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Showing posts from 2012

United Health To Take Over TRICARE West Region 2013

Effective April 1, 2013, TriWest, the current administrator for TRICARE west region, will be replaced by United Healthcare for administration of TRICARE in the west region.  

TriWest recently dropped a 2013 requirement for all premium payments by electronic transfer until UHC takes over the administration.  Premium payments for TRICARE under TriWest can continue by check or telephone.

For those of us on TRICARE, we are hopeful for a smooth and uneventful transition from TriWest to UHC administration.  

TRICARE West Region includes the following states:



Anthem Blue Cross Raising Medicare Supplement Rates in 2013

Anthem Blue Cross California has announced a rate increase for Medicare Supplement plans for March 1, 2013.  

The following open plans will experience a 5% rate increase March 1, 2013:

Plan F
Plan G 
Plan N

In addition, many standardized closed plans (pre-June 2010) and non-standardized closed plans will experience rate increases on march 1, 2013 ranging from 1.3% to 9.9%.

Open plans are Medicare Supplement plans currently available for sale to California residents on Medicare or going onto Medicare.


State Decisions For Creation of Health Insurance Exchanges

As of December 14, 2012, 19 states, including California, have declared a state-based exchange for the PPACA.  The District of Columbia, while not technically a state, is included in this number.  7 states plan to run a partnership exchange (combined state/federal exchange) while 25 states (most recently Arizona) will default to the federal exchange and will not create nor set up a state exchange.

The California Health Benefits Exchange will be a state-run exchange and will go by the name 'Covered California'.

States may choose to set up their own exchange, run a partnership exchange with the federal government or do nothing and allow the federal government to run the exchange for that state.

The Kaiser Family Foundation web site has a list which is current as of 12/14/12.  Link below.

State Decisions For Creating A Health Insurance Exchange


Aetna CEO "Get Ready For Rate Shock" In 2014

From today's Forbes Magazine Blog by Avik Roy.  Aetna CEO Mark Bertolini discusses the likelihood that individual & family rates under PPACA (Obama Care) may experience a large premium increase over the current health plan rates as well as a narrowing of provider networks  and cutting of reimbursement rates to medical providers.

Aetna CEO Bertolini: Get Ready for 'Rate Shock' as Some Health Insurance Premiums to Double in 2014

I am curious to see the 'Covered California' individual & family rates for 2014 however I don't expect them to be available for quite some time as the plan designs for the Qualified Health Plans are still in the infant phase of development.


Blue Shield CA To Return $50 Million In Premium Credit

Blue Shield of California has announced that the insurer will return $50 million in premium credits for the 2012 2% Pledge.  

From the Blue Shield web site:

As a not-for-profit health plan dedicated to providing access to quality health care at an affordable price for all Californians, Blue Shield of California believes health care is a fundamental right. But access to care will only be achieved if coverage is affordable.

That's why we made this pledge: if we earn net income of more than 2% of revenue in any year, we will give back the difference to our customers and the community. Blue Shield is committed to the 2% Pledge, as long as our board of directors determines that the company remains financially solvent, with sufficient funds to make the investments needed to stay competitive.

To date, Blue Shield has returned more than $470 million to customers and the community to offset net income earned above the 2% threshold in 2010 and 2011.

In 2012, Blue Shield will again fulfill our 2%…

Blue Shield CA Increase on IFP Rates 3/1/13

Blue Shield of California has announced a rate increase on their individual & family health plans for March 1, 2012.  

Rate increases on some members may be as high as 20% with an average rate increase of 12% across the board.  

LA Times Article

This rate increase comes at a time when recent news of Anthem Blue Cross' (Blue Cross of California) has notified subscribers of a 25% rate increase February 1, 2013 and Aetna has also indicated a rate increase for 2013.  I would expect Health Net PPO to adjust rates as well in 2013.


California Exchange named "Covered California"

The California Health Benefits Exchange has approved the name for the Exchange, which will open on January 1, 2014.

