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Showing posts from November, 2017

Anthem Discontinuing Individual Grandfathered Health Plans Early 2018

Anthem Blue Cross California notified agents this morning that they intend to discontinue 200 individual & family grandfathered health insurance contracts effective 2/28/18.

Grandfathered plans are those health insurance plan purchased prior to 2010 and still in force.

To reduce the administrative burden of maintaining multiple products/contracts, we will be discontinuing about 200 grandfathered plans/contracts, many of which only have a few members. This change will impact around 14,000 members and some of these members may have other Anthem options to replace their plans.

As of today, the specific products and contracts are unknown.  I was told we should expect more information by mid-December.  

For those on grandfathered plans, be aware that Anthem is only selling individual health insurance (EPO) in areas 1, 7 and 10 (Santa Clara County, Stockton area and northern Counties).  Those in other rating areas will need to change insurers and find new coverage (and move to ObamaCare).

I …

Sutter Health Destroys Evidence In Antitrust Case

LA Times is reporting that health giant Sutter intentionally destroyed 192 boxes of documents that were being sought in a lawsuit.

The lawsuit accuses Sutter of abusing its market power and charging inflated prices.

I’ve pushed the button … I’m running and hiding. … ‘Fingers crossed’ that I haven’t authorized something the FTC will hunt me down for.
— Sina Santagata, Sutter executive assistant
The United Food and Commercial Workers and its Employers Benefit Trust initially filed the case against Sutter in 2014.

Read the full LA Times Article



HealthNet Traditional PPO & EnhancedCare PPO For California 2018

When it comes to HealthNet individual & family health plans, things can get a little tricky.

HealthNet has offered their traditional PPO plan in selected areas of California for a few years now.  This PPO is a broad-network plan.  In areas where it is available, the network exceeds that or competitor Blue Shield.  The new EnhancedCare PPO is a smaller network PPO plan introduced in certain regions for 2018.

In 2018, HealthNet has made some changes so I want to cover them here.

Traditional PPO (off exchange only)
HealthNet's traditional individual & family PPO plan for 2018 will be available in the following regions:

Region 2  Marin, Napa, Solano, and Sonoma counties
Region 4  San Francisco County
Region 5  Contra Costa County
Region 7  Santa Clara County
Region 8  San Mateo County
Region 9  Santa Cruz County
Region 10 Merced, San Joaquin, Stanislaus, and Tulare counties
Region 14 Kern County (partial)
Region 15 Los Angeles County: ZIP codes starting with 906-912, 915, 917, 918, 935

Dept of Managed Health Care Fines Anthem $5 Million

According to Kaiser Health News, the California Department of Managed Health Care (DMHC) has fined Anthem 5 million dollars for failure to address member grievances.  

According to DMHC, between 2013 and 2016, it (DMHC) identified 245 grievance-system violations by Anthem.  

Rouillard cited one example in which Anthem denied a submitted claim for an extensive surgical procedure, even though it had issued prior approval for the operation. Twenty-two calls contesting the denial — placed by the patient, the patient’s spouse, the couple’s insurance broker and the medical provider — failed to resolve the complaint. It was not until the patient sought help from the managed-care agency, more than six months after the treatment, that Anthem paid the claim.
Read the full article at KHN



California Silver Plans Cheaper Off Exchange in 2018

Rates are now live for California ObamaCare 2018 health insurance plans.

Silver Plans on the marketplace experienced an additional premium rate increase.  This increase is to compensate for the loss of CSR (Cost Share Reduction) subsidy funds from the federal government.  

Those who receive tax credit subsidy (and cost share subsidy) will generally not experience any substantial premium increase for 2018.  

Those who are not eligible for subsidies and want a to enroll in a Silver plan would be better served purchasing coverage in the private market.

An example I ran on myself aged 58, Santa Clara County:

Blue Shield Silver 70 PPO Covered CA $1,298
Blue Shield Silver 70 PPO Off Exchange $1,198 (save $1200/yr premium)

Anthem Blue Cross Silver 70 EPO Covered CA $1,066
Anthem Blue Cross Silver 70 EPO Off Exchange $1,021 (save $540/yr premium)