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Showing posts from 2011

California PCIP Receives Additional Funds

California PCIP has received additional federal funds to expand the enrollment cap. Projections from November minutes of the MRMIB indicated that the PCIP would have to lower the cap on subscribers from the estimated 23,100 down to 6,800.

The additional federal funds in conjunction with the rollover of 2011 funds will be used by MRMIB to increase the number of slots for enrollment in CA PCIP above the 6,800 cap. Final enrollment cap is not provided at this time by MRMIB.

This is good news for those with high risk health conditions who may have been denied enrollment in CA PCIP due to enrollment cap.

Letter from MRMIB


California PCIP Substantially Lowering Enrollment Numbers

California PCIP has lowered the number of available slots due to excessive utilization of benefits. The CA PCIP will cap enrollments at 6,800 down from the originally projected 24,100 by 72%.

CA PCIP was granted funding in 2010 to establish the risk program run by the MRMIB (Major Risk Medical Insurance Board) which also runs the MRMIP -- California's state risk program.

The funding was intended to provide health insurance coverage for those who were uninsurable and had not had coverage in more than six months prior to applying. Original utilization projections were between $1000 and $1,100 Per Month Per Member. Actual utilization has been determined at $3,100 Per Month Per Member, over three times the projected usage. (see MRMIB November PCIP Agenda Item)

CA PCIP is currently seeking an additional $500,000,000 of funding to increase the available member slots to 11,247, still over 50% below the original projection of 24,100 member slots. If such additional funding is not recei…

Blue Shield CA Continues 'New to Medicare' Supplement Discount

Blue Shield of California currently offers a discount of premium for the first 12 months to those who are turning 65 or otherwise "new to Medicare". The discount is $20.00 per month off of the premium for each of the first 12 months. For those who wish to use the checking deduction payment options (EFT), an additional $2 discount is available.

In addition, Blue Shield CA Medicare Supplement plans include Silver Sneakers at no additional cost.

Blue Shield is planning to continue the discount for those "new to Medicare" into 2012. This discount combined with the free Silver Sneakers benefit makes Blue Shield Medicare Supplements very competitive in California.

For more information, give me a call, e-mail or use the Information Request Form on my web site.

Find Me Here

Anthem Blue Cross CA Discontinues Short-Term Policies

Anthem Blue Cross California will discontinue the sale of short-term health insurance policies effective January 1, 2012. Those on existing short-term policies will be able to continue until their normal end date.

This is no surprise as Anthem removed short-term policy applications from our online agent web sites a few months ago.

You may continue to purchase a short-term policy with Anthem Blue Cross in California until the end of the year.

We are discontinuing new sales for all Short Term policies effective January 1, 2012 for California. Applications will continue to be accepted and processed if we receive them by December 30, 2011 for effective dates on or before December 31, 2011

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Blue Shield CA Medicare Supplement Discount

Starting August 1, 2011, Blue Shield of California will be offering a $20 per month premium discount for 'new-to-Medicare' Supplement enrollees. This discount applies to anyone who is new to Medicare (just enrolled in Part B). Generally this applies to those turning 65 although certain 'late enrollees' can qualify who are over age 65.

The discount is good for one year for eligible applicants. An additional $2 discount is available for those who are eligible also choose the Easy Pay method of paying monthly premiums.

This represents a great value to those going onto Medicare and a Supplement Plan.

Contact me for more information.

Dave (

Blue Shield CA New 15-Day Enrollment Rule

Mirroring Anthem Blue Cross' current requirement, Blue Shield of California announced (9 days after it went into effect,btw) yesterday to agents that effective June 1, all individual & family applicants start dates cannot be set less than 15 days prior to Blue Shield's receipt of the application.

For PPO plans, the start date must be 15 or more days after the receipt date. Example: Application received on June 10th soonest start date June 26th.

For HMO plans because they only have a 1st of the month start date, any application received by Blue Shield after the 15th of a month (earlier for February) would start the 1st of the following month. Example: Application submitted on June 10th soonest start date Jule 1st. Application submitted on June 20th, soonest start date would be August 1st.


Dave (

Anthem Blue Cross CA Premium Payment Final Update

This is a final update for Anthem Blue Cross individual & family plans premium payment changes.