Although I though "Avocado" was cool, and also liked "Condor" quite a lot (and hated Ursa which did make the finals), those names were eliminated in test panels and "Covered California" was chosen as the new exchange name going forward.


Exchange marketing is set to begin on July 1, 2013 and we should have a clearer idea on both Qualified Plan design and pricing in the market (inside or outside of the exchange).

Blue Shield of California Extends "Birthday Rule" Medi-Gap Open Enrollment

Blue Shield of California (and Blue Shield Life & Health) has extended the Medicare Supplement change period through February 2013.

California is one of the few states that has a "birthday rule" with regard to those on Medicare with a Medicare Supplement or "Medi-Gap" plan.  In California, those on Medicare may choose to move to a "like or lesser" supplement plan every year on their birthday and 30 days thereafter.

Blue Shield of California currently offers an 'anytime' option for those wishing to move to a like or lesser Medicare Supplement with Blue Shield from their current Supplement plan.

Blue Shield has raised Supplement rates for the first time in 2 years effective December 1, 2012.  They also reduced the "new to Medicare" first year monthly discount from $20 per month to $15 per month and increased the discount for paying by check/savings deduction from $2 per month to $3 per month.

Blue Shield Medicare Supplement plans include t…

Anthem Blue Cross IFP Rate Action 2/1/13

Anthem Blue Cross has announced a rate action from California individual & family health plans that will take effect on February 1, 2013.  This rate action does not effect HIPAA nor Conversion policies but does effect underwritten Blue Cross of California and Blue Cross Life & Health policies.

Anthem will begin sending notifications to effected members this month.  

For those who continue to be eligible for plan change options under either Serencsa or Feller-Freed (or both) and experience a rate increase, enrollment periods for this rate change will be made available for February 1 plan changes.


California Senior Gateway Protection Web Site Online

California Insurance Commissioner Dave Jones recently announced a new web site designed to help protect California Seniors from fraud, scams, abuse and neglect.

The Senior Gateway web site is a California state-sponsored site and is a "one stop" web site intended to provide seniors, their families and caregivers with the information they need to connect to helpful services and resources, to find answers and to solve problems.
This site is an excellent resource to help protect California seniors  Click on the link below to visit the California Senior Gateway site.

California Senior Gateway


Medicare Changes for 2013

Medicare has released new premium and deductible numbers for 2013. They are as follows:

*Medicare Part A Deductible 2013   $1,184 (up from $1,156 in 2012)
*Medicare Part B Deductible 2013   $147    (up from $140 in 2012)

Medicare Part B Premiums 2013:

*Singles with income $85,000 or less or Joint $170,000 or less will pay $104.90 
(up from $99.90 in 2012)

*Singles with income $85,001 to $107,000 or Joint $170,001 to Joint $214,000 will pay $146.90 
(up from $139.90 in 2012)

*Singles with income $107,001 to $160,000 or Joint $214,001 to $320,000 will pay $209.80 
(up from $199.80 in 2012)

*Singles with income $160,001 to $214,000 or Joint $320,001 to $428,000 will pay $272.70 
(up from $259.70 in 2012)

*Singles with income $214,001 and above or Joint $428,001 and above will pay $335.70 


No More Phony CA Health Exchange Web Sites - CA AB 1761

We've all seen them.  Web sites touting themselves as the "California Health Exchange" or something similar.  Some provide a disclosure (usually at the bottom and often in small type) that the site is, in fact, an insurance agent's web site and is in no way actually affiliated with the 'real' CA Health Benefits Exchange.  Lately I have seen a couple with no disclosure at all.  
Well, that party is now over in California and those of us who have been following the HBEX (Health Benefits Exchange) knew it was coming.  
On September 30, 2012, Governor Brown signed into law California Assembly Bill 1761.  The bill, now law, prohibits agents (and other entities) from claiming any affiliation with the CA HBEX as well as any advertising including social media that makes any such claim.  It is now against the law in California for an agent or agency to pretend that they are somehow representing or affiliated with the California Health Exchange.
From AB 1761: (j) Holding o…

The Cost of Mandatory Maternity Benefits in California

Under CA SB 222, all individual & family health insurance plans in California were required to provide, or add and provide, mandatory maternity coverage to all plan members. 

