Women's Preventive Care Enhancements August 2012

As directed by the ACA (Affordable Care Act), preventive care services for women will be enhanced for all non-grandfathered health plans in California (and all other states as well).

In addition to current preventive benefits, the following preventive benefits for women will be added to existing and new non-grandfathered health insurance plans including self-funded group health plans:

* Well-Woman visits
* Screening for gestational diabetes
* Testing for HPV (human papillomavirus)
* Counseling for sexually transmitted infections
* Screening and counseling for HIV
* FDA-approved contraceptive counseling and contraception methods
* Breastfeeding support, supplies and counseling
* Screening and counseling for interpersonal and domestic violence

For those purchasing coverage on or after August 1st, the health plan will include the expanded preventive benefits.

For those on existing health plans prior to August 1st, the benefits will be added at the policy renewal of your policy. Most likely not later in any case than January 2013. Each carrier will determine at what point it will add the benefit, this (above) is how Anthem Blue Cross intends to do it.

For those on grandfathered health plans (plans purchased prior to March 23, 2010), grandfathered plans will not receive and additional preventive benefits for women.

Dave
www.davefluker.com

Blue Shield CA Adds Premium Requirement for Applications

Beginning May 1, 2012, Blue Shield of California (and Blue Shield Life & Health) will require initial premium to be submitted with new individual & family applications.

Currently (and in the past), Blue Shield has allowed applications to be processed without the premium accompanying the application.

As of May 1, 2012 any individual & family plan application submitted without premium will be returned and not processed.

Dave
www.davefluker.com

April CT Health Reform Dashboard -- 10.8% progress to date

This month again CT is making progress toward health reform. This month we are 10.8% of the way toward health reform. Unfortunately we are only up from 10.7% last month. At this rate, it will take 48 years to fully implement reform. Track CT’s progress on the CT Health Reform Dashboard at www.cthealthreform.org

What Would Individual Health Insurance Cost if the Court Strikes the Mandate Down and Still Requires Insurers to Cover Everyone?

With the Supreme Court justices sounding like they might strike the mandate down, this is a question I've been getting a lot lately.I have pointed to New Jersey as a real life example of what can happen when insurance reforms take place but there is no incentive for consumers to buy it until the day they need it.In 1992, New Jersey passed health insurance reform that required insurance carriers

If the Supreme Court Overturns the Individual Mandate

First, trying to predict how the Court will rule is at best just speculation. I know what Justice Kennedy said both today and yesterday and it certainly doesn’t look good for the Obama administration and upholding at least the mandate.But I will remind everyone, based upon oral arguments, most Court watchers expected a ruling in favor of the biotech industry on a recent case involving health care

Exchange advisory committees begin work

Last week the four CT Health Insurance Exchange advisory committees held their first meeting jointly. The meeting included a very good presentation on the basics of the exchange and a list of the decision points for each committee. The next advisory committee meetings, all public and all tentatively in Room 310 of the Capitol, will be:

Consumer Experience and Outreach

April 10^th  9 to 11am

Brokers, Agents and Navigators

April 10th  12:30 to 2:30pm

Health Plan Benefits and Qualifications

April 11^th   9 to 11am

Small Business Health Plan Options Program (SHOP)

TBD

Experience to inform health insurance exchange outreach

CT has a long and varied history of outreach programs; some worked very well and some were less successful. There is a great deal of experience available to the CT Health Insurance Exchange and their consultants to design a robust program that meets the needs of individuals and small businesses likely to enroll. As individuals will be required under federal law to purchase coverage, and 140,000 state residents will have to buy it on the exchange to access subsidies, it is vital that we learn from experience and not repeat mistakes. We’ve collected some of that experience in a new brief. We offer this experience to the Exchange to help ensure a viable, trusted Exchange is developed that makes serving its customers their first priority.

Insurance Exchange meeting allows limited public comment

Partially responding to widespread calls to respect consumer voices, the CT Health Insurance Exchange Board allowed 12 minutes of public comment at the beginning of today’s meeting. Speakers were limited to two minutes each – there was only time for five. They heard from a struggling consumer, a small business owner, advocates and a representative of the faith community that, while we are grateful for this effort, the process needs to be far more open. Several Board members seemed moved by the testimony and understood that they are missing important perspectives critical if the exchange is going to work. The Board is currently hiring senior staff, developing a budget, beginning to develop a mission statement and guiding principles, and choosing an administrator for the exchange, all without voting consumer input. Mintz and Hoke, the advertising agency hired for consumer input, was criticized by speakers and Board members for soliciting limited input and not reaching out to CT’s well-organized consumer advocacy networks. Their scope is limited to message-testing for the eventual exchange products, not listening to customers about how those products should be designed to meet the demands of the market. They emphasized mass media, which has not historically been successful in outreach in CT, social media and texting. While texting and social media are commonly used between young invincibles in personal communications, it is unclear whether they are effective vehicles to sell health insurance. They are still researching other states’ consumer research efforts and populations eligible for the exchange; unfortunately, it is unclear if there is time for a learning curve. The speaker helping the Board with governance put consumers at the end of the chain of stakeholders (never mentioned small businesses) and equated consumers with providers and health plans in importance. It was clear that Board members have not seen consulting contracts, RFPs or other solicitations before they are finalized. The administrative RFP will be “fast tracked” concerning many consumers and small businesses.  Mike Devine, the only small business owner on the Board, asked whether KPMG, hired for business operations, had investigated overlap with other agencies in CT, and other states. There is likely a great deal of overlap with other states, particularly the New England collaborative, and federal and very well-resourced privately funded programs that are developing innovative enrollment, operations and outreach programs. After an hour and a half of public meeting, the Board went into secret executive session for an hour and twenty minutes. After which they reconvened for less than a minute to adjourn, without voting or reporting on what was discussed in executive session.