Effective August 1, 2011 Anthem will eliminate the following premium payment methods:

*Recurring Credit Card
*Bi-monthly Billing
*Quarterly Billing

There will be three premium payment options available to subscribers. All should have received information from Anthem by mail regarding these options. They will be:

*Monthly Direct Billing ($2 fee will be waived until further notice)
*Checking Accound Deduction (EFT) Monthly
*Ability to pay premiums via Anthem web site (

The use of the web site will require creation of a login and there is no charge to pay premiums via the web site.

Dave (

Anthem Blue Cross CA To Add Paramedical Exam Requirement

Effective 6/15/2011, Anthem Blue Cross California will begin requiring (and paying for) a paramedical exam for certain applicants. This is a new requirement, however it has been done in the past but at the applicant's expense. Now it will be paid for by Anthem Blue Cross.

The following situations will require a paramedical examination paid by Anthem Blue Cross CA:

1. Applicants 55 years or older who have not seen a doctor in 24 months or more;

2. Applicants 30-54 years old who have not seen a doctor in 5 years or more

Situations like this are fairly uncommon although I have seen a few cases where the new paramedical exam would apply. The good news is that the applicant no longer will have to pay for the exam themselves!


Dave (

California MRMIP and PCIP

Just wanted to post a quick note that I have added a separate page to my web site for MRMIP and PCIP in California. The information will continue to be available on the state programs page, but I didn't want to bog that page down with MRMIP and PCIP information as it is more a general information page.

By adding a special section for MRMIP and PCIP in California, I have the opportunity to expand the information concerning these risk pools and dedicate the necessary room on my site.

The MRMIP and PCIP California information including enrollment materials, rate information and plan summaries can be found here: California MRMIP & PCIP Plans.

Dave (

Anthem Blue Cross CA Delays Premium Payment Change

Anthem Blue Cross recently stated that they would elminate month recurring credit card payments as a premium payment option on individual & family health plans.

Agents were recently notified that this change will be pushed out at least two months beyond the May 1 original deadline. Until futher notice, credit card premium payments will continue with Anthem Blue Cross CA. I will advise when and if the final date of change for this is actually set.

Dave (

Blue Shield CA Cancels May 1 Rate Increase

Blue Shield of California has announced this evening that the health insurer is officially withdrawing the proposed May 1 rate increase. Blue Shield is further guaranteeing no further rate action for the remainder of 2011 on all CDI (CA Dept of Insurance) registered PPO plans (excluding HIPAA and Conversion). This affects approximately 340,000 California residents.

Blue Shield originally proposed a rate increase set for March 1, 2011 (The third since October , 2010). The carrier agreed to hold off 60 days on that rate increase to allow California Insurance Commissioner Dave Jones time to have an audit of the rate increase performed. The audit found the rate increase to be in-line and justified.

Those currently enrolled on Blue Shield CDI-registered underwritten PPO plans (not including HIPAA or Conversion) will have no rate change at all until at least 1/1/12.

Read Blue Shield's Press Release here

Dave (

Health Net CA Security Lapse Affects 1.9 Million

IBM, which manages Health Net's technology infrastructure, recently notified Health Net that it cannot find several computer hard drives. These drives store information on subscribers (past and current), employees and healthcare providers. The drives contain information related to approximately 1.9 million people.

Health Net has agreed to provide two years identity theft protection to those affected. You can get more information from Health Net by calling (855) 434-8081.

This is the second security lapse in the California health industry. Anthem Blue Cross had a breach which compromised some online information about a year ago. In both cases, the security breach was the fault of the third-party technology vendor, no the health insurer. Seems the people who are supposed to build and maintain the technology are lacking, at least in these two cases.

LA Times Article

Dave (

Blue Shield CA Cumulative Rate Increase Could Exceed 85% For Some

The newest rate increase on Blue Shield CA/Blue Shield L&H individual and family plans in California is now set for May 1, 2011. It was originally scheduled for March 1, however it was delayed 60 days at the request of California Insurance Commissioner Dave Jones.

This rate increase represents the third rate increase on Blue Shield family plans since October 2010. Blue Shield increased rates on 10/1, again on 1/1/11 to accommodate PPACA (ObamaCare) and now again on 5/1/11. For some these rate changes will have a cumulative increase of over 85% in just seven months.

Blue Shield, even with the rate increase projects losses in individual & family business in California of $20-$30 million in 2011. They lost $27 million in 2010. By contrast Anthem Blue Cross CA estimates losses as high as $100 million on the same business for 2011 with almost $70 million lost in 2010.