Prior to July 1, 2012 when the mandate went into effect, plans offering maternity coverage were priced higher in terms of monthly premium to reflect actuarial maternity benefit utilization.  

Because the PPACA allows HHS (federal) to review and approve or reject insurance company rate increases on health plans that are 10% or more, and because the California Insurance Commissioner can make enough bad press for a carrier (he currently does not have rate authority in California--that is pending under AB 52), insurance carriers had to add the benefit and try to make the plans actuarially sound. 

Looking at California's two largest PPO insurers for individual & family plans (HMO plans were and are always required to provide maternity benefits) the effect is a bit stunning.

Blue Shield Life & Health (Blue …

Anthem Blue Cross CA Closing More PPO Plans 2012

Anthem Blue Cross (Blue Cross of California and Blue Cross Life & Health) has announced additional closures in California for individual & family health plans.  
In addition to the plan closures earlier this year (2012) which were posted on my blog, the following individual & family health plans will close on November 1, 2012:
*SmartSense Plus PPO 1000 Standard Rx *SmartSense Plus PPO 1000 Upgrade Rx *Lumenos 3000 HSA PPO (single) *Lumenos 4500 HSA PPO (single) *Lumenos 3500 HSA PPO (family) *Lumenos 1500 HSA PPO
Members currently enrolled in these plans may stay on the plan after it closes on November 1.  Applications for enrollment into any of these plans will not be accepted after October 16, 2012. Applicants may enroll in these plans so long as their effective start date is prior to November 1, 2012.

Blue Shield CA Medicare Plan Changes Coming

Blue Shield of California has announced some changes for Medicare beneficiaries in California. Medicare Supplement plans will have a plan premium rate change effective December 1, 2012. I will post the December California Medicare Supplement rates on my site 
(Medicare Supplements) in a few weeks. In the meantime I have the rates available for quoting via telephone or e-mail. In addition, 

Blue Shield CA will be adding two new Medicare Supplements to their portfolio. Additions will include High Deductible Plan F and Plan N. The current $20 per month "new to Medicare" discount will be reduced to $15 per month for those enrolling in Medicare Part B for the first time. As always, Blue Shield of California Medicare Supplement Plans include the Silver Sneakers health club membership at no additional cost. For more information about Blue Shield Medicare products, visit my web site. 


SB 1431 Moved to Inactive File

On August 31, SB 1431 was moved to the Inactive File. This bill was ordered to inactive file on the request of Assembly Member Charles Calderon.

Inactive file bills may be opened again at a later date for reconsideration. As of now, it appears that SB 1431 (the "stop-loss" bill) is no longer on the table in California.

Small group plans may continue to utilize current 'self-funded' plans for their employee health benefits.

SB 1431 Status

Previous Blog updates on SB 1431:

July 24 SB 1431 Update

May 21 SB 1431 Update

April 20 Original SB 1431 Blog Post


As always, for specific information on health insurance plans and programs, visit my site using the link above

Naming the California Health Exchange

Please feel free to submit your idea for a name for the California Health Benefits Exchange in the comments below. It won't make it to Sacramento but should be fun nonetheless.

According to David Gorn at Californiahealthline, these are the current 'nominees" for the name of our upcoming health benefits exchange in California.

More Traditional:

*Covered California

Interesting Names:

*Healthifornia (A Better State of Healthcare)
*Eureka (Discover Affordable Healthcare)
*Avocado (A Uniquely California Approach to Affordable Healthcare)

Apparently 'Condor' has already been eliminated from contention due to it being being both a vulture and in peril of extinction.

