Qualified Health Plan committee date changed

The exchange’s Qualified Health Plan advisory committee will meet Friday, June 8th from 10:30 am to noon replacing the June 13th meeting.

Anthem Blue Cross CA Closing Clear Protection Plus 1000 PPO

Anthem Blue Cross (Blue Cross of California) announced very late this afternoon (4:40 PM PST to be exact) the pending closure of the Clear Protection Plus 1000 PPO plan (06B3) effective July 1, 2012.

No reason for the closure was given with the announcement. I have a query in but don't expect an answer until after the holiday.

Current members may remain on the Clear Protection Plus 1000 plan or may elect to move to a new plan (choices not yet identified) during an upcoming open enrollment (also not specified).

This represents the second closure of a Clear Protection Plus plan in the last 60 days. The Clear Protection Plus 5000 PPO was closed May 1, 2012. This leaves only one Clear Protection Plus plan available to the public after July 1, the Clear Protection Plus 3300.

Dave
www.davefluker.com

Blue Shield California Removes HIPAA 4000 HSA PPO

One of the more popular HIPAA guaranteed-issue plans over the last couple of years has been the HSA-compatible Spectrum Savings PPO 4000 with Blue Shield of California (Life & Health).

With the previously blogged closure of the majority of Blue Shield's PPO health plans (July Plan Closure Blog), including the 4000 Savings PPO, the plan has also been removed from the offerings for HIPAA.

As of today, it is my understanding that Blue Shield does not intend to replace the 4000 HSA PPO plan in the HIPAA portfolio and has no intention of offering any HSA-compatible PPO plan for HIPAA-eligible individuals & families. I was told that until and unless I hear otherwise, the HIPAA portfolio available from Blue Shield will be as follows:

*Access+ HMO
*Access+ Value HMO
*Spectrum PPO 5000
*Spectrum PPO 5500

These are also the four remaining underwritten individual & family plans that are not being closed to new enrollments July 1.

Both Blues (Blue Cross of California (Anthem) and Blue Shield of California) are excellent PPO carries with large networks in California. The loss of the only HSA-compatible PPO plan by either Blue for HIPAA enrollees is a bit sad. There are many who need to enroll in HIPAA that would benefit from both the lower annual out-of-pocket and the combined Rx and medical expenses.

Should Blue Shield provide information on any new HIPAA plans I will post here on the blog.

Dave
www.davefluker.com

Upcoming Exchange meetings

The CT Health Insurance Exchange Board’s next meetings are June 21, July 19 and August 16 all from 9am to noon. The SHOP Advisory Committee will meet June 12th from 9 to 11am, July 11th from 1 to 3pm, and August 8th from 1 to 3pm. The Navigators Advisory Committee will meet June 12, July 10, and August 7 all from 1 to 3pm. The Qualified Health Plans and Benefits Committee will meet June 13, July 11, and August 8 all from 9 to 11am The Consumer Committee will meet June 13th from 1 to 3pm, July 10th from 9 to 11am, and August 7th from 9 to 11am.

Taking the pulse of CT’s Health Insurance Exchange

As health insurance reform begins to take shape here in Connecticut there are many important elements of implementation that the Health Insurance Exchange Board, their staff and advocate/stakeholders need to focus on. But nothing is more important than educating health care consumers. Securing reasonably priced, quality health insurance is hard enough; how health care reform, and the Exchange, will help consumers is complex. The educational message needs to reach all segments of our population, bridging age, race, gender and geography. One of those critical groups is entry level employees of small businesses that do not provide health care. Recently, the Exchange board hired a marketing firm, which has been reaching out to groups and individuals to collect and mine data, with the goal of educating the public. But sometimes feedback from a "boots on the ground" approach to data collecting is as helpful, or even more helpful, in bringing clarity. I run such a business, providing commercial maintenance services. To that end, a member of my staff and I spent two weeks talking to two people each day as we did our business at area big box home improvement stores. We asked 3 questions: 1. Are you an employer yes / no? 2. Do you have health insurance ? 3. Do you know what the Health Insurance Exchange is? Of the 40 individuals we interviewed, 31 were employees; 9 were small business owners. Not one of the 40 individuals had ever heard of the Connecticut Health Insurance Exchange. Not one of the 31 employees knew about health care reform. Seven of the 9 employers believe that health care reform will increase their costs; 2 employers (interestingly enough) believed that health insurance would be FREE under reform. One individual confused the CT Health Insurance Exchange with the NY Stock Exchange. Our survey wasn’t scientific, to be sure. But it does provide a very telling indication of just how much work needs to be done on brand development and awareness of the Exchange. And we haven’t even touched yet on the complexities of what it is the Exchange will do. Our informal survey highlights just one of the many challenges the Connecticut Health Insurance Exchange is facing. I am hopeful that the new marketing firm, and the Exchange board will make good use of the wealth of knowledge of the many health care advocates. Where small business owners and employees buy their wares might be a good place to get the message out. Kevin Galvin, owner, CT Commercial Maintenance

