Anthem Blue Cross Health Insurance blogs

Anthem Blue Cross and Individual Practice Association Medical Group of Santa Clara County to Form First ACO for PPO Members

Dennis — Thu, 18 Aug 2011 21:06:49 +0000

WOODLAND HILLS, Calif., and FOSTER CITY, Calif. —August 10, 2011— Anthem Blue Cross and Individual Practice Association Medical Group of Santa Clara County (SCCIPA), today announced they are launching an Accountable Care Organization (ACO) program to provide coordinated, seamless medical care to Anthem PPO members in the Silicon Valley. The ACO is the first of its kind in Northern California, and includes a direct contract agreement between Anthem and the IPA.

Anthem Blue Cross expects that initially tens of thousands of PPO members whose physicians participate in the SCCIPA network will benefit from the care coordination, chronic disease management, increased provider accountability, and improved availability of medical information for patient decision-making that are hallmarks of the ACO model. SCCIPA’s network includes 284 primary care physicians, 550 specialists and ten acute care facilities throughout Santa Clara County. Members will be included in the program if they have received the majority of their medical care from these same treating physicians in the past and where there is already a strong physician/patient relationship.

“We are pleased to expand our relationship with SCCIPA to include both a direct provider group contract and the launch of an ACO model,” said Pam Kehaly, president of Anthem Blue Cross. “Individuals who receive coordinated, patient-centered care through a collaborative partnership with their physicians can better navigate their options and more effectively manage their health care needs. SCCIPA’s investment in its innovative coordinated care IT platform and demonstrated quality clinical and administrative management performance across its electronically integrated network, make them an ideal partner to offer our first ACO model in northern California.”

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Dennis — Thu, 18 Aug 2011 01:10:24 +0000

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Anthem Blue Cross Video Walkthroughs

Dennis — Mon, 18 Jul 2011 20:52:22 +0000

1. Video walkthrough on how to get a individual and family health insurance quote online through Anthem Blue Cross. Click in the video to open up a larger size and watch it on YouTube.

2. Video walkthrough on how to compare Anthem Blue Cross individual and family health insurance plans online. Click in the video to open up a larger size and watch it on YouTube.

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Chart summarizes health care reform provisions

Dennis — Fri, 27 May 2011 21:00:47 +0000

The following chart is a summary of provisions within the Affordable Care Act (ACA) and their impact on different funding types and lines of business. This is subject to change as we receive additional guidance and information and should be used for informational purposes only.

Provision	Fully Insured (Small Group) Plans	Fully Insured (Large Group) Plans	ASO Plans	Individual & Family Plans	Implementation Date**
Dependent coverage for adult children up to age 26 (In some states, dependents can stay on the plan even longer.)	Required	Required	Required	Required	Plan years beginning on or after 9/23/10
No lifetime coverage limits	Required	Required	Required	Required	Plan years beginning on or after 9/23/10
100% coverage for preventive services in network*	Required	Required	Required	Required	Plan years beginning on or after 9/23/10
No annual limits on certain types of benefits (Restricted annual limits permitted until 2014)	Required	Required	Required	Required*	Plan years beginning on or after 9/23/10
No prior authorization for emergency services or higher cost sharing for out-of- network emergency services*	Required	Required	Required	Required	Plan years beginning on or after 9/23/10

No pre-existing condition exclusions for children	Required	Required	Required	Required*	Plan years beginning on or after 9/23/10
Revised appeals process*	Required	Required	Required	Required	Depending on specific requirement: Plan years beginning on or after 9/23/10 or 1/1/2012 Some requirements are to be implemented on 7/1/11 regardless of plan year Some have been delayed beyond 7/1/11***
Nondiscrimination in favor of highly compensated employees prohibited*	Required	Required	Required, but not a new requirement for these plans	N/A	Plan years on or after 9/23/10 (implementation delayed until further guidance issued) ***
Early Retiree Reinsurance Program	Available	Available	Available	N/A	Active until the fund is exhausted
MLR requirements	Required (80%)	Required (85%)	Exempt	Required (80%)	Reporting and paying rebates in 2012 for 2011 plan year