Personally, I like Avocado the best. So you can put me down as an Avocado man!

I wonder if I should change my business to 'Condor Insurance Services' (smiley).


As always, for specific health insurance information please…

California Health Benefits Exchange August 25 Update

Some updates to my previous HBEX blog post August HBEX Update from August 13th. The HBEX Board meeting on August 23rd has some agent/broker actions as follows:

*Agent Compensation for individual & family coverage plans (IFP) will be paid to agents directly by the health insurance carrier at an equal level (parity) for plans sold both inside and outside of the health benefits exchange.

*Agent Compensation for small group coverage plans (SHOP) will be paid directly to agents by the SHOP exchange for SHOP plans and directly to agents by the carrier for plans sold outside of the SHOP exchange.

*Member premiums for individual & family coverage plans will be paid to the insurance carrier and not to the exchange.

*Employer premiums for small group coverage plans will be paid to the SHOP exchange directly and not to the carrier(s).

*Agents and Brokers must certify with the exchanges in order to sell health plans for the exchange. Agents and Brokers who do not certify will not be allowed t…

California Individual & Family Exchange Similar to

I recently ran across an article comparing the purchase of individual & family health insurance coverage through the California Health Benefits Exchange to shopping online at Amazon, Travelocity, or Expedia. Sure sounds easy enough. Just pick the health plan you want and click on a button to buy it from the Exchange, just like you get your airline tickets or new book by your favorite author shopping online today. And with no medical underwriting it should be even easier than it is today. And it will provide a tax subsidy for the cost of premiums for those who qualify. What could be simpler?

Well, no, the Amazon example that has been bandied around is a very poor example of how you will buy health insurance coverage in the Exchange in California. Unless, of course, Amazon and Expedia initiate new requirements to provide a bit more of your personal and financial information that just a credit card number to purchase the ticket or the book.

California individuals & families p…

California Medicare Supplement MLR (Medical Loss Ratio) Requirement (Current)

Under the PPACA (Obamacare), individual & family health plans (IFP) as well as small group health plans (2-50 employees) in California must meet a Medical Loss Ratio (MLR) of 80% or above. This means that 80% of each dollar earned in premium must be spent on direct medical care and cannot be used for sales, marketing or administrative expenses.

Large group health plans in California (51+ employees) must meet a slightly higher MLR under PPACA of 85%.

PPACA did not impact the Medicare Supplement market and, as such, Medicare Supplement health plans for seniors and those under age 65 on Medicare are not subject to PPACA-mandated Medical Loss Ratios.

However, California Health & Safety Code Section 1358.14 does specify the Medical Loss Ratios (MLR) for California Medicare Supplement Plans.

Individual Medicare Supplement Plans must meet an MLR of at least 65% and group (employer-sponsored) Medicare Supplement Plans must meet an MLR of at least 75%.

When a carrier falls below the curren…

California Medicare Supplement "Birthday Rule"

For those on Medicare and enrolled on a Medicare Supplement Plan, the California Insurance Code provides a provision for annual Medicare Supplement changes. This provision is commonly referred to as the "Birthday Rule".

Under California Insurance Code 10192.11 (h) 1, the following is available in regard to Medicare Supplement Plans in California:

"(h) (1) An individual shall be entitled to an annual open
enrollment period lasting 30 days or more, commencing with the
individual's birthday, during which time that person may purchase any
Medicare supplement policy that offers benefits equal to or lesser
than those provided by the previous coverage. During this open
enrollment period, no issuer that falls under this provision shall
deny or condition the issuance or effectiveness of Medicare
supplement coverage, nor discriminate in the pricing of coverage,
because of health status, claims experience, receipt of health care,
or medical condition of the individual if, at the time …

California PPACA 2011 Individual Plans Rebate Breakdown By Insurer

Approximately 1.9 Million Californians will receive or should have already received MLR (Medical Loss Ratio) rebates from their Dept of Insurance-registered health insurance plans. Not all plans nor all members were entitled to a rebate from the 2011 medical plan. Overall per carrier rebates are as follows:

Blue Shield of California Life & Health - $10.8 million dollar rebate to policyholders in the individual & family market. Applies to approximately 239,595 subscribers. $45.15 average rebate per subscriber.