See the LA Times article by Duke Helfand.

Dave (

3 Minutes of Brilliance (Jack LaLanne) You Can't Buy Health

Jack LaLanne, the 'godfather' of fitness, has been one of my personal idols since I was a child. This video from over 50 years ago is perhaps more pertinent today than it was then.

Dave (

Anthem Blue Cross CA To Change Premium Payment Options

Anthem Blue Cross CA will be making the following changes to premium payment options for individual & family health insurance plans (including dental and life).

By May 1, Anthem will eliminate the monthly recurring credit card payment option. Those currently on monthly credit card premium payment will be required to change to another option.

Anthem will offer a monthly direct billing option (currently it is only bimonthly or quarterly)and will continue to offer checking account deduction option.

Letters will be mailed from Anthem to subscribers concerning this change and the options available. Those on credit card premium payments will need to make an alternate arrangement to pay premiums for their health insurance policies.

Dave (

BSE, Mad Cow, Creutzfeldt-Jakob disease - Fellow Veterans

Good evening. This particular blog is not really so much about health insurance as about a health issue I only recently discovered. It is directed to my fellow military veterans who served in the UK and/or Europe as well as any of my readers who lived in Europe for an extended period between 1980 and 1996 (between three and six months or more).

I was stationed in Berlin, Germany from 1983-1986 serving with the USAF Electronic Security Command (ESC) as a Cryptologic Slavic Linguist.

We are prohibited from ever donating blood. I had no idea! Apparently anyone who lived or was stationed pretty much anywhere in the UK or most of continental Europe during those years is at risk due to exposure to Mad Cow Disease (BSE) and possible development of vCJD (Creutzfeldt-Jakob Disease).

There is no "test" for these so the blood banks and Red Cross take the approach of just refusing to avoid any potential future problems. From my reading, the incubation period for these diseases is basical…

California's Hidden Non-Dependent Tax On Health Premiums

A part of the PPACA (ObamaCare) provides that parents may add children to their employer-sponsored coverage plan up to age 26, whether a dependent student or not.

Turns out California's tax law requires the state to levy taxes on any amount of premium paid by the employer for non-dependent children of employees.

Many California workers added non-dependent children under age 26 to their group health plans in favor of paying premiums for the coverage. According the the Sacramento Bee article, the result is a bump in taxable income to reflect the employer's contribution.

See the article here.

Florida Halts PPACA Implementation

On Monday, Florida US District Judge Robert Vinson declared the PPACA (ObamaCare) unconstitutional. This sets the stage for appeals and eventually the US Supreme Court. Because the 'individual mandate' requiring all Americans under 65 (not insured by an employer or government program) to buy health insurance or face a fine was deemed as unconstitutional and was written as non severable, the mandate itself renders PPACA as a whole unconstitutional (per Judge Vinson).

In the first of what will undoubtedly be several state rebellions, Florida today shut down all further implementation of the PPACA (ObamaCare) in the state and retracted a MLR (medical loss ratio) waiver that had been submitted. 27 States were represented in Judge Vinson's decision (not California)and it might be expected that the remaining states may take similar action in the near future.

Article here

Dave (

Blue Shield CA Agrees To 60-Day Rate Hold On Individual Plans

Blue Shield of California (and Blue Shield Life & Health) announced this afternoon that the company will abide by the request of Insurance Commissioner Dave Jones and hold the March 1, 2011 rate increase for 60 days so that the rates can be reviewed.

Late last week Blue Shield stated that they were satisfied with the rate increase and would not honor the request of the CA Insurance Commissioner.

For those with Blue Shield CA individual & family health plans who are not in your initial rate guarantee period, your rates will not be increasing on March 1 as projected.

Blue Shield will notify agents as to when, if and by how much the rate increase will actually go into effect.

Dave (

Anthem Blue Cross CA Finally Gets Approvals!

Just received a voicemail from Anthem Blue Cross California that the plan portfolios held up by the California Dept of Insurance have finally been approved.

These plans have been pending approval since September 22, 2010.

According to the voicemail the new plans (all PPACA-compliant) will be available for sale tomorrow (1/14/11) to the public.

I will update this post with the particulars of the plans now available as soon as I receive the written confirmation in the morning.

Dave (