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Showing posts from 2010

Health Net CA Individual Plans Approved!

Health Net CA has announced this morning that they have received regulatory approval to sell their new January 1 plans to individuals & families.

Health Net CA (not including the Farm Bureau) will only be offering 3 total individual health plans for January 2011. These include:

*HMO 40
*ValueNet PPO
*Optimum Advantage HSA PPO

That's it folks. I have the rates and paper applications available for use until the online quoting and application system goes live for these plans.

Dave (

Anthem CA Quote Upload Available Today (New Plans)

The Anthem Blue Cross CA quoting and application system has been uploaded and is currently quoting the new approved individual & family health plans for 2011 (PPACA-compliant).

The new plans quoting include:

*Tonik 5000 PPO
*Premium Plus PPO (six deductible choices)
*PPO Share 3500, 5000 and 7500
*HMO plans

You can get quotes for the current plans via my link

Lumenos HSA plans will not be available for online quoting until approximately January 20, 2011. For more information on Lumenos HSA, send me an e-mail as I have the rates available at this time.

Plans still pending CDI approval are

*Core Guard PPO
*SmartSense PPO
*Clear Protection PPO
*some Lumenos PPO & HSA

Dave (

Child Only Health Insurance California 2011 -Anthem Blue Cross Live Blog

I am blogging this live while attending an Anthem Blue Cross conference call. Important news concerning Child-only health insurance coverage in California beginning January 1, 2011 for children under 19.

Per CA AB 2244, children may apply for coverage without a parent being a co-applicant during certain periods. This includes both healthy children and children with pre-existing conditions who need guaranteed-issue coverage. Children receiving guaranteed-issue coverage can be rated up in premium (as of today) but cannot be declined.

The enrollment periods will be as follows:

*January 1,2011 - March 1, 2011 Open Enrollment Period
*The Birthday Month of the Child (regardless of which day in the month)

Outside of these open enrollment windows, children will not be able to apply for coverage on child-only coverage policies. Outside of the open enrollment or birthday month, children will only be allowed to apply with a parent as co-applicant (and the parent must be approved for coverage for the …

Anthem Blue Cross CA Partial Plan Release 12/10

Anthem Blue Cross has announced that a portion of the health plans held up for approval by the CDI (California Dept of Insurance) have been approved and are available for sale today.

In addition to the 3 HMO plans and PPO Share 3500 and 7500 which were previously approved for sale, the following plans are now available today for quoting and applications:

Premier Plus PPO (1000, 1500, 2500, 3500, 5000 and 6000 deductibles)
Lumenos HSA PPO 1500 (non-maternity)
Lumenos HSA 5000 (with maternity)
Tonik 5000 PPO
PPO Share 5000
PPO Share 1000

Anthem has indicated that plan online quotes and applications for the new plans will be available Saturday, 12/18 and after.

Quotes and plan summaries can be found on my Anthem Plan Finder
Click on "Get Quotes" under "individuals & families" and it will open the planfinder in a new window.

Still pending are:

SmartSense Plus
Core Guard Plus
Clear Protection Plus
Lumenos Plus

MLR and Agent Commission (and the future) California

As many of you may have heard, the health insurance carriers have begun announcing commission reductions to agents due to MLR (Medical Loss Ratio) requirements under PPACA. Blue Shield CA just left us all a nice voicemail this evening (after business hours BTW) about commission cuts. The average for an agent is approximately 50% pay cut in 2011 (starting in 3 weeks).

No doubt that is going to hurt and it is possible many agents (especially newer agents) will leave the health insurance business. Veteran agents may be able to withstand the slash on new business compensation because of a large client base of older business which will be, at least for now, uneffected by the cuts.

I have observed in the last few days an attempt by agents, insurance carriers and organizations that train, recruit or mentor agents, to justify this going forward. To the extent that reduced earnings on health insurance would allow fewer agents to achieve higher potential production at lower commission (the overal…

PCIP Premium Decrease (HHS)

According to recent press, the federal government has indicated that it plans to decrease the premiums for the federal PCIP (temporary risk pools) by 20% in order to encourage greater enrollments.

Apparently enrollment in the new PCIP has been lackluster at best.

I do not yet know if the decrease will be applied to the CA PCIP as it is being run by the state (MRMIB) and not a direct federal risk pool.

Unless the government can find more $$$ to pump into the pools, this is going to likely create a reduced number of enrollment slots meaning less people will be able to be covered at the lower premium.

California's PCIP is scheduled to hold an average of 23,100 people at any given time with a possible increase in two years if scheduled federal funding is available. Obviously a 20% premium decrease under existing funding ($761MM) would likely lower the number of subscribers by that same percentage.

Health Net CA Blackout Coming Up

Health Net of California has announced a blackout for individual & family coverage plans (IFP) in a couple of weeks. The blackout will be lifted when the new PPACA-compliant plans are approved and available for January 1, 2011.

The blackout will occur on November 18th (online quoting), and the last day to submit applications for December 1, 2010 start dates will be November 22nd. Any applications received after 11/22 will not be processed.

