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.
Tuesday, 28 August 2012
Saturday, 25 August 2012
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.
*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
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
Friday, 24 August 2012
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.
Thursday, 23 August 2012
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.
Monday, 20 August 2012
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
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
Friday, 17 August 2012
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.
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.
Wednesday, 15 August 2012
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.
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.
Tuesday, 14 August 2012
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.
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.
Monday, 13 August 2012
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.
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
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
Friday, 10 August 2012
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
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
Tuesday, 7 August 2012
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
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.
Wednesday, 1 August 2012
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
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
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