California MRMIP: How To Get There From Here

I wanted to post about a relatively new enrollment process with regard to the California MRMIP (Major Risk Medical Insurance Program). Mainly I want to advise people interested in enrolling in MRMIP to be sure and submit paperwork well ahead of the desired start date.

Until recently, California residents wishing to enroll in the Major Risk Program (MRMIP) or the temporary PCIP (Pre-Existing Conditions Insurance Program) could choose which program they wished to enroll into based on qualifications and eligibility requirements. At one time there was a separate application form and enrollment guide for each of the Risk programs.

Currently, the PCIP handles all enrollment processing for both PCIP and MRMIP in Folsom. Using the newer, unified application form, applicants must submit the paperwork first to PCIP for initial processing. Even if you choose the MRMIP and have no interest nor eligibility for PCIP, the PCIP folks must first determine that you are, in fact, not eligible for PCIP before they will forward the paperwork down to MRMIP to enroll you.

This process causes delays and you might miss a desired start date as a result. In complicated MRMIP enrollment situations, the PCIP, which is apparently not trained on how MRMIP actually works, may hold up application paperwork for several weeks requiring the applicant to provide certain additional documents. Even if you check MRMIP only on your application, PCIP still has to vet your application before forwarding to MRMIP.

Unfortunately, MRMIP only has liaison with PCIP and they sometimes have difficulty explaining to the PCIP the eligibility rules as they pertain specifically to MRMIP. Trust me, I have been on a phone call or two like that. It can get very frustrating especially when MRMIP is getting ready to close 1st of the month slots and your application is still sitting at PCIP.

I understand that the system is in place to ensure that no one accidentally enrolls in MRMIP if they are actually eligible for PCIP. However, the process slows down the rollover to the MRMIP and I personally feel that there should be at least one MRMIP specialist in Folsom assisting up front with the applications.

So, if you want MRMIP, submit your paperwork a couple of months prior to the desired effective month to give yourself enough time to clear the PCIP.

Information about MRMIP and PCIP, including brochure, rate guide and application forms can be found on my web site at MRMIP/PCIP.

Dave
www.davefluker.com

CA SB 1431 Update (May 21)

I just wanted to provide an update on CA SB 1431 which deals with self-insured group health plans. See my previous blog post:

California SB 1431 To Limit Self-Funded Small Group

California SB 1431 passed appropriations by a 4-2 vote on May 14th, 2012. On May 16th, a second reading was conducted and the bill was ordered to a a third reading which has not yet been scheduled.

Stay tuned to this blog for updates regarding the status of CA SB 1431 (De Leon).

