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Showing posts from 2014

Covered CA Cancels 4,100 Health Net Subscribers!

We have received a communication from Health Net CA regarding plan terminations from Covered California.

According to the e-mail, Covered CA has cancelled over 4,100 current Health Net subscribers effective 12/31/14.  No one knows how or why this has happened and I have not heard of this issue with any other carriers at this time.  Since Health Net has no agent/broker information for the 4,100 plans, they will be calling and e-mail those who are being terminated.

According to Health Net, cancelled members must re-enroll in health insurance via Covered CA as a new user through Covered CA ( and select a new health plan for 2015.  Cutoff to enroll is Sunday, 12/21/14 for coverage beginning January 1, 2015. 

If you are a Health Net member via Covered CA, I would suggest you check with Covered CA and/or Health Net to verify whether or not you are one of the cancelled subscribers.  


Blue Shield CA Grandfathered IFP Rate Change for 2015

Blue Shield of California has announced a rate increase for all grandfathered indivdiual &family health plans (including HIPAA plans).

The average rate increase will be 9.6% on grandfathered plans across the state.  That is the average so your rate increase could be more, less or the same 9.6%.  Just be aware of the upcoming change.


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Health Net Changing Plans/Networks in California (and other states)

For 2014 in California, Health Net was the only domestic carrier featuring a fairly robust PPO network on Individual plans under Obama Care.  As I expected, some serious changes are coming for 2015. (pending regulatory approvals). Health Net is referring to these as "significant changes".

Basically, on-exchange (via Covered CA) Health Net will be suspending all plans in Mariposa, Monterey and San Benito Counties.  Plans will change in northern and central CA to an EPO (exclusive provider organization) and a Health Service Plan (HSP) in southern California. These are referred to as "tailored networks".  These plans will be available both on and off exchange as required by the ACA.  

Current Health Net PPO will be offered off-exchange ONLY and only in the same rating regions where it is currently available.  Subscribers in Mariposa, Monterey and San Benito Counties will only have this choice, off-exchange with no subsidy, in order to maintain any coverage with Health N…

Stanford Health Care terminates its contract with Anthem Blue Cross

(Note: In late 2014 Anthem renegotiated the contract with Stanford and they are back in the Pathway network).

Effective September 8, 2014, Stanford Health Care (formerly Stanford University Medical Center) has terminated its contract with Anthem Blue Cross.  Below is the information from Anthem.........

Anthem Blue Cross and Stanford Health Care (formerly known as Stanford University Medical Center) have been engaged in Commercial contract negotiations for several months to reach agreement on reasonable reimbursement rates and contractual terms that are beneficial to both organizations. Unfortunately, Anthem Blue Cross and Stanford Health Care were unable to reach agreement and Stanford terminated the contract effective September 8, 2014.  From that date forward, Stanford Health Care will no longer participate in our provider network.  The hospital is located in the City of Palo Alto in Santa Clara County. Letters are being mailed today, September 8, 2014, to subscribers that …

New QLE (Qualifying Life Event) & Special Enrollment Period Info on my Site

I've added a new page to my site as we move into the autumn and towards the 2015 Open Enrollment Period.

There are quite a few Special Eligibility criteria currently available for people outside of the open enrollment period and I wanted to summarize them in a concise list.  #11 alone has 7 different scenarios for enrollment eligibility outside of open enrollment.

If you are viewing this blog on my web site ( then just select either the ACA or Health Insurance tab and there will be a link on either of those pages.  If you are on the blogspot page click on the link below.  

Dave's QLE List

Remember, 2015 open enrollment begins November 15th, 2014 and runs through February 15th, 2015.  


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IRS Releases Draft Forms for 2014 Health Insurance Tax Reporting

The IRS has released the draft versions of the multiple forms required for 2014 taxes related to health insurance under ObamaCare.  These forms represent everything from tax subsidy to exemption of coverage.  

Take a look here.  Forms are 1095 A, B and C as well as 8962 and 8965.  Good luck filling these out.   I am sure there will be some community service available to assist lower income people with these forms.  For the rest, better get a good CPA.


$250K fine for lying on health insurance forms

This came out Friday from the administration.  If you intentionally lied to get subsidy you could face $250,000 in IRS fines.  If you just made a mistake with no malicious intent, it could still be a lesser $25,000 fine.  Oh, and if you were less than truthful to avoid buying coverage during the last open enrollment, the fines could still apply. 

The Obama administration Friday spelled out civil fines of up to $250,000 for knowingly and willfully providing false information to get taxpayer-subsidized coverage under the new health care law.
Washington Post Article


CA Doctors Bailing on ObamaCare Patients?

Recently I saw some numbers for reimbursement rates on the spiffy new Obamacare 'stuff' from a large insurer in California. 

For CPT code 99213 (routine office visit)

Old Legacy Network pays doctor: $71.00
New Off Exchange Network pays doctor: $66.00
New Exchange Network pays doctor: $45.50

Article published today in the Visalia Times and Tulare Advance-Register.  