Anthem Blue Cross Life & Health - $1.3 million dollar rebate to policyholders in the individual & family market. Applies to 407, 429 subscribers. $3.16 average rebate per subscriber.

Kaiser Permanente Insurance Company - $277,034 dollar rebate to policyholders in the individual & family market. Applies to 21,823 subscribers. $12.69 average rebate per subscriber.

Aetna Life Insurance Company - $1.3 million dollar rebate to policyholders in the individual &a…

California Health Benefits Exchange - August Update

I decided to blog about the updates from the CA HBEX (Health Benefits Exchange) because I am sure that the public has curiosity and a lot of agents have contacted me for updates and information.

Some time ago I was advised to stop reading 3rd party materials and concentrate on information provided directly by the CA HBEX Board and Stakeholders. Best advice I have received regarding California Health Care Reform. I want to personally thank Mr. Peter Lee and the Board of the California HBEX for the remarkable transparency of information they provide. An agenda is provided for each board meeting which is available live via Webcast and also is later made available to re-watch via link. They even have live Twitter feeds ongoing during the meetings.

For the general public, the August Webcast won't have a ton of action items. The main items of interest (in my opinion) would be action items of Election of Chair, Exchange Bylaws and Qualified Health Plan Policies.

For health insuranc…

Blue Shield CA Reaches Contract Agreement with University of California (UC)

Blue Shield of California finalized negotiations with University of California and signed new agreements with the providers at each campus.

UC San Siego, UC Irvine, UC San Francisco and UC Davis remain in the Blue Shield network.

UCLA providers will return to the network effective September 1, 2012.

The new, long-term agreement runs through June 30, 2015.

Product impact as follows:

UC San Diego
Medical Centers - HMO & PPO
Transplant Services - HMO & PPO
Ambulatory Surgery Center - HMO & PPO
Dialysis Center - HMO & PPO
Pharmacy Home Infusion Services - HMO & PPO
Medical Group - PPO only

UC Irvine
Medical Center - PPO & HMO
Medical Group - PPO only

UC San Francisco
Medical Centers - HMO, PPO, Medicare Advantage HMO
Transplant Services - HMO, PPO, Medicare Advantage HMO
Medical Group - PPO only

UC Davis
Medical Center - HMO & PPO
Transplant Services - HMO & PPO
Medical Group - PPO only

UCLA(effective 9/1/12)
Medical Center - HMO & PPO
Transplant Services - HMO & PPO

Anthem Blue Cross CA Issues MLR Refunds to Qualifying Medicare Supplement Members

Owing to lower-than-anticipated expenses on Medicare Supplement plans in 2011, Anthem Blue Cross (Blue Cross of California) has announced a MLR (Medical Loss Ratio) refund for certain qualifying subscribers on their Medicare Supplement plans.

Refund distributions will begin on August 13, 2012, on certain plans in California. Other effected states include Colorado, Maine, Ohio and Wisconsin.

* Refunds range from $8.00 to approximately $1,780.00
* Not all policies and not all members qualify for a refund
* Members on qualifying plans who were enrolled on 12/31/2011 may receive a refund
* Anthem cannot predict whether there will be refunds in future years. This specific refund is based on total claims experience of all Medicare Supplement policyholders of a particular policy or group of policies.

California Members who have questions about their California refund should contact Customer Service Toll-Free at 800-333-3883.


Women's Preventive Care Enhancements Begin Today

August 1, 2012

Today health plans implemented the mandated expansion of women's preventive care services as directed by HHS.

