United Health To Take Over TRICARE West Region 2013

Effective April 1, 2013, TriWest, the current administrator for TRICARE west region, will be replaced by United Healthcare for administration of TRICARE in the west region.  

TriWest recently dropped a 2013 requirement for all premium payments by electronic transfer until UHC takes over the administration.  Premium payments for TRICARE under TriWest can continue by check or telephone.

For those of us on TRICARE, we are hopeful for a smooth and uneventful transition from TriWest to UHC administration.  

TRICARE West Region includes the following states:

ALASKA, ARIZONA, CALIFORNIA, COLORADO, HAWAII, IDAHO, IOWA (EXCEPT FOR THE ROCK ISLAND ARSENAL AREA), KANSAS, MINNESOTA, MISSOURI (EXCEPT FOR THE ST. LOUIS AREA), MONTANA, NEBRASKA, NEVADA, NEW MEXICO, NORTH DAKOTA, OREGON, SOUTH DAKOTA, THE EXTREME WESTERN PORTION OF TEXAS, 

UTAH, WASHINGTON AND WYOMING

Dave

www.davefluker.com

Exchange staff back off eroding essential health benefits

At yesterday’s CT Health Insurance Exchange meeting we learned about an attempt by Exchange staff and the Insurance Dept. to reduce the Essential Health Benefit Package that had been agreed to earlier this year in a contentious but inclusive and public process. Like the last process that rejected active purchasing, this process happened in evening conference calls not open to the public in a very short time frame. This time, however, providers and advocates on the committees voted down the benefit package erosion (active purchasing was not part of the reconsideration) and the staff finally agreed to pull the proposal from the Board committee agenda yesterday. However at the meeting, staff stated that they plan to lobby the fed.s to let them re-consider, and lower, the agreed-upon essential benefit package. The issue is CT mandates for coverage in state law – whether they cost or save money in premiums and how much. A public commenter noted that affordability is very important, but eroding mandates may not work to keep costs down. Active purchasing is proven to reduce costs, but the Board and staff have rejected that proven tool and have indicated no interest in re-visiting that decision. Other news included a strong theme of affordability in the Healthy Chat public events. Staff noted that many people were new faces to health care, not traditional activists. They also noted that people had “done their homework” and were very sophisticated in their understanding of active purchasing and its potential for affordability. The staff is still working on the details of the health plan benefit standards and benefit design, how plans will be rated for innovation and plans for quality monitoring. Advocates will be watching this process carefully for further standards that erode consumer protections, if there is any transparency or opportunities for meaningful public input.

Anthem Blue Cross Raising Medicare Supplement Rates in 2013

Anthem Blue Cross California has announced a rate increase for Medicare Supplement plans for March 1, 2013.  

The following open plans will experience a 5% rate increase March 1, 2013:

Plan F
Plan G 
Plan N

In addition, many standardized closed plans (pre-June 2010) and non-standardized closed plans will experience rate increases on march 1, 2013 ranging from 1.3% to 9.9%.

Open plans are Medicare Supplement plans currently available for sale to California residents on Medicare or going onto Medicare.

Dave
www.davefluker.com

State Decisions For Creation of Health Insurance Exchanges

As of December 14, 2012, 19 states, including California, have declared a state-based exchange for the PPACA.  The District of Columbia, while not technically a state, is included in this number.  7 states plan to run a partnership exchange (combined state/federal exchange) while 25 states (most recently Arizona) will default to the federal exchange and will not create nor set up a state exchange.

The California Health Benefits Exchange will be a state-run exchange and will go by the name 'Covered California'.

States may choose to set up their own exchange, run a partnership exchange with the federal government or do nothing and allow the federal government to run the exchange for that state.

The Kaiser Family Foundation web site has a list which is current as of 12/14/12.  Link below.

State Decisions For Creating A Health Insurance Exchange

Dave
www.davefluker.com

Aetna CEO "Get Ready For Rate Shock" In 2014

From today's Forbes Magazine Blog by Avik Roy.  Aetna CEO Mark Bertolini discusses the likelihood that individual & family rates under PPACA (Obama Care) may experience a large premium increase over the current health plan rates as well as a narrowing of provider networks  and cutting of reimbursement rates to medical providers.


Aetna CEO Bertolini: Get Ready for 'Rate Shock' as Some Health Insurance Premiums to Double in 2014

I am curious to see the 'Covered California' individual & family rates for 2014 however I don't expect them to be available for quite some time as the plan designs for the Qualified Health Plans are still in the infant phase of development.

Dave
www.davefluker.com

Blue Shield CA To Return $50 Million In Premium Credit

Blue Shield of California has announced that the insurer will return $50 million in premium credits for the 2012 2% Pledge.  

From the Blue Shield web site:

As a not-for-profit health plan dedicated to providing access to quality health care at an affordable price for all Californians, Blue Shield of California believes health care is a fundamental right. But access to care will only be achieved if coverage is affordable. That's why we made this pledge: if we earn net income of more than 2% of revenue in any year, we will give back the difference to our customers and the community. Blue Shield is committed to the 2% Pledge, as long as our board of directors determines that the company remains financially solvent, with sufficient funds to make the investments needed to stay competitive. To date, Blue Shield has returned more than $470 million to customers and the community to offset net income earned above the 2% threshold in 2010 and 2011. In 2012, Blue Shield will again fulfill our 2% Pledge commitment and will return $50 million to our customers. The funds will be returned to eligible customers in the form of credits on their billing statement for December 2012 dues/premium.

The 2% Pledge credits will be returned as follows:

Fully insured individual plan (including Medicare Supplement) and group customers will receive a 9% credit on one month's dues/premium Customers with whom we share risk with will receive a 3% credit on one month's dues/premium Self-funded groups are not eligible for the credit, nor are persons covered under certain federal and state government contracts that don’t provide a way to give credits

Customers will be sent a letter notifying them of their credit amount, which is based on their August 2012 dues/premium. Customers must have coverage in effect from August 1, 2012 through December 31, 2012 to receive the credit.

Dave
www.davefluker.com

Blue Shield CA Increase on IFP Rates 3/1/13

Blue Shield of California has announced a rate increase on their individual & family health plans for March 1, 2012.  

Rate increases on some members may be as high as 20% with an average rate increase of 12% across the board.  

LA Times Article

This rate increase comes at a time when recent news of Anthem Blue Cross' (Blue Cross of California) has notified subscribers of a 25% rate increase February 1, 2013 and Aetna has also indicated a rate increase for 2013.  I would expect Health Net PPO to adjust rates as well in 2013.