Any application submitted on or before 11/22 that is not approved and enrolled by 12/10/10 will be cancelled and returned to the applicant.

Health Net CA will advise agents as to the progress of the PPACA-compliant plans and at what point applications and online quoting will be made available after the blackout.

This blackout does not effect HIPAA plans, only underwritten coverage plans.

Congratulations Rick Bronstein!

Rick Bronstein, a fellow agent and friend, ran for the office of CA Insurance Commissioner in the 2010 election.

Rick placed third in the race and garnered almost 300,000 votes. Not to shabby for a 3rd party candidate with no corporate backing nor war chest.

Congratulations, Rick. You certainly made them take notice. Now, get back to work LOL!

Anthem Blue Cross CA Update

Just wanted to update on my suspending sales with Anthem Blue Cross CA.

I have spoken with Anthem concerning my issues with their processes and am supposed to be receiving some correspondence from "on high" regarding my issues and concerns. As of today I have not yet received anything from Anthem in this regard. I understand the correspondence has to be cleared by the legal department due to technical nature (I am sure it's HIPAA-related).

I am willing to work with Anthem Blue Cross to resolve these concerns and to assist people in buying both guaranteed-issue HIPAA coverage and underwritten coverage (one the plans are actually available -- they are still blacked out pending DOI approvals).

In the meantime, I am continuing with Anthem Blue Cross small group products as they are a good carrier for the types of groups with which I specialize (spousal/family).

I just wanted to update and let you all know where things stand.

California Exchange Bills Signed Into Law

The Governor signed both health insurance exchange bills into law yesterday in California.

AB 1602 and SB 900 (companion bills) were signed yesterday, paving the way for the creation of the California Health Insurance Exchange.

I will update as the process moves forward with information on the exchange, how it will work, when it might be operational and so on.

Anthem Blue Cross HIPAA Enrollment Change (California)

Effective October 1, 2010, Anthem Blue Cross California will institute a new enrollment process for HIPAA applicants.

Beginning 10/1, applicants will have start dates as follows based on application submission (WITH premium):

1st-15th of the month, 1st of the next month
(ex. Apply 11/1-11/15 start date is 12/1) (one month gap)

16th-31st of the month, 1st of the second month
(ex. Apply 11/16-11/30 start date is 1/1)(two month gap)

In order to avoid gaps in coverage, I need all Anthem HIPAA applications to be submitted to my office at least 30 days PRIOR to the requested effective date.

Anthem Health Plan Blackout (California IFP)

Anthem Blue Cross of California has today suspended it's online application program for individual & family health plans. The application will be unavailable until approximately October 1. I will update when it becomes available.

For those seeking quotes for Blue Cross coverage plans (non-HIPAA), currently over 75% of the plan portfolio is not available for sale pending Dept of Insurance approval of plan designs and rate changes. The PlanFinder tool will still work via my web site ( however it is currently only quoting the DMHC registered plans that have been approved (the expensive plans). I will update as soon as I receive word as to the availability of the new DOI-registered PPO plans.

These plans are currently being changed to meet PPACA guidelines including elimination of lifetime caps and addition of no-cost preventive services.

Currently Anthem is pending approvals for the following plan portfolios:

-SmartSense PPO
-Clear Protection PPO
-Core Guard PPO

Anthem Blue Cross CA Eliminates Child-Only Enrollments

Effective 9/23, Anthem Blue Cross CA will no longer offer individual coverage plans to children under 19 as a stand-alone enrollment. Children of any age may apply for coverage as long as they are applying with parents/guardians over the age of 19. However, Anthem will no longer accept applications for children-only under the age of 19.

Several carriers in many states have taken similar action in recent weeks. It appears that Anthem across the 14 states they cover will take this action in all states. Other carriers have also instituted the same policy.

PPACA requires insurers who provide child-only coverage to insure all children under 19 regardless of health conditions. HHS is supposed to provide guidance to the insurance companies regarding open enrollment periods, however such guidance has not yet been forthcoming. As such, Anthem CA (so far) has chosen to stop selling health coverage plans to children under 19 at least until HHS provides clarification on the open enrollment.


PacifiCare Fined $9.9 Billion by CDI

PacifiCare is once again the target for CA Dept of Insurance regulatory action.

A couple of years ago, the carrier was fined $1.2 Billion for poor claims practices.

Aocording to the article below, PacifiCare committed over 1 million violations of California law between 2006-2008.

I have maintained for several years my refusal to contract with this carrier, as have many CA health agents.

This is going to hurt if enforced.

LA Times Article

California PCIP (Federal Risk Pool) Opens

The PCIP (Pre-existing Condition Insurance Program), also referred to as the Federal Temporary Risk Pool, is now open and accepting applications for enrollment.

The PCIP is an individuals-only enrollment with no dependents. Rates are set correspondent to the standard rate for a similar $2500 deductible PPO plan on the open market in California. PCIP will use a larger network of providers than MRMIP, approximately 65,000 should be available. The PCIP plan offers both in-network participating benefit levels and and out-of-network non-participating benefit levels.

Applications received by the 10th of the month will be enrolled for the first of the following month.