Enhanced benefits include:

*Well Woman Visits
*Screening for Gestational Diabetes
*Testing for HPV
*Counseling for Sexually Transmitted Infections
*Screening and Counseling for HIV
*FDA Approved Contraception Methods and Contraceptive Counseling
*Breastfeeding Supplies, Support and Counseling
*Screening and Counseling for Interpersonal and Domestic Violence

The important thing to remember here is that these new benefits are automatically included in any new health policy with an effective start date of August 1, 2012 or after, Existing health insurance policies may not add these enhancements on immediately and woman on existing policies may have to wait until a specified date for the addition of the enhanced benefits.

For example, Anthem Blue Cross of California will add these enhanced benefits onto existing policies (before 8/1/12) at the start of the new policy yea…

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.


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.


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


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…

SCOTUS on PPACA (ObamaCare) June 28, 2012

Live blog while watching the decision on Scotusblog.

PPACA (ObamaCare) is upheld and will go forward! Individual mandate deemed constitutional.

I will blog later with more details.

Well, that was an interesting morning and for many a bit of a surprise. The Supreme Court ruled that the individual mandate to purchase health insurance coverage is considered a "tax" and not a "penalty" and, as such, falls under Congressional authority and is constitutionally legal.

Undoubtedly there will be many announcements, blogs and video responses from the various parties with regard to this decision.

Below is a link to the PDF of the court's decision (all 67 pages):

SCOTUS Decision


Martin Vs. Blue Shield CA (The Next Feller-Freed)

After the Feller-Freed and Serencsa-Lichtman class action settlements with Anthem Blue Cross (Blue Cross of California) I assumed it would simply be a matter of time before similar action was taken against Blue Shield of California. That action was announced by Consumer Watchdog last week.

Blue Shield recently announced (and I blogged) the closure of the majority of their current individual health plans to be replaced by new plans July 1,2012.

Until this case is settled there really isn't a lot to talk about. I will blog when we get information regarding any potential settlement with Blue Shield and the plan migration choices that might be available to those on closed or closing individual plans.


Update: Anthem Blue Cross CA Closing Clear Protection Plus 1000 PPO

Anthem Blue Cross California has announced the options available to those who are currently members of the Clear Protection Plus 1000 PPO plan.

In my prior blog (CP Plus 1000 Closing) Anthem Blue Cross CA announced the closure of the plan on June 30, 2012. Today, Anthem provided clarification on the options available to those who are enrolled on the plan or those who will enroll before the end of the month. The options are as follows:

*Members currently on the Clear Protection Plus 1000 policy may remain on their policy and add family members to the policy subject to medical underwriting. They may do so until or unless they request a plan change via current underwriting procedures.

*Members may elect to change plans during a special open enrollment period from September 1, 2012 to September 30, 2012 with no medical underwriting. Clear Protection Plus 1000 members can move to the following plans during the open enrollment period:

*CoreGuard Plus 750 (06B6)
*CoreGuard Plus 1500…

Blue Shield HIPAA Plan Update

To follow up on my May 25th blog post regarding Blue Shield of California HSA 4000 plan closure for HIPAA, I wanted to post an update.

After several days of run around and legalese, I finally was able to determine that Blue Shield of California's current HIPAA portfolio is heavily weighted on DMHC (CA Dept of Managed Health Care) registered health plans (3) with only 1 CDI-registered plan (California Dept of Insurance). A normal arrangement would be 2 plans from each registration and, in the case of Blue Shield prior to 6/1, 3 DMHC and 2 CDI registered plans.

California Health & Safety Code requires an insurance company selling individual plans in California to offer two "popularly marketed health plans" to the HIPAA risk pool for each registration. Over the last several years most insurers have registered PPO plans with the Dept of Insurance (CDI) as opposed to the DMHC.

Blue Shield of California is opening a new portfolio of plans on July 1. The entire portfolio of…

Blue Shield CA Extends Medicare Supplement Special Enrollment Period

Blue Shield of California has announced the extension of their "special enrollment period" for Medicare Supplement plans in California to November 30, 2012. Previous end date was September 30, 2012.

