California PCIP (Federal Risk Pool) Opens

The PCIP (Pre-existing Condition Insurance Program), also referred to as the Federal Temporary Risk Pool, is now open and accepting applications for enrollment.

The PCIP is an individuals-only enrollment with no dependents. Rates are set correspondent to the standard rate for a similar $2500 deductible PPO plan on the open market in California. PCIP will use a larger network of providers than MRMIP, approximately 65,000 should be available. The PCIP plan offers both in-network participating benefit levels and and out-of-network non-participating benefit levels.

Applications received by the 10th of the month will be enrolled for the first of the following month.

According to MRMIB, which will run the program for California, agents may assist applicants in the enrollment process for PCIP and receive a $50 fee the same as currently available on the MRMIP program.

Eligibility for the PCIP consists of the following:

1. California state residency as evidenced by applicant having a California address or other appropriate documentation as determined by MRMIB

2. US Citizenship and immigration status for applicants obtained through questions and supporting documentation

3. Applicant has a pre-existing health condition as evidenced by a denial letter from a health insurer or acceptance in a health plan which has rates in excess of PPO rates in the MRMIP (state risk program)

4. Applicant has been without creditable coverage for a least 6 months prior to applying for the PCIP

The California PCIP intends to provide enrollment to an estimated 23,000 California residents. By comparison, MRMIP, the state major risk plan, enrolls a maximum of 7,100. If the PCIP is a maximum enrollment in 2012, the federal government may grant additional funds to the CA PCIP to increase enrollments.

I will place a PCIP application on my web site as soon as it is available for download from MRMIB. It will be available here

Here is the final BROCHURE for the California PCIP including plan summary and rate guide.

California PCIP (Federal Risk Pool)

MRMIB has published the final document for PCIP (Pre-existing Condition Insurance Program) which includes both rates and plan summary of benefits.

Rates are reasonable and benefits fairly rich.

PCIP Summary

October 1 Rate Increases on Individual Health

October 1 will see major rate increases by both Anthem Blue Cross and Blue Shield of California.

Blue Shield will average 18.2% increase but some age groups may experience rate increases as high as 50%!

Anthem Blue Cross will average 14% with a max rate of 20% increase.

Interesting article from today's Sacramento Bee.

In addition, Anthem Blue Cross has currently blacked out all individual and family health plans for new enrollments on 9/23 and after to replace the current plans with newer, PPACA-compliant plans. I have heard rumors that we may see the end of lower-deductible versions of some plans in favor or high and very high deductibles to offset preventive benefits and childrens guaranteed-issue.

California Health Insurance Legislative News (Lots of it!)

Big day in Sacramento today. And with 8/31 deadlines looming, we will likely see more activity.

California AB 1602 (Perez) and SB 900 (Alquist) has passed and is awaiting the Governor's signature to make it law. AB 1602 sets up the California health insurance exchange. I expect this to be signed as Gov Schwarzenegger indicated earlier this year that he wants the exchange model set up before he leaves office.

SB 900 sets up the exchanges, and AB 1602 which is a companion bill delineates the specific duties of the exchange.

AB 1825 has passed the Senate and now goes back to the Assembly for final action. AB 1825 requires mandatory maternity benefits on all health plans sold in the individual market.

AB 2244 prohibits insurers from refusing coverage to children simply because they have a pre-existing condition. AB 2244 also goes back to Assembly now for final action.

Other Bills to watch:

SB 890 (Alquist) - sets requirement for health plans to offer only 5 plan designs either inside or outside of the exchange. Gold, Silver, Bronze, Platinum and Catastrophic.

AB 2345 (De La Torre) - prevents insurers from charging an additional co-pay for cancer screenings and other types of preventive care

AB 2042 - (Feuer) - prohibits insurers from raising premiums more than once per year.

CA Individual Plan Upgrades (PPACA)

As of today, this is what I am being told regarding individual & family health plan updates to comply with PPACA benefit requirements.

Anthem Blue Cross upgrading for 9/23 currently blacked out pending approvals (no plans currently available for sale after 9/22 start dates).

Blue Shield, Health Net and Kaiser are all targeting plan change dates of 1/1/11 to upgrade new plans to PPACA compliance. Their current plans will be available for purchase through 12/31/2010.

Exising plans purchased before these upgrade dates will also be upgraded, but each carrier will decide when and how the upgrades will occur. They can either upgrade on the renewal month of the plan or at one time.

CA AB 2042 Moves To Assembly

CA Assembly Bill 2042 passed the state Senate yesterday (21-13) and now goes to the Assembly. AB 2042 would prohibit health carriers selling individual & family plans from raising rates more than one time per year.

AB 2042 only applies to individual coverage, not to group coverage.

CA Health Bills Up Against Deadline

There are currently four bills in process in Sacramento which need to be passed or rejected by August 31, 2010. If they are not passed or rejected, the bills will die.

The following are the applicable bills:

AB 2578 (D. Jones) - Requires approval from state regulators for increases in health coverage premiums.

SB 1163 (M Leno) - Would require insurers to justify denials of coverage and premium increases.

SB 900 (E. Alquist) and AB 1602 (J. Perez) - Companion bills would establish health insurance exchanges in California to comply with PPACA.

PPACA Update on Existing CA Plan Upgrades

I wanted to add that it may happen that some or all carriers choose to make the PPACA-compliant changes to existing plans on one unified date. Likely this will be the portfolio renewal date.

