Posted on Tue, Aug 31, 2010
Today, about 2,000 organizations, ranging from small and large companies, educational institutions, unions, nonprofit organizations and local governments have received acceptance into a program that reimburses employee claims beginning this fall.
The Early Retiree Reinsurance Program was created by Healthcare Reform, and is meant to be a bridge between now and 2014, which is the date that medical insurance exchanges will be in effect. This program offers $5 billion to unions and employers to assist them in maintaining insurance coverage for retirees that retire early at age 55 or older, that aren't qualified for Medicare yet. These 2000 employers will get reimbursed for early retirees' health claims for themselves and their spouses, dependents, and surviving spouses.
This new program will lessen the cost of businesses' medical insurance costs for many retirees. The high cost of medical care has prohibited employers from providing affordable medical insurance for their retirees and employees, while still being competitive in their field. In 1988, 66% of large employers provided employees with retiree medical coverage; whereas in 2009, just 29% of large employers provided these benefits. Medical insurance costs for older employees and retirees are more than 4 times more costly than they're for younger employees. Likewise, the deductibles they pay is about 4 times higher than a company sponsored plan.
More applications for the next round of approvals are being reviewed each day. Beginning in September, applicants that have been approved in this first batch of approvals will be able to submit their claims that are dated back from the 1st of June, 2010. Then, beginning in October, reinsurance payments will begin to be dispersed to applicants that have been approved.
Posted on Tue, Aug 31, 2010
Last March, Anthem Blue Cross had filed rate increases with the CA Dept. of Insurance that was declined due to miscalculations on Anthem's part. Originally, medical insurance rates were expected to be increased by as much as 39%.
Since then, Anthem Blue Cross has revised and resubmitted their rates for October 1, 2010. These new medical insurance rates have been approved, and rates will be increased by 14% up to 20% for their members that were scheduled to have rate increases is March, April, May, June, July and August.
According to Anthem, they have said that there is a lot of misinformation in the media regarding their rate filings. They clarified that the miscalculations were mostly related to the way that they had estimated future medical costs, and that their original March rate filings met the requirements of CA law for 7 out of 8 of their products.
Going forward, Anthem has taken many steps to improve their internal rate review processes to make sure that their rate filings are accurate. They have enhanced the outside 3rd party evaluation, and have enforced a meticulous internal evaluation process by actuaries that are independent of Anthem Blue Cross's individual business. They have also been helping people to understand what goes into their rates, by publishing information on their website at www.anthem.com/ca, to improve transparency.
With these new rates, Anthem expects to lose at least $100 million in 2010, following another loss in revenue that occurred in 2009.
Posted on Fri, Aug 27, 2010
According to the University of California at Los Angeles Center for Health Policy Research, the number of people without medical insurance in California jumped in all counties due to the recession.
The state of California's uninsured rate averages about 24.3%. However, 37 counties ranging from Shasta to Kern to Imperial had higher uninsured rates than the average.
The majority of people who lost their medical insurance was in Southern California counties, such as San Bernardino, Riverside and Imperial. All counties within the San Joaquin Valley, and most counties within the Northern/Sierra areas (except Humbolt and Sutter) had uninsured rates higher than 24.3%
The loss of medical insurance within these areas was mostly due to drastic increases in unemployment, employer sponsored coverage being dropped, and household incomes dropping as a result.
Posted on Thu, Aug 26, 2010
Aetna Insurance Company has introduced a cutting-edge service which gives their members access to online tools and resources that are simple, relevant and customized to their needs. It's called SmartSource, and it is a free service that's based on each member's profile and Aetna medical insurance plan.
In a snapshot, it can give you information regarding prescription medications you've filled in the past, doctor office visits you've had, and can even proactively suggests search topics based upon the medical conditions that are listed in a member's personal health record, if that member has one.
The intuitive service gives you specialized doctors in your area that treat a certain condition, commonly prescribed medications for a certain medical condition, treatment options, estimated health care costs out of your pocket based upon your medical insurance plan, and programs and discounts that help you to manage your healthcare needs.
For more information, visit www.AetnaTools.com.
Posted on Fri, Aug 13, 2010
Finally, it looks like a medical insurance plan may be put into place in California in September for people who have pre-existing medical conditions that have prohibited them from obtaining medical insurance. This plan is meant to be a bridge until 2014, when people with medical conditions will no longer be declined coverage or be rated up for it. Applications for this medical plan will be taken starting in late August.