The special enrollment period is basically a full-time "birthday rule". In California, those who are covered by Original Medicare and a Medicare Supplement Plan (Medi-Gap) (A-N) have the right, on their birthday, to move to any other insurance companies' like or lesser Medicare Supplement Plan with no medical underwriting. California is one of the few states that has a "birthday rule" in regard to Medi-Gap plans.

The current Blue Shield CA special enrollment period allows those covered by a Medicare Supplement with another insurer to move to a "like or lesser" Supplement plan with Blue Shield with no medical underwriting in any month, not just the month of your birthday.

Additionally Blue Shield CA has also extended the "new to Medicare"…

Anthem Blue Cross CA Closing Clear Protection Plus 1000 PPO

Anthem Blue Cross (Blue Cross of California) announced very late this afternoon (4:40 PM PST to be exact) the pending closure of the Clear Protection Plus 1000 PPO plan (06B3) effective July 1, 2012.

No reason for the closure was given with the announcement. I have a query in but don't expect an answer until after the holiday.

Current members may remain on the Clear Protection Plus 1000 plan or may elect to move to a new plan (choices not yet identified) during an upcoming open enrollment (also not specified).

This represents the second closure of a Clear Protection Plus plan in the last 60 days. The Clear Protection Plus 5000 PPO was closed May 1, 2012. This leaves only one Clear Protection Plus plan available to the public after July 1, the Clear Protection Plus 3300.


Blue Shield California Removes HIPAA 4000 HSA PPO

One of the more popular HIPAA guaranteed-issue plans over the last couple of years has been the HSA-compatible Spectrum Savings PPO 4000 with Blue Shield of California (Life & Health).

With the previously blogged closure of the majority of Blue Shield's PPO health plans (July Plan Closure Blog), including the 4000 Savings PPO, the plan has also been removed from the offerings for HIPAA.

As of today, it is my understanding that Blue Shield does not intend to replace the 4000 HSA PPO plan in the HIPAA portfolio and has no intention of offering any HSA-compatible PPO plan for HIPAA-eligible individuals & families. I was told that until and unless I hear otherwise, the HIPAA portfolio available from Blue Shield will be as follows:

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

These are also the four remaining underwritten individual & family plans that are not being closed to new enrollments July 1.

Both Blues (Blue Cross of California (Anthem) and Blue Sh…

California MRMIP: How To Get There From Here

I wanted to post about a relatively new enrollment process with regard to the California MRMIP (Major Risk Medical Insurance Program). Mainly I want to advise people interested in enrolling in MRMIP to be sure and submit paperwork well ahead of the desired start date.

Until recently, California residents wishing to enroll in the Major Risk Program (MRMIP) or the temporary PCIP (Pre-Existing Conditions Insurance Program) could choose which program they wished to enroll into based on qualifications and eligibility requirements. At one time there was a separate application form and enrollment guide for each of the Risk programs.

Currently, the PCIP handles all enrollment processing for both PCIP and MRMIP in Folsom. Using the newer, unified application form, applicants must submit the paperwork first to PCIP for initial processing. Even if you choose the MRMIP and have no interest nor eligibility for PCIP, the PCIP folks must first determine that you are, in fact, not eligible for PC…

CA SB 1431 Update (May 21)

I just wanted to provide an update on CA SB 1431 which deals with self-insured group health plans. See my previous blog post:

California SB 1431 To Limit Self-Funded Small Group

California SB 1431 passed appropriations by a 4-2 vote on May 14th, 2012. On May 16th, a second reading was conducted and the bill was ordered to a a third reading which has not yet been scheduled.

Stay tuned to this blog for updates regarding the status of CA SB 1431 (De Leon).


