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Showing posts from February, 2012

RIP Davy Jones

Not health insurance-related, but I wanted to acknowledge the passing today of Monkees singer and actor Davy Jones. In the 60's millions of American girls wanted to grow up and marry him, and millions of boys wanted to grow up and be him. May the stars shine brighter now that you are up there, Davy.

Health Net and Cigna Settle with CDI over Autism

California Insurance Commissioner Dave Jones announced today that he has reached a settlement with Health Net and Cigna regarding coverage of Applied Behavioral Analysis Therapy (ABA) for autism.

This makes three carriers who have reached settlement with the CA Dept of Insurance with regard to appropriately covering ABA and autism in California.

Last month CDI reached a settlement with Blue Shield of California to provide ABA coverage for autism. See my Jan 31 blog post: (http://davefluker.blogspot.com/2012/01/blue-shield-ca-agrees-to-settlement.html)

Of interest is Dave Jones' comment regarding Anthem Blue Cross of California (which was not forced to settle any issues with regard to autism and ABA coverage). Per Dave Jones:

"And we are pleased to reconfirm and acknowledge Anthem Blue Cross of California for providing this treatment as the Department of Insurance has directed since November 2009."

Link to the full announcement from CDI: http://www.insurance.ca.gov/0400-news…

Blue Shield CA To Reduce April Premium On DMHC Settlement

Blue Shield of California has announced to agents that they will be providing a premium reduction (March 1 increase) for those subscribers currently seeing a March 1 rate increase on their DMHC-registered health plans.

Instead of a regular premium increase reduction (say that three times fast) Blue Shield of California has agreed instead to pay the overall reduction at one time. Subscribers currently on DMHC-registered Blue Shield plans will receive a premium credit for the month of April, 2012 on average approximately 62%.

The rate increase goes into effect March 1, 2012 so those on DMHC-registered plans need to make sure and pay the full March premium. Letters regarding the April premium credit have been sent to affected subscriber.

Those on DMHC-registered plans who are currently in their initial six-month rate guarantee period will receive the premium credit the first month after the end of the rate guarantee period.

DHMC-registered plans include:

*Shield Spectrum 5500 PPO
*Acce…

HHS Unveils Final Health Plan Label Design

HHS has announced the final regulations regarding the information that health insurers must provide to consumers to explain their health plan.

The labels will simplify the now-complex legalese and fine print associated with health plan benefit summaries. All health plans must follow the same guideline so that plan benefits will be much easier to understand and easier to compare.

I believe that unified plan summaries in this format are a great thing and will help people better understand exactly how their health insurance plan will work for them.

This standardized form will be available in September, 2012.

Here is an article with benefit summary samples.

Dave
www.davefluker.com

HPV DNA Screening - A Request

I have a request I want to put out to California women. I am in need of information regarding health insurance medical underwriting of the HPV DNA Screening test.

I have received a few phone calls recently from women needing health insurance who told me that they were declined for individual coverage in California due to the results of the HPV DNA Screening test (indicates potential high risk HPV strains).

I have asked for underwriting clarification from both Anthem Blue Cross CA and Blue Shield of CA concerning how they underwrite this test result. Neither carrier has been able to give me an clear answer and they are asking for specific cases to review to determine how to answer the question.

This test is going to be included in women's expanded preventive benefits as directed by HHS starting August 1, 2012 and I expect it will become more common as a screening tool for HPV strains in the near future. As such, independent agents working directly with California women are pretty…