No pretax reimbursements from health account for nonprescribed, over-the-counter medications	Required	Required	Required	N/A	Plan years on or after 9/23/10
20% tax for nonqualified HSA withdrawals	Required	Required	Required	Required	1/1/11
Reporting the value of employer- sponsored coverage on W-2s	Required	Required	Required	N/A	Optional for W-2 s issued in 2012; required for 2013; some exceptions for small groups
Automatic enrollment in new long-term care program, with ability for employees to opt out	Required	Required	Required	N/A	TBD***
Uniform explanation of coverage	Required – health plan will take care of it on employers’ behalf	Required – health plan will take care of it on employers’ behalf	Required – support from health plan is dependent on additional guidance from HHS	Required	2012; specific date TBD***
Pre-enrollment document sent explaining benefits and exclusions	Required	Required	Required	Required	2012; specific date TBD***

60-day notice for material modifications, if not provided in uniform explanation of coverage	Required	Required	Required	Required	2012; specific date TBD***
Employee notification of exchanges, premium subsidies and free choice vouchers	Required	Required	Required	N/A	2013***
FSA contributions limited to $2,500 per year	Required	Required	Required	N/A	1/1/13
Fee for comparative effectiveness research agency for fiscal year 2013, which technically begins October 1, 2012	Required - health plan will take care of it on employers’ behalf	Required - health plan will take care of it on employers’ behalf	Required – employer responsible for determining amount and paying of fee	Required	Federal FY 2013 (applies to plan years ending 10/1/2012 and later)***
Free choice voucher required to be provided to qualifying employees	Required	Required	Required	N/A	2014***
Individual mandate	N/A	N/A	N/A	Required	2014***
Guaranteed issue	N/A	N/A	N/A	Required	2014***
Employer requirement to offer minimum essential coverage (50+ employees)	Required - dependent on size of organization	Required	Required - dependent on size of organization	N/A	2014***

HIPAA nondiscrimination rules on wellness programs	Required	Required	Required	N/A	2014***
30% incentive cap for wellness programs	Required	Required	Required	N/A	2014***
Large groups required to auto- enroll employees into health benefits (200+ employees)	N/A	Required – dependent on size of organization	Required - dependent on size of organization	N/A	2014***
Small group redefined as 1 – 100 (state may defer until 2016)	Required	N/A	Required depending on size of organization	N/A	2014***
Rating limitations	Required	N/A	N/A	N/A	2014***
Ensure that annual cost-sharing for essential health benefits doesn’t exceed the maximum out-of- pocket limits for a high-deductible health plan (HDHP), as defined by Internal Revenue Code (these limits are adjusted for inflation annually)	Required	N/A	N/A	Required	2014***
New fee on fully insured coverage	Required	Required	Not applicable	Required	2014***
90-day limit on waiting periods for coverage	Required	Required	Required	Required	2014***

Coverage of routine patient costs for clinical trials of life-threatening diseases*	Required	Required	Required	Required	2014***
40% excise tax on high-cost “Cadillac” plans	Required	Required	Required	Required	2018***

*The law does not require grandfathered plans to comply with this provision, however in some cases we have
decided to extend these provisions regardless of grandfathered status.

** Some dates may change based on additional guidance/requirements from HHS, these are intended to be
general implementation timeframes.

*** Best understanding subject to publication of regulations.

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Anthem Blue Cross ClearProtection premiums start at $2.04/Day!

Dennis — Sun, 22 May 2011 22:29:54 +0000

Thank you for your interest in Anthem Blue Cross ClearProtection health plans. With the rising cost of medical care today, it's important that you have the right health care plan.

Anthem Blue Cross offers a wide range of plans that include:

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$0 deductible and $0 copay on ALL nationally recommended Preventive Care Services In-Network
Plus we still offer coverage for Preventive Care services out-of- network - a benefit you may not see elsewhere!
Discounted rates apply immediately within our provider network, one of the largest in the state. With nearly 80,000 doctors and specialists and more than 315 hospitals, chances are your doctor already participates.
Term Life and dental plans also are available at an additional cost

Additionally ClearProtection Plus plans also offer:

Affordable monthly premiums (best value in California)
Coverage for the first 2 doctor visits before the deductible
Prescription drug benefits that cover both Generic and select Brand-name drugs,
A wide range of deductibles so you can find a plan that fits your budget
Inpatlent, outpatient and emergency room services

Or for a little more, consider SmartSense® Plus plans which feature:

Coverage for the first 3 doctor visits before the deductible
Your choice of prescription benefits... either Standard or Upgraded drug coverage

Why trust Anthem Blue Cross? With all the changes in health care, it's impotant to patner with a name you can trust. Anthem Blue Cross has been serving our California neighbors for over 70 years. Financial strength and quality coverage give you peace of mind - after all, your health is your most important asset. And, Anthem Blue Cross's wide network of independent doctors and hospitals gives you choice and flexibility - it's your health, your decision. Find out why so many people in California trust Anthem Blue Cross.