Dave
www.davefluker.com

More Predictions of Rate Shock Because of the New Health Law

Last week, I reported on my informal survey of health insurance companies and their estimate for how much rates will rise on account of the Affordable Care Act ("Obamacare").

Today, there are press reports quoting the CEO of Aetna with their estimate. The Aetna estimate is worse than mine.

From Bloomberg:

Health insurance premiums may as
much as double for some small businesses and individual

HHS approves CT insurance exchange plan

Along with six other states, CT’s health insurance exchange received approval yesterday from the federal agency providing funding. CT was among the first six states to apply to HHS for approval – 14 states have applied to date. No state’s application has been denied. CT’s exchange has been criticized for their plan to accept any willing plan and refusing to negotiate with insurers to control costs and reduce consumer premiums. CT’s exchange also voted not to conduct a secret shopper survey to monitor whether people who purchase their insurance plans can find a provider. The exchange has also been criticized for having no independent consumer Board members, having Board members with close ties to the insurance industry and for members with insurance company investments.

Conservative States: Do a Partnership Exchange? Expand Medicaid?

Should states build their own health insurance exchanges under the Affordable Care Act (ACA) ("Obamacare")?

Should states expand their Medicaid programs under the ACA?

These are the tough questions many, particularly conservative, states are now wrestling with. While it is too late for a state to now decide to build an exchange before the fast approaching launch date, it is still possible to

The Affordable Care Act: Ten Months to Launch "Obamacare"––Get Ready for Some Startling Rate Increases

What will health insurance cost in 2014?

Will the new health insurance exchanges be ready on time or will the law have to be delayed?

There Will Be Sticker Shock!
First, get ready for some startling rate increases in the individual and small group health insurance marketplace due to the changes the law dictates.

In a November 2009 report, the CBO estimated that premiums in the individual

Outreach recommendations for reform

Small grants, engaging an army of trusted community messengers, ubiquitous marketing, and robust monitoring will be critical to enrolling the estimated 130,000 newly eligible CT Medicaid members in January 2014, according to a report by the CT Health Policy Project. Best opportunities for outreach include small businesses, providers, current HUSKY members, faith-based communities, connecting with employers and other state programs, targeting life transitions, improving application and enrollment processes, and thanking outreach partners. It will require strong, concerted efforts to overcome the program’s stigma and other barriers to enrollment. The report draws on the experience of community organizers, consumer advocates who worked on HUSKY outreach, providers that care for CT’s uninsured patients, and lessons from other states. While aimed at Medicaid, many of the report’s findings also apply to the new CT Health Insurance Exchange. Report

The Feds Will Administer the Insurance Exchanges for Twice What it Costs to Administer Medicare

The Obama administration just released another set of regulations, the "Draft Notice of Benefit and Payment Parameters for 2014."

Among many other things in the 373 pages, they have announced their proposed assessments to cover the cost of running the federal exchange.

In order for the feds to administer the new insurance exchanges, they have proposed a fee of 3.5% of premium on each insurance

Exchange Board and staff water down already watered-down affordability and access provisions In a surprise to advisory committee co-chairs, CT Health Insurance Exchange staff submitted four alternative policy proposals at today’s Board meeting – they were adopted virtually intact by the Board. The staff alternatives were contrary to the recommendations adopted Tuesday by the Consumer and Qualified Health Plan Advisory Committees, with Exchange staff at every meeting. One staff change increased the number of options insurers can offer (in response to insurance industry comments); research shows that consumers prefer and make better choices with a limited number of well-vetted options. Another eliminated a secret shopper survey to ensure that the plan’s provider panels are accurate; in a Mercer study of HUSKY plans, shoppers were only able to get appointments with one in four providers on those HMO panels. Staff stated that accountability in secret shopper surveys seem “too adversarial” with insurers. Another proposal reduced the number of essential community providers that plans have to include in their networks, such as community health centers. The last one eliminated even the guidance that the Exchange will develop a plan of some undefined type to eventually, someday move along a continuum toward an active purchasing model. Active purchasing now saves MA exchange consumers millions in premiums by fostering competition and negotiating rates with insurers.

Staff reviewed comments to the draft health plan solicitation. Ten of the 22 comments mentioned were from insurers – half were accepted in the staff proposals, two were not, and three others were not relevant. Five comments came from NCQA, two from unknown sources, four from this consumer advocate (none were reflected in proposals) and one from a provider (was reflected in joint committee proposal).

The Exchange staff also announced they have hired Pappas Macdonnell, a Westport marketing firm with experience in selling corporate insurance and financial products. When asked if they have any experience in marketing to low-income, uninsured populations, one representative noted that he has worked on Democratic political campaigns.

In other news, they have settled on a new name for the Exchange – Access Health. They also have submitted an application for $2.6 million in federal funding for application assisters. They expect to award about 300 grants of about $6,000 each to community organizations to publicize the exchange, help people figure out what assistance they are eligible for, and help them enroll. They have hired three new Exchange staff this month.

The official vote tally for today’s vote to kill active purchasing

From Exchange staff: Below lists the results of the votes cast by the Consumer Experience and Outreach and Health Plans Benefits and Qualifications Exchange Advisory Committees with concern to the certification of Qualified Health Plans within the Exchange.-- Note -- a vote to approve is against active purchasing -- Results:
Twenty (20) – Approve Two (2) – Reject Approve
-- Sheldon Toubman Vicki Veltri
Gerard O’Sullivan Anne Melissa Dowling Deb Polun
Marcia Petrillo
Steve Frayne
J. Erlingheuser
Mark Espinosa
Gloria Powell Margherita Giuliano Tanya Barrett
Bonnie Roswig
Mary Fox
Alta Lash
Arlene Murphy
Sarah Frankel
Cee Cee Woods
Dr. Robert McLean Dr. Robert Scalettar Reject
-- Kevin Galvin Deirdre Hardrick

Joint exchange committees voting down active purchasing, cost control

While the votes are reportedly still coming in, it appears that the Consumer and QHP Insurance Exchange committees have voted against active purchasing. With active purchasing, other state exchanges are using the power of numbers, as large employers do, to negotiate better premiums, lower costs and better coverage for their members. MA has saved millions for consumers in their state with active purchasing. While the committees’ language includes a symbolic nod to possible future negotiation, it is far weaker than current state law. Reportedly, through a procedural maneuver, Exchange staff and committee co-chairs agreed to link all the proposals in one vote. Providers on the committees were picked off by adding back requirements that their organizations be included in network standards. Reportedly consumers lost votes we would have had if active purchasing had had a fair vote. All meetings this week and negotiations over language were conducted in secret. A critical negotiation session happened by conference call, but the public was not allowed to listen in. (The public was told to come to the LOB, from 6 to 7pm Monday to hear the call. However the building closes at 5:30.) This secrecy would not be allowed if the Exchange was part of state government – there are laws about that. But as a quasi-public entity, they can make their own rules. It is ironic as 50% of the Board members are public officials (71% if you count spouses and retirees), and all their millions in funding come from taxpayers. Exchange staff also incorrectly argued that they had to have this issue decided in time to release the health plan solicitation next month. However, state RFPs rarely release specifics on how they will score bids with the RFP release. Why would you? Now the HMOs know that as they prepare their premium bids, that the sky is the limit. We will post the vote tally as soon as we get it.