According to MRMIB, which will run the program for California, agents may assist applicants in the enrollment process for PCIP and receive a $50 fee the same as currently available on the MRMIP program.

Eligibility for the PCIP consists of the following:

1. California state residency as evidenced by applicant having a California…

October 1 Rate Increases on Individual Health

October 1 will see major rate increases by both Anthem Blue Cross and Blue Shield of California.

Blue Shield will average 18.2% increase but some age groups may experience rate increases as high as 50%!

Anthem Blue Cross will average 14% with a max rate of 20% increase.

Interesting article from today's Sacramento Bee.

In addition, Anthem Blue Cross has currently blacked out all individual and family health plans for new enrollments on 9/23 and after to replace the current plans with newer, PPACA-compliant plans. I have heard rumors that we may see the end of lower-deductible versions of some plans in favor or high and very high deductibles to offset preventive benefits and childrens guaranteed-issue.

California Health Insurance Legislative News (Lots of it!)

Big day in Sacramento today. And with 8/31 deadlines looming, we will likely see more activity.

California AB 1602 (Perez) and SB 900 (Alquist) has passed and is awaiting the Governor's signature to make it law. AB 1602 sets up the California health insurance exchange. I expect this to be signed as Gov Schwarzenegger indicated earlier this year that he wants the exchange model set up before he leaves office.

SB 900 sets up the exchanges, and AB 1602 which is a companion bill delineates the specific duties of the exchange.

AB 1825 has passed the Senate and now goes back to the Assembly for final action. AB 1825 requires mandatory maternity benefits on all health plans sold in the individual market.

AB 2244 prohibits insurers from refusing coverage to children simply because they have a pre-existing condition. AB 2244 also goes back to Assembly now for final action.

Other Bills to watch:

SB 890 (Alquist) - sets requirement for health plans to offer only 5 plan designs either inside o…

CA Individual Plan Upgrades (PPACA)

As of today, this is what I am being told regarding individual & family health plan updates to comply with PPACA benefit requirements.

Anthem Blue Cross upgrading for 9/23 currently blacked out pending approvals (no plans currently available for sale after 9/22 start dates).

Blue Shield, Health Net and Kaiser are all targeting plan change dates of 1/1/11 to upgrade new plans to PPACA compliance. Their current plans will be available for purchase through 12/31/2010.

Exising plans purchased before these upgrade dates will also be upgraded, but each carrier will decide when and how the upgrades will occur. They can either upgrade on the renewal month of the plan or at one time.

CA AB 2042 Moves To Assembly

CA Assembly Bill 2042 passed the state Senate yesterday (21-13) and now goes to the Assembly. AB 2042 would prohibit health carriers selling individual & family plans from raising rates more than one time per year.

AB 2042 only applies to individual coverage, not to group coverage.

CA Health Bills Up Against Deadline

There are currently four bills in process in Sacramento which need to be passed or rejected by August 31, 2010. If they are not passed or rejected, the bills will die.

The following are the applicable bills:

AB 2578 (D. Jones) - Requires approval from state regulators for increases in health coverage premiums.

SB 1163 (M Leno) - Would require insurers to justify denials of coverage and premium increases.

SB 900 (E. Alquist) and AB 1602 (J. Perez) - Companion bills would establish health insurance exchanges in California to comply with PPACA.

PPACA Update on Existing CA Plan Upgrades

I wanted to add that it may happen that some or all carriers choose to make the PPACA-compliant changes to existing plans on one unified date. Likely this will be the portfolio renewal date.

So, it may be that your existing pre-9/23 healthcare plan gets the upgrade at the renewal of your plan anniversary or on January 1, 2011.

Realistically it makes more sense cost- and logistics-wise for a carrier to make the unified upgrade instead of spacing them out over a period of 12 months.

I will post when I receive clarification from each carrier on how they intend to process the upgrades to existing coverage plans.

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 betwe…

Welcome To The Blackout

As of today, individual and family health plans in California can only be purchased with start dates of 9/22/10 and prior. There are literally no health plans available for sale starting 9/23 or after at this time. Several carriers have already shut down online quoting for start dates of 9/23 and beyond, pending the regulatory approval of the new, PPACA compliant plans. All health plans for "new enrollment" sold 9/23 and after must meet the PPACA guidelines which include such things as no-cost preventive care, no lifetime maximums nor annual maximums and child GI coverage ages 0-18.

All of the IFP carriers have submitted new plans to the two regulatory bodies, DMHC and CA DOI for approval. Now the waiting begins until the new plans are approved for sale to the public. This could be very soon or could take a few more weeks. I will advise once plans begin to be made available.

HIPAA plans are also included in the "transformation", so anyone with a HIPAA eligibi…

PPACA Update

It appears that Anthem Blue Cross and Health Net are planning to re-tool their individual and family plans products for 9/23.

Anthem will close online quoting for any plans with a start date of 9/23 or after on Saturday (8/14). Online quoting will resume once the plans are filed and approved.

Health Net CA is currently not quoting any plans with effective date of 10/1 or after. Probably a similar change-over.