Doctor Networks Opt Out of New Plans

Insurance agents and doctors agree — call your doctor before the end of open enrollment (March 31) to confirm whether your doctor accepts your new plan. The alternative, they say, is boarding what can become a frustrating insurance merry-go-round.
 To add insult to injury, her doctor — whom she’d seen for years — informed her that his  office no longer accepted individual Blue Cross insurance plans, regardless of whether they were purchased from Covered California or not
 In many cases, private physicians who don’t practice in a federally qualified, hospital-owned or rural clinic ar…

It's ALL Obama Care, People!

There sure is a lot of confusion out there about individual & family coverage in California (and elsewhere).

Quite simply, it's all Obama Care.  There are two channels to purchase coverage but all of it complies with the ACA by law.  They are not separate markets, just separate channels within a market with some variations in terms of carriers and subsidies.

One, you can purchase your coverage from the exchange (Covered CA) if you want to get some money from Obama to subsidize your premiums/benefits and you are eligible for help.

Two, you can pay the full boat yourself and purchase outside of Covered CA in the private market.  Those plans must still comply with the ACA standards and must at least offer 'mirrors' of the exchange (Covered CA) plans (there can be extras in the private channel but they still have to meet metal and ACA standards).

It all comes down to only where the premium $$ are coming from.  Otherwise, all plans are part of a single market risk pool and all …

Whistleblower Confronts Covered California Board

Wow, just wow!  This sure explains quite a lot.

Medicare Advantage Rate Cuts Coming to Insurers Near You

Friday's article from the News Telegram give some detail on the impending cuts CMS intends to apply to Medicare Advantage payments to insurers.  This is part of the Obama Care law and was projected to be as high as 6.5% cut to carriers but may come in lower at around 3.6% cut.

From the article:
Next year may mark a turning point: Medicare's actuaries estimate that enrollment will decline for the first time since 2004 because payment cuts will cause plans to drop out or reduce benefits. 
News Telegram Article


Emergency Retina Surgery - Office Closed!!

I will be undergoing emergency retinal surgery on Jan 29th and will be unable to do any work for at least 10 days during the recovery period.  I anticipate I should be back to work right around 2/10 however the final decision will be up to the doctor.

Please refrain from contacting me while in recovery as I will not be able to talk on the telephone nor conduct normal business sctivitites.

Thank you.


Anthem & Health Net CA Premium Payment Extended to 1/31

Anthem Blue Cross just announced that individual & family plan premiums for January 1 effective dates will be extended from the 1/15 cutoff to 1/31/14 cutoff.

That gives everyone with Anthem another 2 weeks to pay the January premiums.   This applies to both Covered CA enrollments and to private market off-exchange enrollments.


Update:1/16/2014 -- Health Net has also announced the same change of deadline to 1/31/14 for premium payments.

Covered CA Plan Premium Deadline Extended to Jan 15th

Covered California announced this morning that they have reached agreement with the carriers to extend both Individual & Family and SHOP plan premium due dates to January 15, 2014.

All  premium payments must now be made by January 15, 2014 Individual Market:  All payments, either by phone, online (if available) or by mail must be received by the health insurance plans by COB (5:00 p.m. PST) on Jan. 15  for coverage beginning Jan. 1st.  SHOP Market:  Small businesses that have enrolled in coverage for Jan. 1st must pay Covered California’s SHOP no later than COB (5:00 p.m. PST) on Jan 15.  This means that all premium payments must arrive at the SHOP office on Jan 15; payments that are received after Jan. 15 will be processed for Feb. 1st coverage.

Covered California stresses that this is a one-time payment deadline extension, and that payment for coverage going forward is due at the beginning of each month. 


Anthem's Secret CA Extensions?

If you are one of the lucky or not-so-lucky people who did not receive a plan migration notice from Anthem Blue Cross (CA), you might be extended to April 1 without you're knowing you have been extended to April 1 on your old plan.  It's kind of a super secret or something, I guess.

Anthem apparently failed to properly notify a whole bunch of non-grandfathered HIPAA plan members and also some non-HIPAA non-grandfathered members in sufficient time not to get spanked down by the regulatory powers that be in the Golden State.  Whether directed by those powers or in an effort to avoid bad PR for this foul up, Anthem has secretly extended those members to April 1 and actually scrubbed their plan migrations for January 1 to ObamaCare compliant coverage.

I got a call from someone there today about another migration that didn't happen and during the "conversation" I asked what the deal was.  I was told that since those members did not actually receive any migration notice …

Got Coverage? I Dunno!

Since my last blog post in November we have had a whirlwind of ca-razy and of course the holidays.  I hope that everyone had a safe and enjoyable holiday season.

Well, the expression of the day for agents (and carriers and subscribers) right now is "I don't know"

Do I have Coverage?  
How can I pay me premium?
What is my premium?
Did Covered CA forward my enrollment information?
Did Covered CA complete my enrollment?
Did my change in plan migration go through yet?
Why do I have to pay for pediatric dental?
How can my doctor/provider/pharmacy verify my new coverage?

And so on.  The answer today......... "I don't know".  That's what the carriers are telling us and unfortunately that's what we have to tell you.  Did I mention that this sucks?

All I can recommend is hold on and wait for a bill/card/welcome kit/anything from the health insurance carriers indicating that they might have actually processed something for you in a timely manner (timely being measure in…