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Showing posts from September, 2014

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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