Just 6 days to comment on exchange health plan solicitation

Stakeholders had only six days to comment on the 40 page health plan solicitation from the CT Health Insurance Exchange – and it’s already over. Stakeholders in CA and MD had months to comment, with multiple drafts, meetings and opportunities to craft better proposals. The CT Health Policy Project’s initial comments centered on active purchasing, network adequacy, and the proposed “iterative process”. MA’s Connector has used active purchasing to save consumers millions in premiums – CT should do the same. When consumers are required to purchase coverage in the exchange, they must be able to get an appointment with a provider. HUSKY secret shoppers were only able to get appointments with 1 in 4 providers on the health plan lists. Using the standards from HUSKY contracts, thoroughly vetted in CT, and intensely monitoring compliance is key. The exchange’s proposal to initially implement a weak exchange and implement some standards later will sound eerily familiar to CT advocates – with a very poor history. Other comments include better cost sharing structures, standardize rating options so differences are meaningful, wellness programs that aren’t a screen for cherry-picking, constructive connections to the Medicaid program, accreditation standards, quality improvement plans (at least have one), and CID rate reviews as a floor. Perhaps the most troubling thing about the proposal is how much is taken on faith in attestations from insurers. Will anyone be monitoring to see if the promises are real?

Exchange advisory committees reject “any-willing insurer”

Today in a joint meeting of the Health Plan Benefits/Qualifications and Consumer Experience/Outreach committees of the CT Health Insurance Exchange voted against the staff recommendation “that the Exchange not deny any carrier QHP certification on the basis of its approved rates”. The only votes for the staff’s any willing insurer proposal were from Aetna and CT Insurance Dept. representatives. The committees asked staff to come back with a new proposal that includes rate negotiation.

California Exchange named "Covered California"

The California Health Benefits Exchange has approved the name for the Exchange, which will open on January 1, 2014.

Although I though "Avocado" was cool, and also liked "Condor" quite a lot (and hated Ursa which did make the finals), those names were eliminated in test panels and "Covered California" was chosen as the new exchange name going forward.

Logo

Exchange marketing is set to begin on July 1, 2013 and we should have a clearer idea on both Qualified Plan design and pricing in the market (inside or outside of the exchange).

Dave

www.davefluker.com

Blue Shield of California Extends "Birthday Rule" Medi-Gap Open Enrollment

Blue Shield of California (and Blue Shield Life & Health) has extended the Medicare Supplement change period through February 2013.

California is one of the few states that has a "birthday rule" with regard to those on Medicare with a Medicare Supplement or "Medi-Gap" plan.  In California, those on Medicare may choose to move to a "like or lesser" supplement plan every year on their birthday and 30 days thereafter.

Blue Shield of California currently offers an 'anytime' option for those wishing to move to a like or lesser Medicare Supplement with Blue Shield from their current Supplement plan.

Blue Shield has raised Supplement rates for the first time in 2 years effective December 1, 2012.  They also reduced the "new to Medicare" first year monthly discount from $20 per month to $15 per month and increased the discount for paying by check/savings deduction from $2 per month to $3 per month.

Blue Shield Medicare Supplement plans include the Silver Sneakers plan at no additional cost.

Dave
www.davefluker.com

Anthem Blue Cross IFP Rate Action 2/1/13

Anthem Blue Cross has announced a rate action from California individual & family health plans that will take effect on February 1, 2013.  This rate action does not effect HIPAA nor Conversion policies but does effect underwritten Blue Cross of California and Blue Cross Life & Health policies.

Anthem will begin sending notifications to effected members this month.  

For those who continue to be eligible for plan change options under either Serencsa or Feller-Freed (or both) and experience a rate increase, enrollment periods for this rate change will be made available for February 1 plan changes.

Dave
www.davefluker.com

California Senior Gateway Protection Web Site Online

California Insurance Commissioner Dave Jones recently announced a new web site designed to help protect California Seniors from fraud, scams, abuse and neglect.

The Senior Gateway web site is a California state-sponsored site and is a "one stop" web site intended to provide seniors, their families and caregivers with the information they need to connect to helpful services and resources, to find answers and to solve problems.

This site is an excellent resource to help protect California seniors  Click on the link below to visit the California Senior Gateway site.

California Senior Gateway



Dave
www.davefluker.com

Medicare Changes for 2013

Medicare has released new premium and deductible numbers for 2013. They are as follows:

*Medicare Part A Deductible 2013   $1,184 (up from $1,156 in 2012)
*Medicare Part B Deductible 2013   $147    (up from $140 in 2012)

Medicare Part B Premiums 2013:

*Singles with income $85,000 or less or Joint $170,000 or less will pay $104.90 
(up from $99.90 in 2012)

*Singles with income $85,001 to $107,000 or Joint $170,001 to Joint $214,000 will pay $146.90 
(up from $139.90 in 2012)

*Singles with income $107,001 to $160,000 or Joint $214,001 to $320,000 will pay $209.80 
(up from $199.80 in 2012)

*Singles with income $160,001 to $214,000 or Joint $320,001 to $428,000 will pay $272.70 
(up from $259.70 in 2012)

*Singles with income $214,001 and above or Joint $428,001 and above will pay $335.70 

Dave
www.davefluker.com

CT Insurance Exchange holding public events

In response to concerns about the lack of public input, CT’s Health Insurance Exchange will be holding seven “Healthy Chat” events in the next month. Similar to Consumer Conversations last month but sponsored by the exchange this time, they will be reporting on their activities but will also be taking questions. We will be asking why they aren’t willing to negotiate with insurers to keep premiums affordable. The events will all be 5:30 to 7:00pm with registration at 5:00. The events will be in Hartford on November 27th, Waterbury on November 29th, New London on December 4th, New Haven on December 6th, New Britain on December 11th, Stamford on December 13th, ending with Bridgeport on December18th. For more details, click here.

Where Are The Consumers in the Consumer Committee??

