldsboro Fire Department and the $5 Pocono Springs charge. Signs may be ordered in a vertical or horizontal format. You will be notified when signs are available for pick up. It is recommended that 911 Address signs are posted in a way that they are visible from the road in both directions and above the snow level. Please call the office if you have any questions: (570)-676-9259.
Name ____________________________________________ Phone # __________________________________________ PSCA Address ______________________________________
911 # ____________________________________________ Placement: Price: $20*
( ) VERTICAL ( ) HORIZONTAL ( ) CASH ( ) CHECK - made out to PSCA
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MAINTENANCE-FREE VINYL SIDING
By Elaine McMahon Recently, my husband and I took a trip across PA and the northern part of Ohio, Indiana, Illinois and up to Milwaukee, WI. Driving on the interstate got very boring, so we took some secondary and tertiary roads. Driving through farm country and small towns gave us the opportunity to see how people in different places live and how they take care of or neglect their homes and businesses, in other words, if they showed Pride of ownership. Farm after farm, home after home and business after business was groomed, planted, painted, and “dressed” to show how owners felt about their property. Obviously, not every property was in excellent condition, but with the exception of some small areas of the inner cities, most properties were landscaped with mowed lawns, planted flowers, shrubs, trees, and pots filled with blooms of every color. While driving and appreciating the sights, I began to think about Pocono Springs as a microcosm of the vast country through which we were passing. As you drive around Pocono Springs, take a moment to look at your neighbors’ property and yours. Do they look well cared for? Does it appear the owner has Pride in the property? As my Scottie and I walk around the lake and some of the back roads, we see more and more that houses have been “fixed-up”. As in the larger country outside our gates, there are people who can’t or won’t take care of their properties, but it seems to me that the majority of people show a real American Pride when it comes to their homes and businesses. Owning a home is a real accomplishment. Owning a vacation, lake/country home in addition, is an even greater accomplishment. So, the next time you are driving or walking around Pocono Springs, or this great country of ours, from east to west and north to south, see if you agree? And if you do, take a minute to tell the owner. We all enjoy a compliment every now and then, especially if we had to work hard to deserve it. My grandmother always said, “it doesn’t cost much to be clean and neat”. As you back out of your driveway, is your property clean and neat? Show everyone how proud you are of your property. Show your American Pride.
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Pocono Springs News
What’s Happening in Recreation? Out & About – Winter Activities
By Karen Lesmeister Saturday October 26th – Halloween Party at the clubhouse beginning at 6:00 pm. $8.00 per person children 10 and under free. RSVP by Wednesday October 23rd. There will be a Costume contest, dinner and games. Come out for a ghoulish time. Thursday October 31st – Trunk or Treat 6:00 pm at the clubhouse. Free no RSVP. There will be Hot Dogs, Macaroni and Cheese, followed by the parade and trunk or treat. Saturday November 9th – Harvest Dinner 6:00pm at the clubhouse. $8.00 per person children 10 and under free. RSVP by Wednesday, November 6th. We serve a full Turkey, dinner with all the trimmings. Come enjoy an evening with your family and friends. We have so much to be thankful here in our wonderful community. Saturday December 14th – Christmas Social in the afternoon and Dinner Party in the evening –At 1:00 pm we will have cookies with Santa and a social hour. This is free and you need no reservations. Take your family picture with Santa and also pictures with Santa and your friends. Then at 6:00 pm we will have a Christmas Dinner Party. The cost for this will be $8.00 per person with children 10 and under free. Please RSVP by Wednesday December 11th. We will have Christmas Activities in addition to dinner.
Summer was filled with many activities here at Pocono Springs. The pool and lake offered relaxation and the ATV’s offered excitement. Recreation sponsored pool parties, bon fires, ice cream socials, All American BBQ, Chinese Dinner and Auction, and the Luau. Good times were enjoyed with good friends. Memories were made that will last a lifetime.