Blue Shield CA has taken a different interpretation of PPACA. The law allows carriers to make the change-over on 9/23 OR at the next subsequent product renewal cycle. Blue Shield CA has its next cycle on Jan 1, 2011 and intends to hold off on all PPACA compliant plan changes until January. My understanding is that this will include the preventive benefits AND guaranteed-issue coverage for children 0-19.

PPACA Preventive Benefits

Under the PPACA (aka Obamacare), effective 9/23/10 all new health plans available on or after that date will be required to provide certain preventive benefits at no cost to the subscriber.

As noted in my earlier blog, Anthem Blue Cross CA has already begun the process of plan re-tooling and, as of today, you cannot view any plans that will be available on or afte 9/23. I expect the other CA IFP carriers to follow this lead.

Here is a link to the PPACA Preventive Benefits List.

Anthem CA Re-tooling For Obamacare

Effective August 14th, quoting for individual health plans will only be available for start dates of Sept 22 or before. If you request an effective date on or after Sept 23, the system will have a pop up message stating that no plans are available for the requested effective date.

Anthem is currently working on the mandatory changes and rates for plans to be sold Sept 23 and after. Plans sold on or after Sept 23 must meet new guidelines as outlined in the PPACA legislation.

I will post when the new information is available for quoting.

PCIP Getting Closer in California

The PCIP (Pre-existing Condition Insurance Plan)aka Federal Risk Pool will be opening for enrollment in a few weeks.

MRMIB has published some very basic information including a rate guide summary for the PCIP in California.

You can view the summary including the proposed rates here.

Currently you may request an application be sent to you once they are available by sending an e-mail request to

As of today there is no information on plan benefit design nor which carriers will offer plans.

No COBRA Subsidy In New Bill

The newly passed unemployment bill which will extend benefits until the end of November, 2010, does not contain a provision for any further COBRA subsidy. It was eliminated along with several other previously-included benefits to keep the cost down.

Anyone who qualified for the 65% subsidy prior to June 1, 2010 will receive the full 15 months of 65% subsidy. Anyone who would have qualified but began COBRA or state mini-COBRA after June 1 will not be eligible to receive any subsidy.

Bloomberg Article

Anthem Blue Cross CA Security Breach Update Pt IV

Further updates regarding the security breach of Anthem's online application tracker program.

As of today, 470,000 individual subscribers have been notified of a potential compromise. 230,000 are in California, the rest across the various Anthem states.

There are some disturbing bits of information surfacing.

Apparently the breach went on for quite some time and was only discovered in March when an attorney who breached the system filed a class action lawsuit regarding the breach. I have at least two clients who were breached as far back as November, 2009.

Perhaps the most troubling is that, according to the Atlanta Journal-Constitution, a company investigation has yet to identify 10 computer addresses (IPs) that accessed information. This is of concern as this would indicate that these 10 breaches were not conducted by the attorney(s) and are IP addresses of unknown hackers.

I will update when I receive additional information. Questions for California subscribers should be addresse…

CA Temporary Federal Risk Pool Approved

Yesterday, two legislative bills were passed in Sacramento which will allow for California to run a temporary risk pool using federal funds (under PPACA). The risk pool will provide coverage on a temporary basis until January, 2014.

The two bills, SB 227 (Alquist) and AB 1887 (Beall) will provide both parity for mental health and substance abuse (AB 1887) as well as the temporary risk pool for uninsurable California residents (SB 227). Passage of SB 227 was predicated on prior passage of AB 1887.

California will receive $761,000,000 of federal funds for the risk pool. State sources indicate that the risk pool will not use any California state funds.

Details including qualification requirements, insurance plans (will be PPO style) and rates should be forthcoming from the MRMIB. MRMIP will run the program alongside the state major risk program.

Anthem Security Breach Update

Article from the Orange County Register indicating that more than 200,000 affected so far by the security breach of the Anthem Blue Cross Online Application Tracker.

Orange County Register Article

According to the article, the attorneys who breached the system have returned all of the improperly obtained private information to a custodian of the court system. I expect that means that everyone who was affected by the breach can be assured that their private information is now safeguarded.

For clarification to the majority of my clients, this security breach does not impact HIPAA applications (nor small group). The application tracker program allows applicants (and apparently others) for individual & family plans to view a PDF of the electronic application. This PDF file contains the full application information including PHI and financial information.

HIPAA applications, like other "paper" applications, are not rendered to PDF for viewing and list on agent services as &quo…

MRMIB Moving Forward on Fed Risk Pool

MRMIB (California's Major Risk Medical Board) is putting together the federal major risk pool program for California. According to the most recent document, MRMIB is targeting PPO model coverage plans allowing for provisions to match the new federal PPACA guideline (no annual or lifetime caps, lower deductibles (under $1500) and so on).

According the the MRMIB, target date for the risk pool to be operating is September, 2010.

According to information provide by Pricewaterhouse Coopers (PwC) to the MRMIB, enrollment in the new risk pool could be approximately 25,000 California residents.

For comparison, MRMIP (California's Major Risk Insurance Plan) enrolls a total enrollment of about 7,100.

