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Showing posts from April, 2012

California SB 1431 To Limit Self-Funded Small Group

SB 1431 is currently working its way through the California State Senate. The Bill, authored by California State Senator De Leon, would impose new rules for those small groups under 50 employees who choose to use a self-funded or "stop loss" health insurance programs in lieu of fully-insured plans.

Currently some stop loss plans for small groups have very low attachment levels when compared to large employer self-funded health plans. In some cases the attachment (the dollar cost point where the insurer begins paying claims) for small groups is as low as $5,000 for individual attachment (per employee or dependent). Most large and mid-sized groups have a much higher attachment level--somewhere in the area of $75,000 to $100,000 per individual attachment on average.

SB 1431, if passed and signed into law, would raise the attachment rules for small groups in California to $95,000 individual attachment. Essentially that means that the employer would be responsible for the first…

Blue Shield CA To Close and Replace Most Individual Health Plans in California

Blue Shield of California has announced that they will soon close virtually all of their current individual & family health plans and replace those plans with a new portfolio of health plans. This change and plan closure will be effective 7/2/2012.

The following current Blue Shield CA individual & family health plans will be closed to new enrollments not later than July 2, 2012:

*Vital Shield 900 & 2900
*Vital Shield Plus 400/400 Generic, 900/900 Generic, 2900/2900 Generic
*Balance PPO 1000, 1700 & 2500
*Shield Savings HSA 1800, 3500, 4000 & 5200
*Active Start PPO 25/25 Generic & 35/35 Generic
*Essential PPO 1750, 3000 & 4500

The following 4 plans will remain open to new enrollment on and after July, 2012:

*Shield Spectrum 5500
*Shield Spectrum 5000
*Access+ HMO
*Access+ Value HMO

Closed plan choices will be replaced by a new portfolio of health plans for new enrollments beginning in July. The new individual & family portfolio will consist of the following plans i…

PCIP To Agents: Thanks, now take a hike!

The federal PCIP (and those states who have the federal PCIP instead of a state run version) announced today that effective May 1, PCIP will discontinue the agent/broker referral fee. PCIP claims that the enrollment numbers in the PCIP have 'increased dramatically' in the last six months and they no longer need agents/brokers to assist individuals with the plan benefits and enrollment.

Coincidentally, the dramatic enrollment increase was experienced during the short cycle that federal PCIP actually paid the one-time referral fee to agents and brokers to assist with enrollment into the program.

In California, the PCIP is run by the state via MRMIB and initially paid a $50 one-time referral fee identical to MRMIP. When federal PCIP added agent compensation in October, 2011 to try and increase enrollments, they offered $100 per applicant and CA PCIP increased the fee to $100 one-time to match the federal PCIP. Six months later, federal PCIP is cancelling the referral fee alt…

Anthem Blue Cross and HCA Renew Contract

Just an update regarding the contract termination between Anthem Blue Cross and HCA (Hospital Corporation of America). As you may be aware, the agreement was terminated by HCA in early March over the inability to reach an acceptable contract.

Further negotiations were successful and multi-year contracts were achieved between Anthem Blue Cross and HCA effective April 1, 2012.

The following HCA hospitals were affected by the contract termination and are now participating providers with Anthem Blue Cross:

*Good Samaritan Hospital San Jose
*Los Robles Regional Medical Center
*Regional Medical Center of San Jose
*Riverside Community Hospital
*West Hills Hospital and Medical Center.

Have a great Easter weekend!

Dave
www.davefluker.com