I attended this week’s CT Health Insurance Consumer Experience and Outreach Committee meeting to give the Committee an update on the success of the previous week’s Advocate’s “Conversation with Kevin Counihan” event sponsored by Small Business For A Healthy Connecticut and CT Health Policy Project. My point was to emphasize the importance of consumer involvement at the upcoming combined meetings of the Consumer and Qualified Health Plan Committees. My attention was immediately drawn to all the empty chairs at the Committee table. Of the fifteen Committee members listed on the Exchange web site (a list that is not accurate), seven were present and one was participating by phone. Of the eight Committee Members attending, three were Exchange Board Members. With consumer voices being so few in the Exchange structure the Committee absences are particularly troubling. WHERE IS THE CONUMER’S VOICE IN THIS?
Why were the seven Committee members not there?
Why was the Co-chair not there?
Where were the consumers to access their right to address the Committee? The audience was primarily made up of insurance industry representatives and lobbyists. I commented that there were probably more folks in the room with (.Gov) email addresses than there should have been or needed to be for a meeting of consumers. With nearly half of the Committee members missing, what are the Committee members that were present going to do to impress the importance of attendance to the members who were missing? Might it make sense to have Committee meeting times after normal working hours to better accommodate the consumer audience? Might the Committee adopt the practice of having Public Comment at both beginning and end of each meeting again to better accommodate the consumer audience? What are the Committee’s plans to have consumer attendance at the upcoming combined Committee meeting? I’m not sure how we can expect the general public to take the implementation of Health Care Reform seriously when the people charged with representing us do not show up to meetings. Kevin Galvin

The 2012 Elections and 2013––We Face a Daunting To-Do List

The Affordable Care Act ("Obamacare") is now settled law.
It will be implemented. It will also have to be changed but not until after it is implemented and the required changes become obvious and unavoidable. We can all debate what those things will be (cost containment is on top of my list) but it doesn't matter what we think will happen––time will tell. 

There are and will be more lawsuits.
I

Why CT’s health insurance exchange needs to negotiate

CT’s health insurance exchange is not planning to negotiate with insurers to improve value and control costs for consumers. As of January 2014, consumers will be mandated to secure coverage. Consumers eligible for affordability assistance must purchase in the still developing exchange to get the subsidies. Massachusetts’s exchange (the Connector) negotiates, termed active purchasing, with insurers saving consumers $16 to $20 million annually. In contrast, Utah’s exchange does not negotiate with insurers but includes any qualified insurer, as the CT exchange is planning, and premiums are HIGHER inside the exchange than in the outside market. There is some disagreement about whether the Board and the Qualified Health Plan Committee have already made the decision. No public comment was solicited on the issue and the decision memo was posted a day after the QHP committee meeting. For more on the issue, go our Policymaker Brief.

CT health reform progress up to 16.7%

CT inched up only 0.3% in progress toward health reform last month. We have completed 16.7% of the tasks needed to be ready for January 1, 2014 when individuals will be legally required to secure health coverage. Highlights remain Medicaid and patient-centered medical homes. Unfortunately, problem areas continue to be the insurance exchange and insurance review. Last month, CT health care thoughtleaders gave CT a C+ grade for reform progress. For more, visit the CT Health Reform Dashboard at www.cthealthreform.org.

Consumers raise concerns with CT insurance exchange

Consumers and small businesses had a rare opportunity to share their concerns with CT’s health insurance exchange Friday. A standing room only crowd met with the exchange’s CEO, Kevin Counihan at a restaurant in Glastonbury. Christie Hager, HHS Regional Director, also attended. Comments focused on the lack of consumer and small business input to the exchange, inappropriate influence of insurers, and the exchange staff’s decision not to negotiate with insurers to get the best value for customers. Through negotiation, MA’s exchange has been able to keep the rate of premium increases to half what it is outside their exchange. However prices in Utah’s exchange, which does not negotiate with insurers as CT’s exchange is planning, are actually higher than prices outside the exchange. CT’s exchange is being set up by the state, with millions in federal grants, to help consumers get decent, affordable coverage and is expected to purchase on behalf of one in ten state residents. As of Jan. 1, 2014, everyone in CT will be required to have coverage. Residents who qualify for federal affordability subsidies will have to buy their insurance through the exchange. Check back at the CT Health Policy Project’s site soon for a brief on the benefits for CT consumers, promoting value and affordability, through negotiation on CT’s exchange.

CT exchange staff won’t negotiate with insurers on behalf of consumers or small businesses

Staff of the CT Health Insurance Exchange have “opted to utilize an ‘any qualified plan’ approach” for determining which plans can be offered in the exchange. Proposed qualifications are minimal and generally only what is required by the Affordable Care Act. This decision is counter to the CT exchange’s own research. According to the market consultants, “One of the most attractive aspects of the Exchange is that the big insurance companies compete for their business. The feature evoked references to Lending Tree’s slogan ‘When banks compete you win.’” Utah’s health insurance exchange has pursued an “any qualified plan” approach, similar to CT’s staff proposal, and has attracted little enrollment with no evidence of cost control. Massachusetts’s Connector, on the other hand, operates with an active purchasing approach – negotiating with insurers to get the best price and quality for consumers. Annual premium increases for plans in Massachusetts’s exchange have been half the increase of plans outside the exchange. Starting in 2014, every CT resident will be required to secure health coverage. Over 150,000 state residents will have to buy it in the exchange to get federal affordability subsidies. According to the staff memo, the decision not to negotiate on behalf of consumers has been made and they are only taking comment on how to implement that policy. The memo was delivered Monday to the Qualified Health Plan Committee that no longer includes a consumer representative due to the unfortunate loss of Jennifer Jaff.

Private Health Insurance Exchanges––Will They Save Money? Will the Idea Grow?

Private health insurance exchanges will save employers money but not make health insurance cheaper.

Because private health insurance will save employers money, they will grow.

Will Private Insurance Exchanges Reduce Health Insurance Costs?

There's lots of buzz these days about private insurance exchanges. The idea is to give employees more choice in purchasing their own individual coverage

CT still earns a C+ on reform

Once again, CT health care thoughtleaders give our state a C+ on health reform. From the beginning of the CT Health Thoughtleaders Survey in February, CT has varied between C and C+. CT has always received a B for effort. In good news, grades for the CT Health Insurance Exchange improved since June with fewer D’s and some A’s in this survey. Unfortunately, grades for Engaging Consumers in Policymaking and Data-based Policymaking have fallen. The former was the most common recommendation from thoughtleaders to improve progress toward reform. The overwhelming response was to engage consumers in policymaking – increase consumer voices, greater public engagement in the process, and engage advocates. Other suggestions included smarter policymaking (data, best practices), improve communications and transparency, convene stakeholders to build trust, and guard against conflicting financial and special interests. New questions in this survey found that almost all thoughtleaders are somewhat or very engaged in the process of reform, however all but four cite barriers to engagement. Understanding how critical stakeholder engagement will be to success, policymakers should work to improve effective, meaningful access to the process. A disturbing number of respondents have not been asked, or have tried but found few ways to participate. The Thoughtleader Survey is part of the CT Health Policy Project’s Health Reform Dashboard project at www.cthealthreform.org.