The risk pool funding will be a combination of premium from subscribers and federal dollars. No state monies will be used to fund the California federal risk pool.

More information as soon as I get it. Remember, the two primary conditions a person must meet to participate in the federal risk p…

Anthem Security Breach Update

I have a couple of updates regarding the security breach of the Anthem Blue Cross "Application Tracker" system.

1. Anyone who submitted an application for a minor child/children only that was breached and has received ID theft protection for the minor(s) will, if there was information breach for the parent/guardian, also receive the protection. Anthem is currently sorting applications on minors-only to determine if any breach of the parent/guardian information also occurred. This may take a bit of time as the original determinations were made based on the applicants. Anthem will have to research applications in full to determine who else may have had PHI or private information compromised in regard to that application. You can contact member services at 800-333-0912 at Anthem Blue Cross for assistance.

2. It is important to bear in mind that, while Anthem Blue Cross has ultimate responsibility with regard to this hacker manipulation, the responsible party(s) is/are mainly att…

Blue Shield CA To Hold Current Rates For July 2010

Blue Shield of California announced today that the company would make no rate or benefit changes to individual & family health plans in California at this time.

Blue Shield's "product cycle" normally allows adjustments of rates and plan benefit changes two times per year, in January and July.

Communication to agents indicates that everything will remain as current in terms of price and benefits until the next product cycle, which will be announced at a later date.

Anthem Blue Cross Security Breach (Individual Health)

Anyone who has recently applied for individual health insurance with Anthem Blue Cross and been assigned an online application tracker link needs to be aware of the following unauthorized security breach. Affected applicants will receive notification with details and one year of free identity protection services. No agent has been or likely will be notified of specific applicants (if any) who were affected.

PHI Breach by Individual Applicant, Attorneys

Anthem Blue Cross recently learned of a situation in which a small number of individuals manipulated the web address within the website we use to allow people to track the status of their Individual insurance applications. Through this manipulation, some of these individuals gained unauthorized access to certain private information.

The vast majority of the manipulation and the resulting unauthorized access occurred at the hands of certain attorneys, who were representing an applicant. We believe that this manipulation was conducted to s…

CA SB 890 (Alquist)

There is a current California Senate Bill (SB 890) which I find intriguing.

SB 890 is currently under consideration and, if implemented ahead of full reform, would drastically change the landscape of individual health insurance in California.

Essentially, the bill would require all health insurance companies to offer a "standardized" portfolio of plans which would be limited to 5 PPO plans and 5 HMO plans. Any deviation from these 5 plan designs would be illegal to sell after July 2011. These plan designs generally mirror the design concept of the plans which will be available in the exchanges by 2014.

The plans would be designated as "Gold, Silver, Bronze, Platinum and Catastrophic". They would have a proscribed benefit level and include maternity coverage. By the way, there is another bill out there right now which would require all individual health plans to include maternity benefits again. No more non-maternity plans.

The ten standardized plans (5 PPO 5 HMO) woul…

California Moving Forward With Reform

According to a Mercury News article today, the California Legislature is moving forward with several reform bills in the coming weeks.

The legislation, which may include as many as 20 bills, would, amongst other things, create state health insurance exchanges, do away with denials for pre-existing health conditions, extend coverage to children and uncap benefit limits on health plans.

Governor Schwarzenegger has indicated that he wants many reforms in place in California before January, 2011, including health insurance exchanges.

The two most major bills are SB 900 (Alquist) and AB 1602 (Perez). Both bills would create a California insurance exchange which would operate similar to the Massachusetts Connector program.

It appears that California intends to at least try to get systems and programs in place well ahead of the final dates set by federal reform laws.

Current Version of SB 900

Current Version of AB 1602

COBRA versus Subsidy for COBRA (18 vs 15 months)

This week I have been asked about this so many times that I wanted to address some confusion concerning federal COBRA.

Federal COBRA runs a standard 18 months, not 15 months. There are cases where it can be 29 months (disability extension) or 36 months (divorce, separation, death of the employee, state extension or dependent age-off of parent's plan). Generally it runs 18 months for most people.

The subsidy for COBRA (for those who qualify) runs 15 months. It was originally set up to run 9 months but was extended.

You do not exhaust or lose COBRA at 15 months. You only lose the subsidy at 15 months. You still have 3 more months of COBRA (or more if extended) after the subsidy goes away.

You are not eligible for HIPAA at 15 months. You have to complete the 18 months.

Health Exchanges and Independent Agents

I am hearing and reading so much lately from the health insurance agent community about the future of agents under healthcare reform. Specifically as relates to the health insurance exchanges set for 2014. A minority believe that independent agents will have a place in the system while a majority, it seems, are suffering from "Chicken Little Syndrome". Truthfully, no one knows yet what place independent health agents will have in the new system. I do have some thoughts.

For those who know me and my business, I write a lot of HIPAA. HIPAA is guaranteed-issue health insurance, available kind of on an exchange (pick from available carriers and plans) and has no underwriting or medical screening component. Somewhat similar to the future exchanges (if you can get information which is generally only available on web sites like mine).