This new government insurance plan is part of the health care reform legislation, and will help people with pre-existing conditions. California's Managed Risk Medical Insurance Board will run the program, and it is funded by the government, costing $761 million over a 3 year period.
Analysts have estimated that about 25,000 residents of California will be covered by this insurance plan at any one time...which is a lot higher than the 7,100 person maximum that California's current high risk pool covers.
To give you an example of the rates, in Ventura County for example, children up to the age of 14 will have a monthly premium of $127. People between the ages of 60 and 64 will have a premium of $720 per month. The plan is considered a comprehensive medical insurance plan, with a $1500 annual deductible, and an out-of-pocket limit of $2500.
Compared to the current high risk pool plan in California, a 42 year old person living in Ventura county would spend quite a bit less on the new government run plan, paying $304 per month compared to $657.50 on the current high risk pool plan.
To be eligible, you must not have had any insurance for at least 6 months, and have a pre-existing condition that prohibits you from obtaining private medical insurance. While it's still expensive and probably only beneficial to the middle class, it's a great first step for getting many uninsured the coverage that they need.
Please contact us at (877) 812-5111 if you need additional options for guaranteed issue medical insurance.
Posted on Tue, Aug 10, 2010
The new health care reform law includes a provision that requires medical insurance companies to provide preventative services without any member cost sharing.
Non-grandfathered plans issued or renewed on or after September 23, 2010 will not include member cost sharing or copays for the following preventative care services provided in-network:
- Items or services that have an A or a B rating in the current recommendations of the United States Preventative Services Task Force. You can see a list of these services at: http://www.ahrq.gov/clinic/uspstf/uspsabrecs.htm.
- Immunizations for routine use in children, adolescents, and adults that are recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. You can see a list of these immunizations at: http://www.cdc.gov/vaccines/recs/acip/default.htm
- Evidence-informed preventative care and screenings provided for in comprehensive guidelines for infants, children and adolescents that are supported by the Health Resources and Services Administration. You can view more information at: http://www.hrsa.gov/
- Evidence-informed preventative care and screenings for women not otherwise addressed by the U.S. Preventative Services Task Force recommendations that are supported by the Health Resources and Services Administration.
This impacts non-grandfathered plans issued or renewed on or after September 23, 2010, and it only applies to in-network services. Out-of-network services will have the same cost-sharing requirements as they do today.
Most of the recommended screenings, immunizations and exam services are already on Anthem's preventative services list. They are adding the new, required preventative services to this existing list. One example of a new preventative service is counseling for aspirin use, tobacco cessation, obesity and alcohol use. In addition, some services that are currently covered as a maternity benefit, such as recommended pregnancy screenings for pregnant women, will now be covered as a preventative service.
Posted on Thu, Aug 05, 2010
All of Blue Shield's individual and family medical insurance plans, except Essential Plans and Access+ HMO plans, are considered grandfathered if the policy was in effect on or before March 23, 2010 and the plan meets all grandfathering qualifications. In addition, all small group plans (2-50 employees) are considered grandfathered plans if the policy was in effect on or before March 23, 2010 and the plan meets all grandfathering qualifications.
Lifetime coverage limits are being removed as well. If you have reached your lifetime maximum dollar maximum, you will be allowed to re-enroll at your renewal without a dollar value limit. Blue Shield is making efforts to reach those members who have reached their benefit maximum.
However, if you have met your lifetime maximum, then you should contact us for re-enrollment.
Posted on Tue, Jul 27, 2010
Here is a list of a few of the provisions that grandfathered medical insurance plans are mandated to comply with. Please note that this is not a complete list.
- Ban on Annual Limits and Lifetime Limits: Beginning with plan years of September 23, 2010 and after, insurers are not allowed to place lifetime limits on essential health benefits. Group medical plans are allowed to place a reasonable yearly limit on essential medical benefits until January 2014. At that point, all group medical plans must get rid of all annual limits.
- Prohibition of Rescissions: Beginning with plan years of September 23, 2010 and after, insurers may not rescind medical insurance coverage after enrolling a member, with the exception of fraud or other limited circumstances.
- Ban on Preexisting Conditions Exclusions: Beginning with plan years of September 23, 2010 and after, insurers cannot decline children under the age of 19 due to preexisting conditions. On January 1, 2014, medical insurers will not be allowed to decline anyone medical coverage due to preexisting conditions.