No More Phony CA Health Exchange Web Sites - CA AB 1761

We've all seen them.  Web sites touting themselves as the "California Health Exchange" or something similar.  Some provide a disclosure (usually at the bottom and often in small type) that the site is, in fact, an insurance agent's web site and is in no way actually affiliated with the 'real' CA Health Benefits Exchange.  Lately I have seen a couple with no disclosure at all.  

Well, that party is now over in California and those of us who have been following the HBEX (Health Benefits Exchange) knew it was coming.  

On September 30, 2012, Governor Brown signed into law California Assembly Bill 1761.  The bill, now law, prohibits agents (and other entities) from claiming any affiliation with the CA HBEX as well as any advertising including social media that makes any such claim.  It is now against the law in California for an agent or agency to pretend that they are somehow representing or affiliated with the California Health Exchange.

From AB 1761:

(j) Holding oneself out as representing, constituting, or
otherwise providing services on behalf of the California Health
Benefit Exchange established pursuant to Section 100500 of the
Government Code without a valid agreement with the California Health
Benefit Exchange to engage in those activities.

This bill would prohibit an individual or entity from holding
himself, herself, or itself out as representing, constituting, or
otherwise providing services on behalf of the Exchange unless that
individual or entity has a valid agreement with the Exchange to
engage in those activities. The bill would specify that it is an
unfair business practice for health care service plans, entities
engaged in the solicitation of health care service plan contracts,
and persons engaged in the business of insurance to violate this
provision. Because a willful violation of the provisions governing
health care service plans is a crime, the bill would impose a
state-mandated local program. [emphasis is mine]

I expect that agent marketing guidance will be forthcoming from the HBEX or the Insurers next year as we prepare for the initial open enrollment beginning October 1, 2013.  As of today, we have not received any information on either certifying for the exchange or what specific agent marketing will be allowed.  All agents selling HBEX plans to the public will be required to be certified with the CA exchange prior to engaging in any sales activity.

In the meantime, if you run across any sites that are not the official exchange web site, you know that the site is not approved and that the agent is committing a crime by pretending to be or be affiliated with the CA HBEX.

Dave

www.davefluker.com

As always, for specific health insurance information please visit my web site.

Will Many of the Smallest Employers Circumvent the Affordable Care Act by Using Self-Insurance?

Not surprisingly, only about 10% of firms with fewer than 200 workers take advantage of self-insurance––and almost no very small groups (fewer than 50 workers) use the product. It just isn't worth it for these small employer groups to take the risk that they will either have too many claims or very big claims from their workers––that is what insurance companies are for.

Already, 96% of workers

Exchange Board approves Essential Health Benefits standard – false choice between benefits and cost

Yesterday the CT Health Insurance Exchange Board approved CT’s version of the Essential Health Benefit (EHB) package under the Affordable Care Act (ACA). As of January 1, 2014 individual and small group plans will have to cover at least the EHB services. The ACA required that the EHB include at least ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse care, prescriptions, rehab and habilitation services, lab services, preventive and wellness care including chronic disease management, and pediatric care including vision and dental care. States have several plan EHB options including large commercial plans, federal and state employee plans. After long, contentious deliberations, two exchange committees of experts and stakeholders agreed on a moderate, compromise choice based on ConnectiCare’s HMO plan that includes all state mandates. The committees recommended that compromise to the Exchange Board. While the Board eventually approved the committees’ recommendation, there was a great deal of discussion about reducing the “richness” of the plan in the interest of “affordability”. Board members noted that the recommended plan is “richer” than what is offered now in CT. They failed to note that one of the main points of reform was to improve the “value” of health insurance so it truly covers what people need. If what is available now was sufficient, we wouldn’t have needed reform. The Board wants the legislature to “revisit” legislatively mandated benefits next year, eliciting groans from lobbyist and advocate observers in the room. Unfortunately there was no meaningful discussion about the potential for ongoing payment and delivery innovations successful in many other states, to provide flexibility that improve quality, access, patient satisfaction while controlling costs. The Board includes no independent consumer advocates and several insurance industry representatives. Consequently the Board is locked in the narrow false choice between mandated benefits and affordable premiums. That very old, very simplistic dialogue only spirals downward into worse care and upward into skyrocketing costs. The Board is missing a massive opportunity to learn from innovators and truly reform CT’s health care landscape.

Join us for Consumer Conversations: the CT Health Insurance Exchange

January 1, 2014 every CT resident will be required to secure health coverage. The CT Health Insurance Exchange is being developed under the Affordable Care Act to be a fair, user-friendly marketplace for consumers and small businesses to buy decent coverage, hopefully at an affordable price. The Exchange has not heard consumer voices, does not include any independent consumer Board members, and is dominated by insurance interests. Small Business for Healthy CT and the CT Health Policy Project have invited Kevin Counihan, CEO of the exchange, to meet with consumers and small businesses to learn what consumers need and how to make the exchange a success. We will also be joined by Christine Hager, Regional Director of HHS, the federal agency funding the exchange. The meeting will be October 26th from 8:30m to 11am at the Pond House Grille in Glastonbury. To register, click here.

The Cost of Mandatory Maternity Benefits in California

Under CA SB 222, all individual & family health insurance plans in California were required to provide, or add and provide, mandatory maternity coverage to all plan members. 

Prior to July 1, 2012 when the mandate went into effect, plans offering maternity coverage were priced higher in terms of monthly premium to reflect actuarial maternity benefit utilization.  

Because the PPACA allows HHS (federal) to review and approve or reject insurance company rate increases on health plans that are 10% or more, and because the California Insurance Commissioner can make enough bad press for a carrier (he currently does not have rate authority in California--that is pending under AB 52), insurance carriers had to add the benefit and try to make the plans actuarially sound. 

Looking at California's two largest PPO insurers for individual & family plans (HMO plans were and are always required to provide maternity benefits) the effect is a bit stunning.

Blue Shield Life & Health (Blue Shield of California)
On April 17, 2012 I blogged the impending closure and replacement of almost every Blue Shield Life & Health PPO plan.  