One would think that with the fairly small choice of guaranteed-issue plans (perhaps 25 at most in California) and fairly similar plan designs (HMO are…

MRMIP Clears Backlog (No Enrollment Waiting Period)

The California MRMIP (Major Risk Medical Insurance Program) has apparently received some additional funding and has cleared the backlog of applications.

As of today (5/19/10) there is no waiting list for MRMIP enrollments.

I am working on obtaining specific information regarding the federal temporary risk pool which is scheduled to open July 1. In the meantime eligible uninsurables may enroll in the MRMIP without an enrollment waiting period.

More MRMIP information here

Large Companies Contemplate Dropping Employee Health Coverage

The Dallas Morning News is reporting that several very large companies "have concluded that they might be financially better off canceling their health care coverage and moving their workers to government-subsidized exchanges that will be available in four years".

At least four companies have investigated to varying degrees the impact of dropping health care coverage and pushing their workers onto the new exchanges, where they will be able to buy their own insurance.

While doing this would subject companies to fines, the size of the fines would be substantially less than the cost of providing health insurance to their workers.

The four companies identified so far are:

*Verizon Communications, Inc.
*Caterpillar, Inc.
*Deere and Co.

If these four are looking at this option, it is a pretty safe bet that other large employers are doing the same.

HIPAA Enrollment Change (Yet Again) - Anthem

Anthem Blue Cross (CA) has made another enrollment change to the HIPAA plans.

Under the prior change, all enrollments in HIPAA were subject to approval followed by a premium notice. The notice would allow payments in two 15-day periods (1-15th, 16-31st paid or postmarked) to start on the first of the following month. Example:

*Premium paid or postmarked 1-15 June would start July 1 (30-day gap)
*Premium paid or postmarked 16-30 June would start August 1 (60-day gap)

Under the latest change, the premium payment period has changed as follows:

*Premium paid or postmarked 1-15 June would start June 1 (slightly retroactive)
*Premium paid or postmarked 16-30 June would start July 1

Also, Anthem Blue Cross CA has indicated that it will accept certain "substitute" documents in lieu of the Certificate of Creditable Coverage which is not issued until after the expiration of continuation coverage.

A Good Story (sadly not health insurance but life insurance)

Every day it seems the health insurance companies are making mistakes, denying claims, rescinding coverage and all of the rest. They pay claims grudgingly (if at all) and, according to many media sources, try to get out of paying as many as they can.

I asked my doctor during a recent checkup if it was true what 'Dr. Dean' says about doctor spending 1/2 their time working on patient files. He told me "not anymore", most of his time is spent fighting with health insurance companies. Sigh!

So, I wanted to share the following true story. It is not a health insurance story, but a life insurance story. I dream of the day even one California health insurance company could tell a story like this. I doubt any of them could..........

In 1999 I attended the annual agents meeting of Northwestern Mutual Life in Milwaukee, WI. This is an annual "must" for NML agents and it is both educational and a lot of fun.

Then-CEO Jim Ericson opened the first morning session with the f…

Blue Shield CA Adds 5th HIPAA Policy

Effective May 1, 2010, Blue Shield of California has added a 5th policy to the HIPAA guaranteed-issue individual & family portfolio.

The new addition, Access+ Value HMO, is a lower-priced HMO option than the Access+ HMO that was made available 3/2/10.

This is the first time I have seen a carrier offer three plans under one plan registration for HIPAA.

MRMIP Will Not Be Used For Risk Pool

Today the CA Governor announced that California will not use the MRMIP program as the temporary high risk pool for uninsurable California residents.

Instead, MRMIP will continue to operate alongside the federal risk program to be established by HHS in the next few months.

Stay tuned for more details on the temporary risk pool and how to enroll. Remember, the federal risk pool is a temporary program to 2014 to help cover those who cannot obtain private health insurance and have been without insurance coverage for six months or longer.

MRMIP is a California state risk program for CA residents who are unable to obtain private health insurance. The current waiting list for MRMIP enrollment is 3-4 months from application submission.

Anthem Fights Back (Finally!)

On Thursday, a "reporter" at Reuters wrote a story about Anthem/Wellpoint deliberately rescinding health insurance policies on women who developed breast cancer. The article, which was then rebroadcast by other media, is full of factual errors (one of the women was not even insured by Anthem/Wellpoint and another's name was mispelled throughout the article). The media "report" even caused HHS Secretary Sebelius to fire off a nasty letter to Angela Braly (CEO Wellpoint/Anthem).

After getting beaten up over the last few months and being portrayed as an evil cross between Attila The Hun and Adolf Hitler, Anthem finally is fighting back against this kind of lazy and inaccurate "journalism".

Anthem Response to Reuters Article

Anthem Response to HHS Sebelius' Letter

It gets better, folks. The url for the original story is no longer active and the "corrected" story (minus the woman who was not even a Wellpoint/Anthem insured) is available here. H…

Temporary Risk Pool (California)

Just a quick update on one of the provisions of healthcare reform that goes into effect in September--the temporary risk pools for the uninsurable who have 6 months or more uninsured (and are uninsurable).