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Anthem Blue Cross Smart Sense Plus Plans

Dennis — Sun, 22 May 2011 21:04:00 +0000

Is Anthem Blue Cross Smart Sense Plus health plan is right for you? Reliable, comprehensive protection with some of our lowest monthly rates, for individuals and families, which also works great for stand alone children plans. Choose the annual deductible and monthly rate that works best for you. The annual deductible options are: $1000, $2,000, $3,500 and $6,000.

The Anthem Blue Cross Smart Sense Plus plans represent some of Anthems most popular plans. The majority of individual plans on the market today offer limited choices. Anthem Smart Sense Plus plans can be tailored to fit your needs, and has an extremely attractive price point with premiums ranging from as low as $97 to $189 for a thirty year old female.

Anthems Smart Sense Plus plans are designed to provide protection against expensive and unexpected medical bills and offers a variety of deductibles, starting at $1000, that allow you to find a premium you can afford.

Coverage for first three doctor visits with a $30 co-payment before the deductible (per person per calendar year) then, 30 percent coinsurance after your annual deductible. You will also have a choice of prescription drug benefits, either; standard or upgraded option prescription coverage. Both options offer coverege for brand name and generic drugs. With upgraded options your annual deductible for brand name drugs is only $500. Inpatient, outpatient and professional services such as lab work and X-ray are also provided at seventy percent coverage after the annual deductible. Smart Sense Plus will also cover you with unlimited in lifetime benefit per member.

What makes Anthem Blue Cross Plus plans the smart choice?

A choice of plans to fit your budget. No matter where you are in life, we have a plan that will fit your health care needs, as well as your budget.
One of the largest networks in California. With more than 50,000 doctors and specialists and 400 hospitals throughout the state, the chances are that your doctor is in the network. And all our network providers have lower rates for you, so your share of medical costs will be less.
Coverage that travels with you. No matter where life takes you, whether it is around the state or across the country, Anthem Blue Cross Smart Sense Plus has you covered.
Unlimited Life time maximum. You will never run out of coverage once you are insured.
No out of pocket cost for preventative care. When even you decide to get your eyearly physical done you will pay nothing.
Dental and Life insurance. To enhance your health and financial future, we also offer Dental Blue PPO dental plan, either stand alone or with an Anthem Blue Cross health insurance policy. Term life is also available with your health plan.
Peace of mind. You can relax knowing that we have been providing health care coverage and security to California residents for more than 70 years. Anthem Blue Cross is committed to simplifying your life and improving your health.

Give yourself every advantage; good health, a bright smile and financial security.

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8 Ways to Save Money on Health Care and Health Insurance

Dennis — Fri, 13 May 2011 00:17:23 +0000

Sure, health reform was signed into law a year ago on Wednesday and meant to make health care and health insurance more accessible and affordable for more Americans. But many of the enactment's provisions don't kick in until 2014. In the meantime, here are eight ways you can save money--right now.

1. Lock in That Rate. When you’re purchasing private health insurance for yourself or your family, keep in mind that your insurance company may periodically increase your monthly premiums. One way you can temporarily protect yourself is to look for a “rate guarantee” when shopping for coverage. Anthem Blue Cross will automatically lock in your rate for the first year of your policy.

2. Right-size Your Health Insurance Plan. If your current plan is getting too expensive to keep, but you’re afraid of being declined for new coverage based on your medical history, make sure you explore your options. You may be able to stay with the same insurer and transfer to a more affordable plan without undergoing medical underwriting and running the risk of being declined. There are trade-offs, of course. You may need to accept a higher deductible in return for a lower monthly premium. But the new plan may still provide you with valuable protection in case of serious illness or injury, and you may be able to trim a substantial amount from your monthly bill.

3. Negotiate Your Medical Bills. Did you know that you can potentially shave up to 30% off your medical bills by negotiating with your medical care provider? Health insurance allows you to benefit from discounted rates for health care services. Chances are, your insurance company has negotiated discounts with providers ahead of time. If you’re currently uninsured, you’re not benefiting from those discounted rates, so the charges listed on your medical bill may be substantially higher than others are expected to pay. Talk to your doctor or your hospital’s billing department to see if you can negotiate a discount by paying up front or creating a payment plan. Even if you have health insurance, that doesn’t mean all your medical procedures are automatically covered. If you’re seeing an out-of-network physician or receiving medical services not covered by your insurance plan, you may be charged the full rate. In these circumstances, even insured patients should negotiate their bills.

