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Showing posts from August, 2012

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…