Each state was given the option to use a federal risk pool (HHS) or, if that state has its own risk pool, to use the state program and receive federal $$ for it ($5 Billion earmarked for these temporary risk pools).

While I assume California will likely us the California MRMIP program for eligible California residents, a decision has still not been made by the MRMIB (Major Risk Medical Insurance Board) in Sacramento.

I called them this week for an update and was told that they are still meeting about it and working through the myriad of implications for using MRMIP.

I will provide updates as they become available and as we get closer to the initial changes under the new Healthcare Reform law.

For more information on California's MRMIP health insurance risk program (and other state p…

The HIPAA Tango Continues (Anthem Blue Cross)

For those who may be looking at my HIPAA page and wondering what is going on with Anthem Blue Cross enrollments, I thought this might help (I hope!).

Effective 5/1/10, Anthem has a new enrollment process for HIPAA plans. The process works like this: application and supporting documents to get approval to enroll, premium notice sent out upon Anthem's "OK" to enroll (approval), then you pay future premium to get future start date. Gaps can run 30, 60, 90 days or more. Sounds crazy, huh?

I have spent the better part of this week tee-ing off Anthem trying to get clarification and work-arounds for enrollments for Californians in need of HIPAA coverage and don't want to gap coverage.

So, to answer the question of whether or not there would be a necessary gap in coverage from group to HIPAA, a firm "maybe". It is going to depend on how early on we can start the process.

It is possible to enroll under the new system at Anthem and have a seamless start date. But it is t…

This Is What Happens When You Don't Read The Bill!

I guess someone forgot to tell the administration and those who voted for health insurance reform to actually read the bill.

The current bill signed into law yesterday does not, in fact, provide guaranteed-issue health insurance coverage from children this year, sort of.

I assume this will be fixed but we will have to wait and see.

Gap in law for children's healthcare protection

Impact - MLRs (Medical Loss Ratios)

I am watching President Obama sign the new health insurance (care) reform bill on CNN. I wanted to share some things I have heard recently that may eventually impact the number of carriers in California selling individual and family plans either through exchanges or privately, or both.

While carriers (insurance companies) can boast an overall MLR (medical loss ratio) above 85%, this number is generally inclusive of all sectors of insurance (large group, small group, individual and senior). However, when small group and individual (especially individual) is segregated out, the MLR often falls well below 80% with an average running about 74% on individual and family health plans.

"MLR" is the ratio of premiums paid in to what is paid out for medical care and wellness. The current reform will require in 2011 that all carriers selling individual and family plans must meet 80% MLR in that market. That means every company selling health plans in California by 2011 must be spe…

Health Insurance Reform - What To Expect

Happy Sunday to you all. I am watching the House vote and waiting for the final determination on the Health Insurance (Health Care) Reform Bill.

Since I have received many questions concerning changes I thought I'd quickly summarize here what to expect initially if/when this Bill is passed and signed into law today.

During the first year you can expect:

Pre-Existing Conditions - The Bill includes $5 billion in immediate support to provide temporary coverage to uninsured Americans with pre-existing conditions. The money would help until the new health insurance exchanges are created in 2014.

Elimination of Benefit Caps - New policies sold will not have annual caps on benefits nor lifetime caps on benefits.

Children with Pre-Existing Conditions - Children with pre-existing health conditions will not be excluded from purchasing health insurance coverage.

Preventive Care - New insurance policies will be required to offer free preventive care benefits.

Small Business Tax Credit - A tax …

California HIPAA Dance (Redux)

Another change for HIPAA in California.

Blue Shield of California, in response to Anthem's proposed premium payment arrangement (which is apparently not going to be fully implemented), has taken the following action with regard to HIPAA plan enrollments in California.

Effective 3/2/10, PPO enrollments from HIPAA plans will no longer offer any date of the month not before application receipt date. Now, 1st or 15th of the month following approval of the application.

From Wall Street Journal "The Wellpoint Mugging"

A very interesting article from the Wall Street Journal.

The Wellpoint Mugging

Some parts of the article are quite telling.

He ought to subpoena California's political class because Wellpoint's rate hikes are the direct result of the Golden State's insurance regulations—the kind that Democrats want to impose on all 50 states. Under federal Cobra rules, the unemployed are allowed to keep their job-related health benefits for 18 to 36 months. California then goes further and bars Anthem from dropping these customers even after they have exhausted Cobra. California also caps what Anthem can charge these post-Cobra customers.

This next one hits home for me as one of the leading Anthem HIPAA producers in California. While I know that Anthem is taking losses on the guaranteed-issue side, I also am confident that my book of Anthem HIPAA business (which apparently is #2 in the state of CA right behind e-healthinsurance)is not creating losses. Yes, the whole pool is losing money an…

More HIPAA Dancing

I have learned that Anthem Blue Cross California has again changed its position with regard to HIPAA enrollments.

Apparently they have backed off of the "no premium" with application design (which virtually guaranteed a 60-day minimum gap in coverage) and will allow premium submission with the application in the near future.