The new plans released for July 2012 by Blue Shield Life & Health included the mandated maternity benefits and the competitive premiums for the 'new' PPO plans were initially anywhere from 20-30% above the cost of Blue Cross' similar comparative PPO product.  Initially the Blue Shield plans were a bit difficult to sell against Blue Cross lower premium plans.

As of this writing, Blue Shield Life & Health PPO plans appear stable in the mandated CA market.

Anthem Blue Cross Life & Health (Blue Cross of California)
Unlike Blue Shield, Anthem Blue Cross chose to continue their existing PPO plans into the new mandate and pricing was continued on many plans below the Blue Shield premium levels for comparative coverage.  Rate changes were kept low most likely to avoid HHS rate change scrutiny and bad press.  

The result of not replacing the plans with new plans a higher premium levels (see Blue Shield) has seen the following since March, 2012.

Clear Protection Plus 5000 Closed
CoreGuard Plus 10000 Closed
CoreGuard Plus 7500 Closed
Lumenos HSA 5000 w/Maternity Closed
Clear Protection Plus 1000 Closed

Effective November 1, 2012

SmartSense Plus 1000 standard Rx Closed
SmartSense Plus 1000 upgrade Rx Closed
Lumenos HSA 3000 Single  Closed
Lumenos HSA 4500 Single Closed
Lumenos HSA 3500 Family Closed
Lumenos HSA 1500 Closed

11 PPO plan closures in the last six months.  Members on those PPO plans (except the Lumenos 5000 w/Maternity) are allowed to remain on the plan and in some cases may add new family members.  However, all of these plans are closed for new enrollments except family members as mentioned.

As we move towards full implementation of Healthcare Reform, it will be interesting to see what the insurance carries do both in terms of QHP (Qualified Health Plan) implementation and existing plan pricing.

Dave
www.davefluker.com

Anthem Blue Cross CA Closing More PPO Plans 2012

Anthem Blue Cross (Blue Cross of California and Blue Cross Life & Health) has announced additional closures in California for individual & family health plans.  

In addition to the plan closures earlier this year (2012) which were posted on my blog, the following individual & family health plans will close on November 1, 2012:

*SmartSense Plus PPO 1000 Standard Rx

*SmartSense Plus PPO 1000 Upgrade Rx

*Lumenos 3000 HSA PPO (single)

*Lumenos 4500 HSA PPO (single)

*Lumenos 3500 HSA PPO (family)

*Lumenos 1500 HSA PPO

Members currently enrolled in these plans may stay on the plan after it closes on November 1.  Applications for enrollment into any of these plans will not be accepted after October 16, 2012. Applicants may enroll in these plans so long as their effective start date is prior to November 1, 2012.

Dave

www.davefluker.com

Blue Shield CA Medicare Plan Changes Coming

Blue Shield of California has announced some changes for Medicare beneficiaries in California. Medicare Supplement plans will have a plan premium rate change effective December 1, 2012. I will post the December California Medicare Supplement rates on my site 
(Medicare Supplements) in a few weeks. In the meantime I have the rates available for quoting via telephone or e-mail. In addition, 

Blue Shield CA will be adding two new Medicare Supplements to their portfolio. Additions will include High Deductible Plan F and Plan N. The current $20 per month "new to Medicare" discount will be reduced to $15 per month for those enrolling in Medicare Part B for the first time. As always, Blue Shield of California Medicare Supplement Plans include the Silver Sneakers health club membership at no additional cost. For more information about Blue Shield Medicare products, visit my web site. 

Dave 
www.davefluker.com

CT Health Insurance Exchange and other briefs posted

The CT Health Policy Project’s 2012 candidate briefing book on CT’s health is posted – including a brief on the CT Health Insurance Exchange. In addition, this year’s book includes briefs on twelve other timely issues including health care cost drivers, Accountable Care Organizations, and CT & national health reform. The briefing book is part of www.cthealthbook.org – our resource library on health care issues and solutions facing CT.

The Medicaid Controversy––The Republican Governors Should Put Up or Shut Up

Indiana, New Mexico, and Wisconsin are asking the federal government
to exempt people making between 100% and 133% of the poverty level from
the upcoming Medicaid expansion.

These Republican governors need to put up or shut up.

Ever since the passage of the Affordable Care Act (ACA), Republican governors have been clamoring for block granting Medicaid.

The Supreme Court ruled that a state

Romney Intends to Repeal “Obamacare” in 2013—Has He Thought Through the Unintended Consequences If He Does?

Romney says he will repeal “Obamacare” if he is elected. Given that this has been part of his platform from the beginning of the campaign he is entitled to do that if he wins.

I did not support passage of the Affordable Care Act (ACA) in 2010 because I saw it as an unaffordable entitlement expansion with no real hope of containing costs.

But the practical reality of killing the Affordable Care

Obama vs. Romney: A Detailed Analysis of Mitt Romney’s Health Care Reform Plan

Let’s take a look at Mitt Romney’s Health Care plan using his own outline ("Mitt’s Plan") on his website.

Romney's approach to health care reform summarized:

"Kill Obamacare" - There seems to be no chance Romney would try to fix the Affordable Care Act––he would repeal all of it.
No new federal health insurance reform law - There is no indication from his policy outline that he would try to

SB 1431 Moved to Inactive File

On August 31, SB 1431 was moved to the Inactive File. This bill was ordered to inactive file on the request of Assembly Member Charles Calderon.

Inactive file bills may be opened again at a later date for reconsideration. As of now, it appears that SB 1431 (the "stop-loss" bill) is no longer on the table in California.

Small group plans may continue to utilize current 'self-funded' plans for their employee health benefits.