To learn more about negotiating medical bills, visit the Healthcare Blue Book website, where you can find suggested prices for many standard medical services. If you’re surprised by an especially high medical bill and you need help negotiating payment, you can work with a professional medical bill negotiator. Some negotiators are paid only on a contingency, based on how much they are able to save you.

4. Consider Generic-only Prescription Drug Coverage. Find out if health insurance companies in your area offer generic-only prescription drug coverage. If you rarely use prescription drugs but don’t want to go entirely without drug coverage, you may be able to save on your monthly premiums. As a supplement to your insurance coverage, a prescription discount card may help mitigate the cost of a brand-name drug, should it become necessary to take one. Just be sure that any discount card you purchase is accepted by your local pharmacy.

5. Look into a Health Savings Account (HSA). An HSA is a tax-advantaged savings account used in conjunction with a health insurance plan. Account contributions, qualified distributions and earnings are all tax-exempt. An HSA allows you to deposit a portion of your pre-tax income into a savings account and use those funds to pay for qualified medical expenses. Unused money can be invested and accrue from year to year. If you have an HSA, be sure to deduct your contributions up to federally prescribed limits. According to IRS Publication 969, HSA contributions for the 2010 tax year are capped at $3,050 for individuals and $6,150 for families.

6. Shop Smart When Shopping a la Carte. When shopping for private health insurance, you can save money by only considering plans that offer the specific benefits you need. For example, a 2010 survey from eHealthInsurance showed the average individual health insurance customers saved $77 per month on premiums when they selected an insurance plan without maternity benefits (in states where these plans are allowed). By selecting an insurance plan that excludes benefits like robust maternity coverage (not necessary for a single male, for example) or chiropractic and mental health coverage, you may see significant savings on your monthly premiums. Given the choice between going uninsured and cutting benefits for services you may not need, limited coverage is better than none at all.

7. Look Beyond Your Employer’s Plan. If you can no longer afford your share of the premium for an employer group health insurance plan, consider your options in the private health insurance market during your next open enrollment period. While it may not always offer the same benefits, coverage purchased on your own is sometimes less expensive than what your employer may require you to contribute toward your monthly premiums. Employer-sponsored coverage is especially valuable for those with pre-existing medical conditions who may be declined for coverage elsewhere, but healthy individuals should consider all of their options before selecting a health insurance option.

8. Split up the Family. Different people have different health insurance needs. This is true within families too. You may be able to save money by covering family members under two or more separate health insurance plans. For example, if one family member has heart disease or diabetes, you’ll want to keep that person covered under an employer-sponsored health plan or COBRA, since they could be declined for coverage elsewhere. However, you may want to cover your healthy teenager, for example, under a more affordable individual health insurance policy of his or her own. Ask your human resources representative or benefits administrator for more information about how much you can save by removing a dependent from your employer-sponsored plan. Then go to an online marketplace with a large selection of health insurance plans in your area to compare that amount to quotes for privately-purchased health insurance. Be sure not to drop any existing coverage for a dependent until he or she is officially accepted for coverage under a new health plan.

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Buying Health Insurance For Children

Dennis — Thu, 03 Feb 2011 19:26:46 +0000

Los Angeles Times -

Jan. 31: If in the past you tried to buy health insurance for a child with a preexisting health condition and were turned down, it's time to give it another shot.

A provision of the federal health reform law and a new California law punish insurers that refuse to sell policies to children. As a result, those younger than 19 will have access to insurance and cannot be denied coverage, regardless of health condition.

Jan. 1 marked the start of California's initial open enrollment period, which runs through March 1. During this time, parents can purchase health benefits for their children on the individual insurance market without fear of being denied or of significant increases to monthly premiums for kids with preexisting conditions. The law applies only to individual health plans sold after Jan. 1 that do not meet "grandfathered status" (meaning plans that were already in place when the health reform law was enacted in March 2010).

About 576,000 kids in California with medical conditions that often lead to a denial of coverage might be affected, says Kelly Hardy, director of health policy at Children Now, an Oakland-based children's rights group.

If you live in California and are in the market for a child-only health insurance plan, here's what you need to know about signing up.