The current no premium program was only in effect on the HMO HIPAA plans, not the PPO HIPAA plans. Anthem had indicated a desire to have a unified HIPAA application with no premium pre-payment possible. Apparently this has been scrapped and HIPAA applicants will soon be able to pre-pay premiums for both HMO and PPO HIPAA plans with Anthem Blue Cross CA.

Part Deux: Is The California Individual & Family Health Insurance Market In Critical Condition?

Having recently watched the "bi-partisan" meeting in Washington and many videos on youtube, I wonder if the problem is "un"-fixable.

Speaker Pelosi, in a recent youtube video answering questions on the meeting, pointed out two things which are absolutely of concern. 1, our health insurance system is employer-based in design and function. 2, there are many more people not covered under the employer-based system who choose to remain on the sideline than those who participate in the non-employer health insurance market.

I won't go through the numbers again since they are covered under part one of this topic below. Suffice to say, nearly two-thirds of those who should participate in the health insurance market in California for individual & family coverage do not. No employer-sponsored health plan, whether fully insured or self-funded, could operate at a participation level of 33% or less. Employer plans require 75% of all eligible employees to participate. …

Anthem: The Tale of the Tape in California

I was curious about the impact of the now-delayed Anthem Blue Cross rate increase on premium levels. I could only think of one way to find out, so I ran quotes on myself in Gilroy for four comparative coverage plans from the four California health carriers. Kaiser and Blue Shield are not-for-profit, so they should win, right? The results may surprise you!

The rates below include the Anthem rate increase scheduled for March 1, 2010.

1500 Deductible HSA Plan (or closest match)

#1 Anthem Blue Cross Lumenos 1500 HSA...............$243.00
#2 Health Net CA 2500 HSA (closest).................$246.00
#3 Blue Shield CA 1800 HSA (closest)................$311.00
#4 Kaiser 1500 HSA..................................$349.00

3500 Deductible Traditional PPO (or closest)

#1 Health Net Value PPO 4000 (closest)..............$179.00
#2 Anthem Blue Cross 3500 PPO.......................$224.00
#3 Kaiser 3000 Plan (closest).......................$277.00
#4 Blue Shield CA Essentials 300…

Poizer Asks For Temporary Halt To Anthem Rate Increase

California Insurance Commissioner Steve Poizner has sent a strongly-worded communication to Wellpoint/Anthem requesting that they hold off on the proposed 3/1 rate increase until 5/1 so that an independent actuary retained by the DOI can review Anthem's payout ratios.

Additionally, the Obama Administration has expressed serious concerns about such a large rate increase in California.

A link to Mr. Poizner's letter here.

Is The California Individual & Family Health Insurance Market In Critical Condition?

With the recent LA Times article and notifications to approximately 800,000 CA residents by Anthem Blue Cross of California, the future of individual & family health insurance coverage is looking bleak. Anthem announced a rate increase for March 1, 2010 ranging between 30-39% on many private health plans.

I received information just yesterday that Aetna has now laid off the IFP staff support for northern California (and I supposed SoCal as well). The last time Aetna laid off people in these positions, they exited the market in California.

First a look at some "interesting" numbers and how they relate to this issue.

California population (2009) - 36,900,000 (probably 37,000,000 by now)

# California residents covered by private health plans - 2,100,000
# California residents on average uninsured - 6,000,000
# California residents covered under Group/Medicaid/Medicare - 28,800,000

Those numbers tell us a lot about what is going on. IFP (Individual & Fam…

The California HIPAA Dance

For those who have been following the near-hourly updates on my HIPAA insurance page, the one word I would use to describe the recent activity is--CHAOS.

Anthem Blue Cross initiated what has essentially become a "you-know-what contest" between the two Blues concerning their respective HIPAA portfolios.

The chronology is as follows:

Fall, 2009 - Anthem retires the Share PPO portfolio (retired plans do not need to be offered in the HIPAA mirror of plans)

Jan 11,2010 - Anthem Blue Cross announces a complete HIPAA portfolio overhaul, replacing the 1500 and 2500 Share plans with HMO plan. DOI-registered PPO plans remain the same (5000 and Basic 1000)

Jan 15, 2010 - Anthem closes new enrollments on the 1500/2500 at end of business day

Jan 18, 2010 - Blue Shield CA advises an impending change to the HIPAA products, but cannot comment until 1/22

Jan 22, 2010 - In response to the Anthem HIPAA portfolio change, Blue Shield closes the Spectrum PPO portfolio and eliminates the Spectrum PPO 150…

Cal-COBRA Subsidy Change?

I have the current word on the applicability of ARRA extension in regards to Cal-COBRA.

As it stands currently, the state of California has not amended the applicable law nor signed off on this change. If you remember, when the first ARRA came out, California had to amend existing law to allow for subsidy on Cal-COBRA.

Until such time as the state agrees to amend and sign off, there is NO extension of subsidy for Cal-COBRA to 15 months and no eligibility for subsidy for any beneficiaries going onto state continuation after 12/31/09.

I will update the blog if there are any changes forthcoming. In the meantime, it is 9 months subsidy with a sunset of Dec 31 2009.