9/23/10 What Happens To My California Healthcare Plan?

Have been doing some digging this week on the future of healthcare plan changes for the upcoming 9/23 PPACA compliance requirement. I wanted to outline for everyone in California what the most likely scenario will be for your current and/or future healthcare plan. I expect the process to be generally uniform amongst the carriers.

As I understand it today (this is of course all subject to be changed), plans will be handled as follows for the 9/23 PPACA.

New Subscribers - new subscribers who purchase coverage on or after 9/23 will be purchasing healthcare coverage plans (not yet approved) which comply in full with the PPACA requirements. These plans will be fully compliant right from the start.

Existing Subscribers - existing subscribers, whether on a grandfathered healthcare plan (purchased prior to 3/23/10) or on a non-grandfathered healthcare plan will receive the PPACA compliant changes to their plan at the next renewal anniversary date of their plan. Anyone purchasing a plan between today and 9/22 start date will be considered an "existing subscriber". Example: a person purchased an Anthem Blue Cross SmartSense PPO plan on April 1, 2010. The plan renewal will be April 1, 2011 and at that time the PPACA benefit "enhancements" will be applied to that plan.

Group Subscribers - group health plans purchased after 9/23 will also be PPACA compliant. Plans purchased before 9/23 will be treated the same as existing subscribers on individual plans and benefits will be "enhanced" at the group open enrollment renewal month.

Certain PPACA plan changes will apply to all plans, regardless of grandfathered status. Other PPACA changes will only apply to plans which do not have grandfathered status.

Comments

  1. Hi David, thanks for posting these useful information on health care. I have a question. What is the underwriting policy going to be If the new plans are 100% compliant to PPACA?

    Will they still be able to deny application based on pre-existing conditions? I thought it was not going to be fully in effect until 2014.

    ReplyDelete
  2. The new policies will be compliant with the required benefit changes for 2010 (6 months after law passed). These basically include no-cost preventive care, elimination of lifetime maximums and certain annual caps/limits, allowing children to stay on to age 26 and guaranteed-issue coverage from children to age 19.

    So from underwriting, kids will be able to elect coverage during yet-to-be-determined "open enrollment" periods and can't be denied coverage for pre-existing conditions.

    For adults, underwriting will remain the same overall until 2014 when everything is scheduled for guaranteed-issue either through the state exchange or private exchange.

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  3. Hi David, do you know if the prices will increase after 9/23?

    ReplyDelete
  4. Rates are scheduled to increase on 10/1 with Blue Shield CA. Anthem has a rate increase scheduled for 10/1 but I am not sure if that will go into effect or be delayed.

    ReplyDelete

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