First: There's a 60-day initial open enrollment period to purchase child-only health plans in California and it's happening right now. But even after March 1, when that period ends, you can still enroll a child or make a change to a child's health plan during his or her birthday month or after a "qualifying event" meaning a period during which your child loses existing health coverage due to events such as a parent changing jobs, divorce, death or other major life change.

The charge for kids with preexisting medical conditions, signed up during open enrollment or one of these other qualifying periods, cannot be more than twice the standard rate for the same type of coverage. That means that the charge for a child with asthma or diabetes will be no more than double the rate of that for a healthier child.

Anthony Wright, executive director of Health Access California, the statewide healthcare consumer advocacy coalition, notes that this is a temporary bridge until 2014, when both adults and kids with preexisting conditions can neither be denied insurance nor charged more for it.

According to the California Department of Managed Health Care, the state's HMO watchdog agency, insurers can also impose a 20% surcharge for any child who has not had continuous health insurance coverage for 90 days prior to applying for a new plan. But the surcharge can be applied only for a period of 12 months, after which insurers are required to automatically discontinue it.

Parents can buy insurance for their children even outside of these open enrollment periods with a guarantee of coverage. What's not guaranteed, however, is the price. No limitations are placed on what insurance carriers can charge at other times.

"If you have a preexisting condition, you could potentially be charged a lot more, like 10 times more. We don't yet know how the market will shake out," Wright says.

The idea behind the open enrollment periods is to prevent parents from "only signing kids up when they get really sick," Hardy says. "It's a protection for the health plans."

Making sure kids have health insurance before they are sick or injured is in the best interest of families as well, Wright adds. "Just a sprained ankle or fall off the jungle gym the bills can pile up really quickly for minor conditions," he says.

Denying kids coverage may be a thing of the past, but medical underwriting is not, for now. When you fill out an application for coverage, carriers will review your child's health history to determine how much it will cost to insure him or her. So you should expect some questions when you apply.

How will you know whether the price you're offered for your sick child is no more than twice what a kid with no medical conditions would pay? Consumers are given an initial estimate that's based on the standard rate, says Amir Mostafaie, consumer health insurance expert at eHealthInsurance.com, an online source of coverage. "Find out the initial rate, then your worst-case scenario would be twice that."

Experts say you should look beyond the monthly premium and pay attention to annual deductibles, co-pays, coinsurance and the cost of prescription drugs to get a true sense of how much a plan will cost.

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Child Only Health Insurance FAQs

Dennis — Fri, 28 Jan 2011 20:33:28 +0000

Question: Health care reform is supposed to allow me to enroll my child in private health insurance, regardless of my child's health condition. When can I enroll my child in private health insurance in California?

Answer: You can apply for "child-only" private health insurance now, during California's initial open enrollment period beginning New Year's Day 2011 and running through March 1, 2011. During open enrollment you can apply for a private non-group health insurance plan for your child, and the insurer cannot deny the application due to pre-existing medical conditions.

Question: What if I miss the initial open enrollment period (January 1 through March 1)?

Answer: If you miss the open enrollment period in California, you can apply for "child-only" private health insurance policies during annual enrollment which occurs during the child's birth month.

You can also apply up to 63 days following any of the following qualifying events:

The child lost dependent coverage due to termination or change in employment status.
An employer who provided the child's coverage, either directly or through a parent or guardian, stopped contributing financially toward the cost of the employee or dependent's health coverage.
The person through whom the child was covered as a dependent dies.
The person through whom the child was covered as a dependent goes though a legal separation or divorce.
The child loses coverage under the Healthy Families Program, the Access for Infants and Mothers Program, or the Medi-Cal program.
The child is adopted.
The child becomes a resident of California during a month that was not the child's birth month.
The child is mandated to be covered pursuant to a valid state or federal court order.

Question: Why does there need to be an open enrollment period? Why aren't children simply allowed to enroll in non-group health coverage at any time throughout the year?

Answer: Having an open enrollment period for "child-only" health insurance policies prevents consumers from waiting until a child gets sick to sign them up for health insurance, and keeps average rates for non-group health insurance coverage affordable.

Question: How are the rates for "child-only" health insurance policies going to change?

Answer: This is new legislation so it will take some time to determine how the change in policy will impact rates over the long-term.

Question: Does this mean that a sick child with numerous documented health problems will pay the same monthly health insurance premiums as children in good health?

Answer: Not necessarily. Insurers have the option to charge monthly premiums that are up to twice as high for high-risk children as the premiums they charge a child at the standard risk level during open enrollment.