- Required Coverage for Adult Children: Beginning with plan years of September 23, 2010 and after, insurers that provide dependent coverage are required to cover adult children up to the age of 26 without any conditions of dependency. However, grandfathered health insurance plans may still exclude coverage for adult children with other employment-based coverage available until January 1, 2014.
- Prohibition on Excessive Waiting Periods: Beginning on January 1, 2014, group medical insurance plans cannot impose a waiting period for eligible employees to join an employer plan of no more than 90 days.
Posted on Mon, Jul 26, 2010
While most of Health Care Reform's provisions will go into effect in 2014, there have been some provisions of the Health Care Reform Act that will come into effect this year.
For example, children up to the age of 19 will no longer be declined health insurance beginning with plan years (or a policy year) of September 23, 2010 and later. However, grandfathered individual medical insurance plans are exempt from this provision, but there may be limited exceptions to this exemption. A grandfathered medical plan is a plan that you had in place on March 23, 2010 when the health care reform bill was signed. Grandfathered group health insurance plans are not exempt from this provision.
Another provision is that insurance companies will no longer be allowed to rescind policies unless there is evidence of fraud or intentional misrepresentation of material facts. An insurer will only terminate someone's coverage if it's due to a mistake in eligibility, without any fraud or misrepresentation on the member's part. If the policy is rescinded, the insurance company must notify the member 30 days ahead of the rescission. This provision is applicable to non-grandfathered and grandfathered plans.
Anthem Blue Cross is also making changes to their annual and lifetime dollar limits. They are removing the limits, and will no longer have any annual dollar limits on certain "essential health benefits". The definition of "essential health benefits" has not yet been determined.
Members of Anthem Blue Cross who have already reached their annual or lifetime maximum will be offered a special enrollment time to re-enroll in benefits. Anthem will let their members and terminated members know who are no longer receiving benefits for this reason, so that they can take advantage of the special re-enrollment period. The enrollment period for groups will commence during the group open enrollment at the time of the group's renewal. This provision only applies to pharmacy and medical benefits and does not impact vision or dental coverage.
Anthem Blue Cross will be adopting all patient protection provisions for all of their plans, including grandfathered plans.
For example, for all of Anthem Blue Cross plans that require primary care physicians, including grandfathered plans, Anthem will allow the member to choose any available in-network primary care physician, including participating pediatricians for kids. Also, Anthem will allow individuals to obtain care from an in-network obstetrician/gynecologist without any pre-authorization or a referral. However, pre-authorization for certain obstetrician/gynecologist services will still be allowed.
Another patient protection provision applies to emergency room services. For instance, a pre-authorization will not be required for ER services, in-network or out-of-network. Also, Anthem will be covering out-of-network emergency room services, and the copays and coinsurances for these services cannot be more than those for in-network emergency room services. However, deductibles and out-of-pocket limits will be allowed for out-of-network ER services if it's the same used for other out-of-network benefits.
We will continue to pass along Health Care Reform information as we receive it. Please feel free to call us at 1-877-812-5111 if you have any questions.
Posted on Thu, Jun 24, 2010
As it stands now, your chances of fighting and winning against an medical insurance company to get a denied claim paid is slim. There are very few options for disputing a medical insurer's decision. The appeals process can be very time consuming. Most people cannot sue the medical insurer for damages that resulted from the denials and treatments that were delayed.
Beginning this fall, people will be able to challenge claim denials through a procedure that's conducted independently at the state level. This has previously been unavailable to employees of employers that cover their workers' medical claims directly.
As more than 50% of all covered employees are in a self funded plan, this change is huge. However, this new law is not applicable to grandfathered plans, which are the plans that were in place on March 23, 2010.
It will still be difficult for people to file a lawsuit for pain and suffering or punitive damages. The Employee Retirement Income Security Act of 1974 states that employees or their families that are covered by company medical plans can only sue for the cost of the benefit that's been denied.
With the current system, insurers must have a process of internal appeals. Usually, this process has multiple levels of appeals, but most times the original denial remains a denial.
Most of the states in the U.S. have a review of denials that's independent, but the new law will give that option to each state and to self-funded medical plans. These independent reviewers rule on the consumer's side half of the time but most people do not take advantage of these reviewers because they don't know that they exist, and they usually have to go through many layers of levels internally before they get to that point.
There are a few states that make consumers spend up to 50% of the cost of an independent review, and some states allow the medical insurer to stop coverage during the process of appeals. There are hopes that the new law will address some of these concerns.