Dave
www.davefluker.com

Insurance Exchange Board meeting notes

The CT Health Insurance Exchange Board met last week – not much happened. Small business owner, Kevin Galvin, and a consumer who has struggled with health care and insurance access gave very moving public comment to start the meeting. There were lots of updates but no actual substantive information. The committee reports were interesting – somewhat different than reports from advocates who attended them. There was an acknowledgement from the SHOP committee that they need to engage small business owners on the committee; they are going to work on that. They also recognize that the measure of their success should be whether more CT small businesses offer benefits rather than enrollment in the SHOP exchange. MA found that while small business enrollment in their Connector has lagged, more small businesses are finding affordable, decent coverage options and offering benefits to their employees. The SHOP exchange could serve as a competitive catalyst to improve offerings in the entire market. There was discussion about having CBIA run the SHOP exchange as well. The Qualified Health Plan Committee is struggling with defining the essential health benefit package and whether to include all the state mandates. There was discussion about the health benefits offered to employees of the exchange; Board members felt strongly that, as soon as the exchange is operational, employees should get their health benefits there, as will members of Congress. Mintz & Hoke continues their efforts to solicit the best ways to sell the exchange to consumers and small business. They are not collecting input for the exchange to use in designing their system but were asked for the feedback they have gotten so far. Their answers were 1) consumers are confused and uncertain, 2) benefit choices must be kept simple, choosing insurance is intimidating, and 3) they are targeting two populations – families (with mainly women making health decisions) and young invincibles. Upon questioning, they agreed with Vicki Veltri’s experience, matching ours, that the most salient fact about consumers is that they are very distrustful of both insurance and of government. The Exchange crosses both issue areas.

CT’s insurance exchange keeps its solid C grade

Again this month Connecticut health care thought leaders gave our state’s health insurance exchange a C on health reform. Fifteen percent of thoughtleaders gave CT’s exchange a Failing grade; the exchange received no A’s. Several suggestions to improve health reform in CT focused on the exchange including “Speed up progress on the exchange”, “Add consumers and small business owners to [the] exchange board”, “Study what Maryland is doing for their exchange”, and “Get a more representative Exchange Board.” The survey list was collected from membership of health-related state councils, board and committees and leadership of health-related organizations. Respondents represented community organizations, foundations, providers, payers, consumer advocates, labor, business people, insurance brokers, and academics. To ensure independent responses, state officials responsible for reform functions were not surveyed. For more, go to the CT Health Reform Dashboard at www.cthealthreform.org.

InsureBlog: The Passing of a Legend

My friend and fellow agent Bob Vineyard said it as well as I could have. We lost a friend, agent, mentor, colleague and legend this month. RIP Frank Stastny.

InsureBlog: The Passing of a Legend

Dave
www.davefluker.com

Exchange fix bill dies in Senate

The bill to bring the CT Health Insurance Exchange into compliance with federal regulations died on the Senate calendar last night as the session ended. The bill would have added two consumer and two small business representatives to the Board’s membership and given the State Health Care Advocate a vote. Currently there are no voting members representing consumers and three Board members have insurance industry backgrounds. The bill passed two committees and passed the House unanimously but was never called in the Senate. The administration has defended their appointments and the composition of the current Board. Board members are appointed by the Governor and legislative leadership. Thankfully one current member, appointed by House Republicans, is a small business owner.

CT Health Reform Dashboard – CT up to 12.1%

CT has jumped ahead in progress in health reform to 12.1% of the tasks completed, according to the May CT Health Reform Dashboard. This is up from 10.8% last month. While we are closing in on the major January 1, 2014 deadline for many reforms, much remains to be done. At this rate, it will take 5.6 years to achieve reform. The dashboard can be found at www.cthealthreform.org.

Aetna to Add IFP Maternity and Autism Benefits in California

Aetna announced to agents yesterday that they will be adding both the mandatory maternity benefit and the new autism benefit to their existing IFP (Individual & Family Plans) portfolio.

Last year Aetna closed IFP operations in Colorado due, in part, to mandatory maternity benefits. Many agents in California were waiting to see what action Aetna would take here.

In California, effective July 1, 2012, all individual & family health insurance plans must cover maternity benefits under SB 222 which was signed into law last fall.

Dave
www.davefluker.com

Upcoming insurance exchange meetings

The CT Health Insurance Exchange Board’s next meeting is May 17th 9am to noon. Upcoming advisory committee meetings include:

• Qualified health plans committee May 14th 9am to 11am 
•  SHOP exchange committee May 14th 1pm to 3pm 
• Consumer committee May 15th 9am to 11am 
• Navigator committee May 15th 1pm to 3pm

All meetings are at tentatively at the Legislative Office Building.
The Consumer committee will also be holding webinars – Stakeholder Discussions – led by Mintz & Hoke, the exchange’s communications firm. The webinars are scheduled for:

• Small Employers May 9th 3pm to 5pm 
• Consumer Session I May 10th 3pm to 5pm 
• Consumer Session II May 16th 9am to 11am 

For information on how to participate, email Kathy Morelli at kathym@mintz-hoke.com