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Key Healthcare Provision Voided by Federal Judge

Dennis — Fri, 17 Dec 2010 01:33:04 +0000

Declaring a core part of the new healthcare law unconstitutional, a federal judge in Virginia has launched President Obama's signature domestic achievement into a gantlet of conservative-leaning courts that will almost certainly conclude at the Supreme Court just as the 2012 election is cresting.

In the first such decision since Obama signed the law in March, U.S. District Judge Henry Hudson ruled Monday that Congress had overstepped its power in requiring Americans to get health insurance by 2014.

The Obama administration is expected to appeal the decision. "It is acknowledged by all that we expect this case to end in the Supreme Court," Virginia Atty. Gen. Ken Cuccinelli, a conservative Republican who brought the case, said after Hudson issued his ruling.

Hudson denied a request to throw out the mandate while higher courts consider the case. Legal experts are divided on whether the Supreme Court is likely to void the law.

The justices, including its conservatives, have repeatedly said that elected lawmakers, not judges, should set national policy. But the court's conservative majority has also shown itself willing to set aside precedent and strike down laws in politically charged cases.

The legal attack on the mandate is a key element of the conservative strategy to derail Obama's healthcare overhaul, which depends on adding an estimated 30 million more Americans to insurance rolls.

The much-anticipated decision by Hudson added new fuel to the gathering Republican drive. Even in the courts, the partisan nature of the debate is apparent: Two other federal district judges, both Democratic appointees, had previously ruled that the insurance mandate was constitutional. Hudson is an appointee of President George W. Bush and, according to financial disclosure records, has received dividends from Campaign Solutions, a political consulting firm with strong Republican ties.

The unprecedented insurance mandate will require most Americans to get health insurance starting in 2014 and penalize those who do not.

The requirement was designed to spread risk more broadly and control insurance premiums for everyone, enabling the federal government to prohibit insurers from denying coverage to patients with preexisting medical conditions. Without a mandate, Americans would be able to avoid buying insurance until they got sick, driving up premiums, a phenomenon that has occurred in several states that have guaranteed coverage without any requirement.

Most defenders of the law think that eliminating the mandate would undo the healthcare overhaul. "Unfortunately, striking the 'individual responsibility' provision could also jeopardize the most popular insurance reform in the statute: preventing insurance companies from denying health coverage to people with preexisting health conditions," said Families USA Executive Director Ron Pollack, a leading consumer advocate.

"If we're going to outlaw discrimination based on preexisting conditions, the only way to keep people from gaming the system and raising costs on everyone else is to ensure that everyone takes responsibility for their own health insurance," said Stephanie Cutter, assistant to the president for special projects, in a blog post Monday.

Obama administration lawyers argued in the Virginia case that the mandate was permissible under Congress' authority to regulate commerce, which gives the federal government broad powers to regulate economic activity.

But Hudson, backing conservative critics of the law, concluded that the overhaul overstepped this authority by requiring Americans to obtain a specific product.

"Neither the Supreme Court nor any federal circuit court of appeals has extended Commerce Clause power to compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market," the judge concluded.

He added: "Despite the laudable intentions of Congress in enacting a comprehensive and transformative healthcare regime, the legislative process must still operate within constitutional bounds."

Cuccinelli predicted Monday that the U.S. 4th Circuit Court of Appeals in Richmond, Va. the likely next stop for the case would take a year to review the Obama administration's appeal before the high court received the case in 2012. The justices would then take another year to consider the case, he said.

The 4th Circuit was the Bush administration's favorite forum for war-on-terrorism cases because it had been dominated by conservative judges, though the balance of the court has shifted slightly with the retirement of several conservatives.

Also weighing in soon may be the U.S. 11th Circuit Court of Appeals in Atlanta, another conservative court that is expected to hear a challenge to the healthcare overhaul being pursued by Florida Atty. Gen. Bill McCollum.

That case, which is scheduled for a hearing before a federal judge in Pensacola, Fla., this week, has been joined by attorneys general and governors from 19 other states. All but one are Republican.

Leading Republican lawmakers almost uniformly applauded the Virginia decision. Incoming House Majority Leader Eric Cantor (R-Va.) called on the Obama administration and Cuccinelli to request that the case be sent directly to the Supreme Court, an unusual scenario. Incoming House Speaker John A. Boehner (R-Ohio) called the ruling "an encouraging sign for families and small-business owners who have revolted against President Obama's job-killing healthcare law."