So, it may be that your existing pre-9/23 healthcare plan gets the upgrade at the renewal of your plan anniversary or on January 1, 2011.

Realistically it makes more sense cost- and logistics-wise for a carrier to make the unified upgrade instead of spacing them out over a period of 12 months.

I will post when I receive clarification from each carrier on how they intend to process the upgrades to existing coverage plans.

9/23/10 What Happens To My California Healthcare Plan?

Have been doing some digging this week on the future of healthcare plan changes for the upcoming 9/23 PPACA compliance requirement. I wanted to outline for everyone in California what the most likely scenario will be for your current and/or future healthcare plan. I expect the process to be generally uniform amongst the carriers.

As I understand it today (this is of course all subject to be changed), plans will be handled as follows for the 9/23 PPACA.

New Subscribers - new subscribers who purchase coverage on or after 9/23 will be purchasing healthcare coverage plans (not yet approved) which comply in full with the PPACA requirements. These plans will be fully compliant right from the start.

Existing Subscribers - existing subscribers, whether on a grandfathered healthcare plan (purchased prior to 3/23/10) or on a non-grandfathered healthcare plan will receive the PPACA compliant changes to their plan at the next renewal anniversary date of their plan. Anyone purchasing a plan between today and 9/22 start date will be considered an "existing subscriber". Example: a person purchased an Anthem Blue Cross SmartSense PPO plan on April 1, 2010. The plan renewal will be April 1, 2011 and at that time the PPACA benefit "enhancements" will be applied to that plan.

Group Subscribers - group health plans purchased after 9/23 will also be PPACA compliant. Plans purchased before 9/23 will be treated the same as existing subscribers on individual plans and benefits will be "enhanced" at the group open enrollment renewal month.

Certain PPACA plan changes will apply to all plans, regardless of grandfathered status. Other PPACA changes will only apply to plans which do not have grandfathered status.

Welcome To The Blackout

As of today, individual and family health plans in California can only be purchased with start dates of 9/22/10 and prior. There are literally no health plans available for sale starting 9/23 or after at this time. Several carriers have already shut down online quoting for start dates of 9/23 and beyond, pending the regulatory approval of the new, PPACA compliant plans. All health plans for "new enrollment" sold 9/23 and after must meet the PPACA guidelines which include such things as no-cost preventive care, no lifetime maximums nor annual maximums and child GI coverage ages 0-18.

All of the IFP carriers have submitted new plans to the two regulatory bodies, DMHC and CA DOI for approval. Now the waiting begins until the new plans are approved for sale to the public. This could be very soon or could take a few more weeks. I will advise once plans begin to be made available.

HIPAA plans are also included in the "transformation", so anyone with a HIPAA eligibility date of 9/23 or after will need to hold tight until the plans are available for 10/1 and after.

It is my hope that the regulatory agencies work quickly to approve the new plans. If they are slow, it is possible (not probable, but possible) that there could be a period 9/23 and after with no plans available. I am especially concerned about HMO plans as the DMHC has been slow to approve new plans in California.

I suspect most carriers will choose not to re-invent plans and portfolios, but to make PPACA-compliant changes to existing plans/portfolios. Unfortunately, we will have to wait and see what will be available.

PPACA Update

It appears that Anthem Blue Cross and Health Net are planning to re-tool their individual and family plans products for 9/23.

Anthem will close online quoting for any plans with a start date of 9/23 or after on Saturday (8/14). Online quoting will resume once the plans are filed and approved.

Health Net CA is currently not quoting any plans with effective date of 10/1 or after. Probably a similar change-over.

Blue Shield CA has taken a different interpretation of PPACA. The law allows carriers to make the change-over on 9/23 OR at the next subsequent product renewal cycle. Blue Shield CA has its next cycle on Jan 1, 2011 and intends to hold off on all PPACA compliant plan changes until January. My understanding is that this will include the preventive benefits AND guaranteed-issue coverage for children 0-19.

PPACA Preventive Benefits

Under the PPACA (aka Obamacare), effective 9/23/10 all new health plans available on or after that date will be required to provide certain preventive benefits at no cost to the subscriber.

As noted in my earlier blog, Anthem Blue Cross CA has already begun the process of plan re-tooling and, as of today, you cannot view any plans that will be available on or afte 9/23. I expect the other CA IFP carriers to follow this lead.

Here is a link to the PPACA Preventive Benefits List.

Anthem CA Re-tooling For Obamacare

Effective August 14th, quoting for individual health plans will only be available for start dates of Sept 22 or before. If you request an effective date on or after Sept 23, the system will have a pop up message stating that no plans are available for the requested effective date.

Anthem is currently working on the mandatory changes and rates for plans to be sold Sept 23 and after. Plans sold on or after Sept 23 must meet new guidelines as outlined in the PPACA legislation.

I will post when the new information is available for quoting.

PCIP Getting Closer in California

The PCIP (Pre-existing Condition Insurance Plan)aka Federal Risk Pool will be opening for enrollment in a few weeks.

MRMIB has published some very basic information including a rate guide summary for the PCIP in California.

You can view the summary including the proposed rates here.

Currently you may request an application be sent to you once they are available by sending an e-mail request to PCIP@mrmib.ca.gov

As of today there is no information on plan benefit design nor which carriers will offer plans.