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By Karen Lesmeister In addition to the many winter sports such as sledding, ice skating, ice fishing that we have here in Pocono Springs there are many additional things to do in the area. There are many ski resorts in our area and several of them also offer snow tubing. The Ice Works Factory tour and museum are open throughout the season. For more information check them out at http://www.sculptediceworks.com/tour.htm. Also there is Crystal Cabin Fever from February 7-23; check out http://www.sculptediceworks.com/crystalcabinfever.htm The Tobbyhanna Ice Harvest is held the Saturday of Martin Luther King weekend if the ice is thick enough to harvest. If the ice is not thick enough it is held on the Saturday of President’s Day weekend. Located at the Mill Pond in Tobyhanna the ice is harvested and moved to the ice house. You are welcome to watch or participate in the harvest. They always have a bonfire to keep warm with and homemade ice cream. There is also a Steamtown excursion that stops at the train station to allow you to see and participate in the ice harvest. Saturday December 14th – Christmas in Gouldsboro Events throughout the day starting at 9AM with a free pancake breakfast with Santa for the kids at the Gouldsboro Volunteer Fire Company Fireside Hall with crafts and a special dancing DJ. Followed by an entire day of events throughout the village ending with caroling, the Christmas tree lighting and drawing for the “Case of Corks” at the Train Station. GOULDSBORO VOLUNTEER FIRE COMPANY 1ST ANNUAL COYOTE HUNT February 14, 15, 16, 2014 Complete rules and registration forms available at www.55firerescue.com beginning December 1, 2013. Additional information available by calling 570-8422663 or emailing firstname.lastname@example.org Check-ins will be held at Gouldsboro Firehouse 490 Main Street (Route 507), Gouldsboro PA Friday 2/14 6pm-9pm Saturday 2/15 9am12pm and 4pm-8pm Sunday 2/16 9am-1pm No coyotes will be accepted after 1 pm Sunday February 16, 2014 Early registration is $25 and must be postmarked by January 31, 2014. All registrations after January 31st are $30. Optional jackpots for largest male and largest female are an additional $5 each.T-shirts will also be available for purchase. Gouldsboro Fire Company Black Friday Super Bingo – Friday November 29 beginning at 5:30pm. Minimum of $1000 must go jackpot. Reservations recommended, call 570-8428353 and leave a message with name, phone number and the number of people attending. The Greene-Dreher Fire Company located near the GDS fairgrounds holds a breakfast buffet on the first Sunday of every month. From 9:00-12:30. The food is good and we always have a crowd from Pocono Springs attend especially about 9:00am. Please join us. The Greene-Dreher Fire Company Turkey Raffle on Friday November 15 at 6:30pm. Turkey, chickens and baked goods are raffled off throughout the evening and food is served. The Greene-Dreher Fire Company Breakfast with Santa on Saturday December 7th (snow date 14th) from 9:00-11:30. They serve a nice breakfast and Santa arrives on the fire truck and spends time with each child. A very nice morning for Specializing in Customer Satisfaction Route 507 • Gouldsboro everyone. John Huniyack, Proprietor
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Pocono Springs News
The Patient Protection and Affordable Care Act
Quality, Affordable Health Care for All Americans: The Patient Protection and Affordable Care Act will accomplish a fundamental transformation of health insurance in the United States through shared responsibility. Achieving these reforms without increasing health insurance premiums will mean that all Americans must be part of the system and must have coverage. Tax credits for individuals and families will ensure that insurance is affordable for everyone. Health Insurance Market Reform: Beginning in 2014, across individual and small group health insurance markets in all states, new rules will end medical underwriting and pre-existing condition exclusions. Insurers will be prohibited from denying coverage or setting rates based on health status, medical condition, claims experience, genetic information, or other health-related factors. Premiums will vary only by family structure, geography, actuarial value, tobacco use, participation in a health promotion program, and age (by not more than three to one). Available Coverage: A qualified health plan, to be offered through the new American Health Benefit Exchange, must provide essential health benefits which include cost sharing limits. No out-of-pocket requirements can exceed those in Health Savings Accounts. Deductibles in the small group market cannot exceed $2,000 for an individual and $4,000 for a family. Coverage will be offered at four levels with actuarial values defining how much the insurer pays: Platinum - 90 percent; Gold - 80 percent; Silver - 70 percent; and Bronze - 60 percent. A lower-benefit catastrophic plan will be offered to individuals under age 30 and to other exempt individuals. What benefits are considered essential health benefits (EHBs)? EHBs include services and items across these ten essential health benefit categories: Ambulatory patient services, Emergency services, Hospitalization, Maternity and newborn care, Mental health and Substance abuse disorder services, including Behavioral health treatment, Prescription drugs, Habilitative and rehabilitative services and devices, Laboratory services, Preven-
tive and wellness services, Chronic disease management, and Pediatric services. These EHBs are required to the annual out of pocket limit on all individual and group plans. Pennsylvania & Health Benefit Exchanges: The state of Pennsylvania has elected to allow residents of the commonwealth to access coverage through the Federal Health Insurance Exchange. The web address for the exchange is HealthCare.gov. Experienced, professional assistance is available through trained and authorized local insurance professionals at no additional cost. Most of the largest insurance carriers that service Pennsylvania have elected to participate in offering their individual policies through the new insurance exchange. Penalty for Not Obtaining Coverage: Shared responsibility is one of the foundations to the success of the new law. Penalties for not purchasing coverage in 2014 are $95 per adult and $47.50 per child. Up to the greater of $285 or 1% of family income. 2015 penalties are $325 per adult, $162.50 per child. Up to $975 or 2 % of income. Making Coverage Affordable: New, advanced or refundable tax credits will be available for Americans. Individuals qualified to receive tax credits must be ineligible for affordable, employer-sponsored insurance. The credit is calculated on a sliding scale beginning at two percent of income for those with lower incomes and phasing out at 9.8 percent of income at higher levels. If an employer offer of coverage exceeds 9.8 percent of a worker’s family income, or the employer pays less than 60 percent of the premium, the worker may enroll in the Exchange and receive tax credits. Coverage must be obtained on the exchange to be eligible for tax credits. Cost sharing reductions are available as an alternative to tax credits for those with lower incomes. Open Enrollment: To obtain tax credits, open enrollment on the exchange began October 1, 2013 and is scheduled to end March 31, 2014. Qualifying life events in 2014 providing a special open enrollment include: A change in income. Marriage, death of a spouse, divorce, legal separation or annulment. Child birth, death, adoption or placement for adoption. A change in your employment status, or the employment status of your spouse or dependent. A dependent becoming ineligible for existing coverage due to attainment of age. You will have 60 days from the date of the qualifying event to secure new coverage without incurring a penalty.
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