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New Anthem Blue Cross Plans Approved by California Department of Insurance

Dennis — Fri, 17 Dec 2010 01:30:32 +0000

Anthem Blue Cross have finally received partial approval on their Health Care Reform plans and we are excited to introduce 11 new Individual products, available to today. These familiar plan designs are compliant with the Patient Protection and Affordable Care Act (PPACA) mandated benefits and continue to offer you a broad choice of coverage to help you meet your needs. These plans supplement Anthem Blue Cross's PPO Share 3500 and 7500 and HMO plans that were previously approved. Anthem Blue Cross accepts paper applications (mailed, faxed or e-mailed) right away. We will let you know as soon as the new plans are loaded on online sites (this may take a week or so).

Anthem Blue Cross continues to work with the California Department of Insurance in order to have the remainder of our PPACA compliant plans completely reviewed and ready for the Individual and Families as soon as possible. The remaining plans include SmartSense Plus, CoreGuard Plus, ClearProtection Plus and Lumenos Plus. Anthem Blue Cross will update you as soon as the plans are available.

Our new Individual Product Portfolio!
All of our new plans continue to have an initial 12-month rate guarantee!

Premier Plus 1000, 1500, 2500, 3500, 5000 and 6000
Lumenos HSA 1500 (no maternity)
Lumenos HSA 5000 (maternity)
Tonik 5000
PPO Share 5000
PPO Share 1000

Still pending final California Department if Insurance review:

SmartSense Plus
ClearProtection Plus
CoreGuard Plus
Lumenos Plus

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What Is COBRA?

Dennis — Fri, 22 Oct 2010 20:54:34 +0000

COBRA stands for the Consolidated Omnibus Budget Reconciliation Act, which became law in 1986. COBRA gives you the right to choose to temporarily keep the group health insurance benefits that you would otherwise lose after you reduce your working hours, quit your job, or lose your job. It also lets family members choose to keep health insurance after your job loss or other qualifying event that would normally cause them to lose the coverage they have through your employer. (See the section, "What is a qualifying event under COBRA?") COBRA applies to nearly all employers with 20 or more employees.

Before this law went into effect, when employees left their companies, they and any covered family members lost their health insurance immediately. If the employee or a family member were ill, they were often not able to get new health insurance because they were already sick. COBRA allows an employee to buy health insurance through the employer even though the person no longer works there or no longer works full time.

Extra help for some people came through with the economic stimulus package signed into law February 17, 2009 (known as the American Recovery and Reinvestment Act of 2009). It pays part of the COBRA premium for people who lost their jobs, but only if they meet certain requirements. See the section below, "Can I get extra help if I lost my job between September 1, 2008 and February 28, 2010?" for more details.

How long does the COBRA coverage last?

The length of time you can keep COBRA coverage depends on your qualifying event (see below). If your major medical coverage ends because your employment ends (other than for gross misconduct), or because your hours are reduced, you and your qualified dependents are allowed to keep coverage under the employer's health insurance for up to 18 months by paying for the full cost of their coverage.

Also, under the Health Insurance Portability and Accountability Act of 1996, certain people with a disability are allowed to qualify for 29 months (the original 18 months plus an 11-month extension) of COBRA continuation coverage. To qualify for this disability extension, the person must get a formal disability determination from the Social Security Administration (SSA) that shows they were disabled at the time (or within 60 days) of their COBRA qualifying event. This means that the person must apply for disability through the SSA and wait for their decision (determination) about whether or not he or she is disabled. After getting the SSA decision, the employee must send a copy of the letter to the health plan administrator within 60 days of receiving the letter and before the 18 months of coverage ends.

Lastly, dependents who lose job-based coverage due to a change in the family (such as divorce or other qualifying event) can still get COBRA coverage for up to 36 months. (See the section below, "What is a qualifying event under COBRA?") People with COBRA coverage have the same health benefits and rights as active employees. For example, they can change plan options during open enrollment periods and parents can add newborns and newly adopted children to their COBRA policies.

What is a "qualifying event" under COBRA?

A qualifying event is what makes employees or their dependents eligible for COBRA coverage.