SB 1431 Status

Previous Blog updates on SB 1431:

July 24 SB 1431 Update

May 21 SB 1431 Update

April 20 Original SB 1431 Blog Post


Dave
www.davefluker.com

As always, for specific information on health insurance plans and programs, visit my site using the link above

Insurance Company Shenanigans – Part 2

If you live in CT and are insured through Golden Rule, now also known as United Healthcare’s United HealthOne; you should read the State of Connecticut’s Insurance Department notice # 509542, dated 8/17/2012. They filed a rate increase of 9.9% which the State of Connecticut cannot deny; since they filed it saying they will reimburse policy owners if they don’t spend 80 cents of every dollar on medical expenses. Let me interpret for you; according to the State of Connecticut, they are charging 3.3% more than they should be charging. Basically, on average, they are charging and collecting $380 more per year next year than this year; or by the State’s estimate $125 more per year than they should be charging you! Doesn’t sound like much, but consider this: you are financing the operations of a company that paid its CEO over $50 million in salary and benefits just a couple of years ago! Is this fair? Consider that $125 is the average, and that people with family plans are overpaying by far more than $125 per year to finance this $100 billion dollar corporation. Tony Pinto

Insurance Company Shenanigans – Part 1

In case you’re wondering why you don’t hear insurance companies complaining about Obamacare; it’s because they are big winners and don’t want to rock the boat. Insurance companies are “limited” to either paying out 80% of every dollar collected in the Individual and Small Group business market or 85% of every dollar collected in the Large Group business market. What this means is that they can keep 20% or 15% of every dollar respectively for themselves to cover their operational costs and create profits for them. Think about that… In the Individual and Small Group markets, they can keep 20% for themselves to pay their expenses and fill their pockets. Doesn’t seem like a big number; but, this means that the more expensive in dollars the health plan is; the more they make in profit. For example; if you buy a health plan that costs $400 per month with high co-payments; they can make $80 per month at-most at 20%. However; if you buy a health plan that costs $600 per month with lower co-payments; they can make $120 per month at 20%. Interesting, isn’t it… The more a health plan costs; the more profitable it can be for the insurance company. Tony Pinto

When choosing a plan in the exchange, actuarial value just a starting place

A new real-world analysis by the Commonwealth Fund demonstrates devil in the details of the bronze/silver/gold/platinum health plan actuarial value levels designed to guide consumers and small businesses choosing plans in the new insurance exchanges. The metal categories were designed to organize and make sense of confusing choices and combat deceptive insurance industry marketing practices. The analysis describes the very different costs and coverage available to individuals under plans from the same metal category. In some cases a “better” plan based on actuarial value can end up costing consumers more depending on their costs during the year. Unfortunately it is very difficult for most consumers to predict their future health costs – isn’t that why we have insurance in the first place? The study concludes, “actuarial value is a useful starting point for selecting a plan, but it does not pinpoint which plan will produce the best overall value for a particular person.” So much for making things simple. As of January 2014, consumers will be required to secure health coverage under federal law. Individuals eligible for premium subsidies must purchase coverage in the new state insurance exchanges. Leadership of CT’s Health Insurance Exchange, now developing, has been criticized as dominated by insurers and lacking independent consumer representation.

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:

*CaliHealth
*CalAccess
*Wellquest
*Covered California
*PAccess

Interesting Names:

*Ursa
*Healthifornia (A Better State of Healthcare)
*Eureka (Discover Affordable Healthcare)
*Avocado (A Uniquely California Approach to Affordable Healthcare)
*Beneficia
*Cal-Vida
*Condor

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).

Dave
www.davefluker.com

As always, for specific health insurance information please visit my main web site at the link above.

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 to facilitate enrollment into the exchanges (emphasis in on the individual exchange).

*Agents and Brokers must assist prospective clients if they are eligible for Medi-Cal (California Medicaid) and/or the Healthy Families Program. Agents and Brokers will not be compensated for assisting with Medi-Cal or Healthy Families enrollments (Navigators will get $58 for these enrollments). The exchange considers this a "cost of doing business" and a community service.

*Web-based agents' sites will be carefully scrutinized to ensure that they don't develop competing exchange web sites or quoting engines that use algorithms designed to drive business to any specific carrier or plan displays designed to promote a certain carrier or carriers over others.

*Agents and Brokers in the individual exchange must present plans from all carriers in a metal tier in a fair, equal and balanced way.

*General Agents/Agencies will be excluded from the Individual & Family Exchange. They will be allowed in the SHOP Exchange.

That's the big stuff from August.

Dave
www.davefluker.com

As always, for specific information concerning health insurance coverage, please visit my web site at the link above.

California Individual & Family Exchange Similar to Amazon.com?

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 purchasing health insurance under the reform law in California from the Exchange will fall into one of four "buckets".

*Medi-Cal& Healthy Families full coverage levels (no share of cost)
*Medi-Cal at exchange subsidy levels with potential Healthy Families kids
*Those above Medi-Cal threshold entitled to some exchange subsidy
*Those above 400% FPL who will receive no subsidy from the exchange

All applicants seeking to purchase Exchange coverage for themselves and/or their families through the California Health Exchange will have to be financially 'vetted' to determine level of subsidy qualification (if any) before they can purchase an Exchange plan. Specifically the Exchange wants to ensure those qualifying for no-cost or cost-share Medi-Cal and Healthy Families are addressed appropriately and not enrolled incorrectly.

In discussing this with a carrier rep, we were trying to figure out if there is a method to determine what information may be required by the California Health Benefits Exchange to purchase and enroll in an exchange subsidy product. Because those currently covered by Medi-Cal and Healthy Families must certify their financial eligibility every year, we realized that the current Medi-Cal application is likely an accurate framework for the information that will need to be provided to the Exchange (and IRS) to purchase subsidy coverage.

Below I have linked to the current California Medi-Cal Application and and Medi-Cal Instruction brochure. I suggest those considering Exchange coverage take a look at the questions and information required on this application to better understand what information the CA HBEX will require to properly assess subsidy level and qualifications to purchase from the Exchange. It's a bit more 'personal' than Amazon and Expedia.

California Medi-Cal Application Form

California Medi-Cal Application Instructions


Dave
www.davefluker.com

As always, for specific health insurance information, use the link above to go to my web site.

FPL - Federal Poverty Level
HBEX - Health Benefits Exchange
Healthy Families - A low cost health plan for children
Medi-Cal - California's Medicaid program

CT health reform progress up to 15.2%

CT made impressive progress toward health reform in August. We moved from 13.7% of the way to 15.2% this month. Highlights include negotiation of a compromise Essential Health Benefit Package and CMS grant funding to the insurance exchange. The grant is very exciting – the state plans to use most of the funding for a new, comprehensive IT system. If we do this right, this could solve a lot of our systemic problems. Unfortunately we fell behind in limiting monopoly providers by approving the Yale-New Haven – St. Raphael’s merger raising serious concerns about access to care for New Haven area un and underinsured consumers, and about costs for all of us. But we are stepping up progress – it’s been a good month.

HHS approves CT application for more insurance exchange funding

Today Health and Human Services, the federal agency tasked with approving and funding state insurance exchanges under the Affordable Care Act, announced that CT’s Level II insurance exchange application has been approved for $107 million, along with new grants for seven other states. A large part of CT’s grant is meant to fund development of an IT system to coordinate “eligibility, enrollment, and information exchange among individuals, employers, insurance carriers, and state and federal government agencies”. This function is sorely needed, long overdue, and hopefully CT’s Health Insurance Exchange will do a good job of designing and procuring this system. Advocates have been critical of many decisions made by the insurance-dominated exchange Board, which includes no independent consumer representatives.

