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Showing posts from July, 2012

Walgreens Back With Anthem Blue Cross Sept 15th

Walgreens Pharmacy and Express Scripts have reached an agreement for Walgreens to participate as an in-network retail pharmacy.

Beginning September 15, 2012, Anthem Blue Cross members will be able to again use their pharmacy benefit at Walgreens.

This applies to individual & family plans, small and large group plans, Medicare and Medicaid (Medi-Cal) members.

This applies to all Walgreen pharmacies as well as Happy Harry's and Duane Reade pharmacies owned by Walgreens.

Dave
www.davefluker.com

CA SB 1431 Update (July 24) Stop-Loss Coverage

Just wanted to post a further update to SB 1431 which deals with small group (2-50 employees) in California using "stop-loss" or self-funded health plans.

Last week the bill passed Assembly with some revisions to stop-loss numbers. I mentioned in a previous blog ( CA SB 1431 Update (May 21) that some changes were being considered for this Bill.

The current version of CA SB 1431 has the following changes:

*Per employee deductible reduced from the original $95,000 to $60,000 (per employee and per dependent)

*Attachment Point for group stop-loss set at 135% of expected claims for the group

I will advise if and when SB 1431 is passed or not passed into law.

Dave
www.davefluker.com

Medicare Part B Premium To Jump To $247 Per Month in 2014! (Hoax)

One thing I love about these "internets" is the birth and propagation of urban legends. The one I am seeing most right now in the health insurance community is as follows:

Italicized in brackets are my comments.

"The per person Medicare insurance premium [Part B] will increase from the present fee of $96.40 [this was the 2009 rate by the way] to $104.20 in 2012, $120.20 in 2013, and $247 in 2014. These are provisions incorporated in the Obamacare legislation [PPACA] purposely delayed so as not to confuse the 2012 re-election campaign. Send this to all seniors that you know so they will know who is throwing them under the bus. Obama knows that this will kill his chances for a second term if enacted now and he thinks voters are stupid and won't know or care about anything that doesn't affect them now. REMEMBER THIS IN NOVEMBER AND VOTE ACCORDINGLY"

If you receive this information it is a hoax and urban legend that will likely continue to make the rounds at …

California Insurance Commissioner vs Blue Shield CA (Follow Up)

I wanted to post a follow up to my earlier BLOG of July 3rd concerning California Insurance Commissioner Dave Jones disapproval of the Blue Shield Life & Health CDI plan closures.

I spoke with Blue Shield today and we are pending official notification from the insurance company in regard to Mr. Jones' announcement. I will provide information via a new BLOG post once I have it.

In the meantime I wanted to provide a link to the CDI web site and Dave Jones official press release regarding this issue. The official announcement provides a more detailed explanation of the decision.

Dave Jones Blue Shield Press Release

Dave
www.davefluker.com

CA Insurance Commissioner Disapproves Blue Shield CA Plan Closures

California Insurance Commissioner Dave Jones announced today that he has disapproved the announced health plan closures by Blue Shield Life & Health. See my previous blog "Blue Shield To Close and Replace Most Individual Health Plans in California" from April 17th.

The CDI (CA Dept of Insurance)originally disapproved the plan closures in March, 2012, and requested additional information be provided by Blue Shield by June. The CDI reviewed the information and sustained the disapproval of the plan closures citing a lack of size of the remaining open block for pooling so as not to create a "death spiral" with the closed block.

All of Blue Shield's new PPO plans are registered with the CA Dept of Managed Healthcare (DMHC) leaving only one PPO plan from Blue Shield Life & Health.

Additionally the Commissioner notes that one specific health plan, the Vital Shield 2900 PPO has insufficient provision for 20,000 members as it offers no plan transfer right wit…