Ellen Andrews

Anthem Blue Cross CA May 1, 2012 Rate Change Update - Incorrect Rates

Anthem Blue Cross CA announced a rate change on individual & family plans effective May 1, 2012. Affected members received a notice of the rate change and new rate for 5/1.

Some Anthem Blue Cross members (but not all) received an insert indicating that the new May 1 rate quoted was incorrect and and would be lower than the rate quoted in the letter.

In fact, all rate increases sent out to all affected Anthem Blue Cross members show incorrect rates for May 1, 2012 and all rate increases will be lower than the rate increase that was quoted in the letter.

Anthem will be sending out new letters later this month which will indicate the corrected rate change for May 1.

This rate change includes age change which are no longer assessed on the birthday but instead at the annual rate change cycle.

Please be patient as no one including Anthem membership nor your agent currently has the corrected rates and we don't anticipate having correct rates until later in the month of March.

I should also mention that all online quoting services including Quotit and Norvax do NOT have the correct may 1 rates. All online quotes are currently using old rates and won't be updated until the full rate correction is provided.

Dave
www.davefluker.com

Will the Pace of Innovative Change Overtake the Financial Imperative to Slash Spending?

I thought it was worth passing along the comments by Jim Tallon, president of New York's United Hospital Fund, in a recent post.Tallon reflected on an international meeting he attended with health care leaders from a number of industrial nations--"nations whose health care systems, indeed underlying philosophies, ranged from market orientation through hybrids to government authority:" "Across

CT gets a C for health reform

In a new survey, Connecticut health care thought leaders give our state a C on health reform. The state received no A’s. Connecticut received a slightly better grade, C+, for effort. Connecticut’s Medicaid efforts are a bright spot, earning a B. The worst grade was for Engaging Consumers in Policymaking, averaging a D rating. A significant number of responders answered Don’t Know on one or more issue areas, echoing calls for better communication and coordination in health policymaking. Asked for suggestions to improve Connecticut’s progress toward reform, several themes emerged including engaging consumers in policymaking, limiting the influence of special interests, expanding the health care workforce, and improving policy coordination, focus and leadership. Click here for more detail on the survey. The survey is part of the CT Health Reform Dashboard, tracking our state’s progress toward health reform.

CT Health Reform Dashboard -- 10.7% progress to date

The good news is that CT is making progress. This month we are 10.7% of the way toward health reform. The bad news is that we are up from 10.4% last month. Track CT’s progress on the CT Health Reform Dashboard at www.cthealthreform.org

Anthem Blue Cross CA to Shutter 4 Open Individual Health Plans

Anthem Blue Cross Life & Health of California has chosen today to initiate closure of four currently open, non-grandfathered Anthem Life & Health PPO plans. The plans which will be closed are:


*Clear Protection Plus 5000 (06B5)
*CoreGuard Plus 7500 (06BB)
*CoreGuard Plus 10000 (0ADX)
*Lumenos HSA 5000 w/Maternity(06BP)

Clear Protections Plus 5000 and CoreGuard 7500 & 10000, will close for new sales beginning on May 1, 2012. These plans will be closed to new enrollments but will not be discontinued. Those currently enrolled on these plans are free to remain on their policy and add family members through normal underwriting.

Members on the Clear Protection Plus 5000 and CoreGuard Plus 7500 & 10000 will also have an open enrollment period from May 1 to June 30, 2012 to move to another open plan without medical underwriting. Members may switch as follows:

*Clear Protection Plus 5000 can move to the Clear Protection Plus 3300
*CoreGuard Plus 7500 & 10000 can move to the CoreGuard Plus 5000

For Lumenos 5000 HSA with Maternity, it will be quite a bit different.

Effective March 30, 2012, Lumenos 5000 HSA (06BP) will be closed for new sales. In addition, as of July 1, 2012, Anthem will be discontinuing the Lumenos HSA 5000 plan (06BP). There are fewer than 500 members on this plan and members on the plan will be required to change coverage by June 30, 2012. An open enrollment period will be provided to members of this Lumenos plan.

Lumenos HSA 5000 affected plan members will have the following options for plan change:

*Plan members can move to any open Anthem Blue Cross Life & Health plan during the open enrollment. They may not move to a DMHC-registered product from Anthem Blue Cross of California and are excluded from transfer to the following (Share 3500, Share 5000, Share 7500, HMO, HMO Saver and Select HMO)

Any member on the Lumenos HSA 5000 who does not make an election for plan change during the open enrollment will be automatically enrolled as follows:

Individual - Lumenos HSA 4500
Families - Lumenos HSA 7500

Anthem notes that it is important to remember that all Anthem policies, including Lumenos HSA plans, will provide maternity coverage as of July 1, 2012 due to California SB 222 (mandatory maternity law).


Dave
www.davefluker.com