Romney vs. Obama: The Romney-Ryan Medicare Plan Compared to the Obama Medicare Plan—Who’s Telling the Truth on Medicare?

They both are and they both aren’t.

I’ve never seen a week in health care policy like last week. The media reports have to be in the thousands, all trying to make sense of the furious debate between Obama and Romney over Medicare.

As someone who has studied this issue for more than 20 years, it has also been more than exasperating for me to watch each side trade claims and for the press to try

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 current California mandated MLR on Medicare Supplements, they must issue a rebate to members effected by the overcharge. See my earlier Blog regarding Anthem Blue Cross: Anthem Blue Cross Issues MLR Refunds

Currently there is no provision in California to raise the MLR on Medicare Supplement Plans. I have heard rumors, but nothing of substance. Should any potential changes in the MLR requirements for California Medicare Supplements become available, I will post a blog on it.

California Health & Safety Code 1358.14

(a) (1) (A) With respect to loss ratio standards, a
Medicare supplement contract shall not be advertised, solicited, or
issued for delivery unless the contract can be expected, as estimated
for the entire period for which prepaid or periodic charges are
computed to provide coverage, to return to subscribers and enrollees
in the form of aggregate benefits under the contract, not including
anticipated refunds or credits provided under the contract, at least
75 percent of the aggregate amount of charges earned in the case of
group contracts, or at least 65 percent of the aggregate amount of
charges earned in the case of individual contracts, on the basis of
incurred claims or costs of health care services experience and
earned prepaid or periodic charges for that period and in accordance
with accepted actuarial principles and practices.


Dave
www.davefluker.com

As always, for specific information regarding health insurance and Medicare-related products, please visit my web site at the link above.

Last chance: Seeking nominations for CT thought leaders

We are refreshing our invitation list for the CT Health Thoughtleader Survey. The survey has been cited by policymakers as a tool in evaluating our state’s progress toward reform. It is part of our CT Health Reform Dashboard. To keep the list robust and ensure a broad reach, we are seeking nominations for the survey. Who do you rely on for information on health reform in CT? Help us improve the tools for our state’s health policymakers and give us your nominations.

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 of the open
enrollment period, the individual is covered under another Medicare
supplement policy or contract. An issuer shall notify a policyholder
of his or her rights under this subdivision at least 30 and no more
than 60 days before the beginning of the open enrollment period."

So, a California Medicare Beneficiary enrolled in a Medicare Supplement plan will have 30 days from his/her birthday to change to a like or less Medicare Supplement plan with any available issuer with no medical underwriting on a Guaranteed-Issue basis.

Like or Lesser is very important in this regard. If a beneficiary is on Plan F for example, then any available Supplement including another Plan F would be allowed under the Birthday Rule. A similar beneficiary on Plan N would have some limitations as to which Supplement he/she could move to under the Birthday Rule as certain Supplements (including Plan F) would be considered an upgrade in coverage and not 'like or lesser' coverage. An independent agent can be a great assistant in helping you understand your Medicare Supplement plan change options under the "Birthday Rule".

Dave
www.davefluker.com

As always, for information on specific health insurance products and programs, please visit my health insurance web site at the link above.

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 & family market. Applies to 84,428 subscribers. $40.50 average rebate per subscriber.

PacifiCare Life & Health Insurance Company - $789,615 dollar rebate to policyholders in the individual & family market. Applies to 63,600 subscribers. $12.42 average rebate per subscriber.

Connecticut General Life Insurance Company (Cigna) - Not subject to MLR in the individual & family health market. No rebates to any subscribers.


Dave
www.davefluker.com

For specific health insurance information, please use the link above to go to my main web site.

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 insurance agents in California there two critical action items moved to August from the July meeting. Item VII B will be the decision regarding Agent Payment Options for the Individual & Family Exchange. Item VIII B will be the decision regarding Agent Payment Options for the SHOP Small Business Exchange.

Current HBEX Board recommendations are for the health insurance companies to pay agents commission equally for plans sold inside and outside of the individual exchange.

Current HBEX Board recommendations for the SHOP Small Group Exchange to pay agents commission directly from the SHOP exchange and not from the insurance carriers. This would be very similar to the HIPC/PacAdvantage program from some years ago.

I have linked to the agenda below and suggest anyone interested to tune into the live Webcast on August 23rd.

HBEX August 23 Agenda

Dave
www.davefluker.com

As always, for specific health insurance information, please click on the link above to visit my main web site.

Wyden and Ryan—One is Up and the Other is Down—and They Are Both Telling the Truth

Republican Vice Presidential pick Paul Ryan isn’t the only one Democrats are piling on this week. The knives have come out for Senator Ron Wyden, the Oregon Democrat.

I guess that isn’t a surprise. If Ron Wyden is right on Medicare then so are Paul Ryan and Mitt Romney.

The fundamental problem here is that the Democrats have decided that their best path to victory in the November elections is

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
Medical Group - PPO only

As always, for more information on specific health insurance plans available from Blue Shield CA and other insurance carriers, please visit my web site by clicking the link below.

Dave
www.davefluker.com

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.

Dave
www.davefluker.com

Almost half of CT exchange members will pay full price

Almost half of CT residents buying coverage in the new CT Health Insurance Exchange will not get premium subsidies – they will pay the full cost of coverage, including the exchanges’s administrative costs. Small businesses are expected to make up between 14% and 22% of total exchange enrollment. At least 60% of CT’s newly insured under national health reform will be coming into our Medicaid program. Even with reform, up to 197,000 CT residents will still lack coverage. For more, go to CT Health Reform by the Numbers.

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 year (most likely January 1, 2013).

Click on the official Blue Cross Notification

Dave
www.davefluker.com

August CT Health Reform Dashboard – 13.7% progress

This month CT is again making progress toward health reform. We are now 13.7% of the way toward health reform. Unfortunately we are up only slightly from last month’s 13.2% performance. At this rate, it will take over fourteen years to fully implement reform, but January 1, 2014 is only a year and a half away. Track CT’s progress on the CT Health Reform Dashboard at www.cthealthreform.org

Seeking nominations for CT thought leaders

We are refreshing our invitation list for the CT Health Thoughtleader Survey. The survey has been cited by policymakers as a tool in evaluating our state’s progress toward reform. It is part of our CT Health Reform Dashboard. To keep the list robust and ensure a broad reach, we are seeking nominations for the survey. Who do you rely on for information on health reform in CT? Help us improve the tools for our state’s health policymakers and give us your nominations.