InsureBlog: The Passing of a Legend

My friend and fellow agent Bob Vineyard said it as well as I could have. We lost a friend, agent, mentor, colleague and legend this month. RIP Frank Stastny.

InsureBlog: The Passing of a Legend


Aetna to Add IFP Maternity and Autism Benefits in California

Aetna announced to agents yesterday that they will be adding both the mandatory maternity benefit and the new autism benefit to their existing IFP (Individual & Family Plans) portfolio.

Last year Aetna closed IFP operations in Colorado due, in part, to mandatory maternity benefits. Many agents in California were waiting to see what action Aetna would take here.

In California, effective July 1, 2012, all individual & family health insurance plans must cover maternity benefits under SB 222 which was signed into law last fall.


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!


Women's Preventive Care Enhancements August 2012

As directed by the ACA (Affordable Care Act), preventive care services for women will be enhanced for all non-grandfathered health plans in California (and all other states as well).

In addition to current preventive benefits, the following preventive benefits for women will be added to existing and new non-grandfathered health insurance plans including self-funded group health plans:

* Well-Woman visits
* Screening for gestational diabetes
* Testing for HPV (human papillomavirus)
* Counseling for sexually transmitted infections
* Screening and counseling for HIV
* FDA-approved contraceptive counseling and contraception methods
* Breastfeeding support, supplies and counseling
* Screening and counseling for interpersonal and domestic violence

For those purchasing coverage on or after August 1st, the health plan will include the expanded preventive benefits.

For those on existing health plans prior to August 1st, the benefits will be added at the policy renewal of your policy. Most likely not late…

Blue Shield CA Adds Premium Requirement for Applications

Beginning May 1, 2012, Blue Shield of California (and Blue Shield Life & Health) will require initial premium to be submitted with new individual & family applications.

Currently (and in the past), Blue Shield has allowed applications to be processed without the premium accompanying the application.

As of May 1, 2012 any individual & family plan application submitted without premium will be returned and not processed.


Anthem Blue Cross CA May 1, 2012 Rate Change Update - Incorrect Rates

Anthem Blue Cross CA announced a rate change on individual & family plans effective May 1, 2012. Affected members received a notice of the rate change and new rate for 5/1.

Some Anthem Blue Cross members (but not all) received an insert indicating that the new May 1 rate quoted was incorrect and and would be lower than the rate quoted in the letter.

In fact, all rate increases sent out to all affected Anthem Blue Cross members show incorrect rates for May 1, 2012 and all rate increases will be lower than the rate increase that was quoted in the letter.

Anthem will be sending out new letters later this month which will indicate the corrected rate change for May 1.

This rate change includes age change which are no longer assessed on the birthday but instead at the annual rate change cycle.

Please be patient as no one including Anthem membership nor your agent currently has the corrected rates and we don't anticipate having correct rates until later in the month of March.

I shou…

Anthem Blue Cross CA to Shutter 4 Open Individual Health Plans

Anthem Blue Cross Life & Health of California has chosen today to initiate closure of four currently open, non-grandfathered Anthem Life & Health PPO plans. The plans which will be closed are:

*Clear Protection Plus 5000 (06B5)
*CoreGuard Plus 7500 (06BB)
*CoreGuard Plus 10000 (0ADX)
*Lumenos HSA 5000 w/Maternity(06BP)

Clear Protections Plus 5000 and CoreGuard 7500 & 10000, will close for new sales beginning on May 1, 2012. These plans will be closed to new enrollments but will not be discontinued. Those currently enrolled on these plans are free to remain on their policy and add family members through normal underwriting.

Members on the Clear Protection Plus 5000 and CoreGuard Plus 7500 & 10000 will also have an open enrollment period from May 1 to June 30, 2012 to move to another open plan without medical underwriting. Members may switch as follows:

*Clear Protection Plus 5000 can move to the Clear Protection Plus 3300
*CoreGuard Plus 7500 & 10000 can move to the Cor…

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: (

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:…

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

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.


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…