Qualifying events for the employee

Qualifying events for the employee include loss of health insurance for any of the following reasons:

termination of employment (employee quits job, is laid off, or fired for anything other than gross misconduct)
reduction in work hours (for reasons other than gross misconduct)

Qualifying events for the spouse or dependents of the employee

Qualifying events for the spouse or dependents of the employee who had been included on employee’s health plan include:

the insured employee's death
divorce or legal separation from the insured employee
loss of dependent status (as defined by the insurance plan's rules)
employee becomes entitled to Medicare and the employer takes him or her off the health insurance plan
any event in the list above that causes the employee to lose health coverage

The employee's qualified spouse or children may enroll in COBRA even if the employee does not.

What is a "qualifying event notice" under COBRA?

Before a group health plan must offer COBRA coverage, the group health plan administrator must be notified of the qualifying event. The employer has 30 days after the event happens to notify the plan if the qualifying event is any of the following:

employee job loss
reduced hours of the employee
employee death
Medicare eligibility of the employee
employer files for Chapter 11 bankruptcy

The employee or dependent must notify the group health plan administrator within 60 days of family changes:

divorce
legal separation
child's loss of dependent status

How to go about doing this should be outlined in the summary plan description (SPD) you get from your employer when you enroll in a health plan. If your employer does not have a reasonable procedure for notifying the health plan, you can give notice by contacting the person or unit that handles your employee benefits.

What is an "election notice"?

Within 14 days of getting the qualifying event notice (above), the employer or health plan administrator must give the person who is about to lose health insurance written notice of his or her COBRA rights. The election notice should contain all of the information you will need to understand COBRA coverage so that you can make an informed decision on whether or not to continue coverage. It should also give you the name of the person who handles COBRA for the health plan (the COBRA administrator) and tell you how to get more information.

What do I do once I get the COBRA election notice?

The employee or qualified dependents have 60 days after they get the election notice to choose health insurance coverage for themselves under COBRA. The employee or dependent must notify the COBRA administrator listed on their COBRA election notice in writing if they wish to keep their health insurance. The COBRA administrator is the person who keeps up with COBRA continuation benefits for the employer.

How long do I have before I must pay the first COBRA premium?

The beneficiary has 45 days from the date he or she chooses to continue health insurance coverage to pay the first premium bill. That payment generally must cover the period of coverage from the date COBRA was chosen all the way back to the date of the loss of coverage due to the qualifying event. Neither the health plan administrator nor the employer is required to send you monthly premium notices or "bills," so make sure you pay attention to due dates.

How much does COBRA cost?

The premium for COBRA coverage is equal to the full cost of your group health coverage -- including the employer and employee share -- plus up to 2% more for administrative costs. This is usually much more than the employee paid when he or she worked for the company, since the company then probably paid for part of the premium. But it still usually costs less than buying individual health coverage. Some employers may give the option of dropping out of "non-traditional" insurance plans, such as dental and vision coverage, in order to reduce costs.

If you have already had the 18 month standard COBRA coverage and have started on the 11-month disability extension, the premium may be much higher. In this situation, the employer may charge up to 150% of the actual insurance cost.

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Anthem Blue Cross Premier Plans

Dennis — Tue, 27 Jul 2010 16:09:53 +0000

Anthem Blue Cross Premier Plan

Anthem Blue Cross has come out with a number of new plans. This hub will focus on the new Premier Plan.
This plan is higher in premium then the Smart Sense plan. One of the main differences is with the Premier plan is the member has unlimited office visits before the deductible is met, for both primary at $30 and specialist at $50. With the Smart Sense plans a member gets 3 office visits at $30 before the deductible is met.

Members would also have their deductible waived for preventive care, co-pays as followed:

Annual Physical-$30
Routine Mammogram, Pap and PSA tests-$30 copay
Well Child/Baby Care (through age 6)-$30 copay

Your deductible is only waived for members after 6 months.
Premier Plan comes in a number of different deductibles, hopefully able to suit every member out there. They go fro $1,000 to $6,000 with out of pockets maximums ranging from $5,500 to $10,500.
Anthem Blue Cross usually has 30% co-pays for services when In-Network with a PPO policy. The Premier Policy for In-Network services is a 25% Co-Pay, this would include X-Rays, Lab work, Anesthesia, Surgeon etc. All In-Network In and Out-Patient services and Emergency Rooms. A member would pay 25% after their deductible is met.
Each plan comes with $15 Generic drug coverage with no deductible. If a member was to use a Formulary Brand or Non Formulary Brand drug the member would first need to meet a $500 drug dedutable. After the RX deductible is met it would cost $40 for Formulary Brand and $60 for Non-Formulary.

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Smart Sense Health Insurance Plan From Anthem Blue Cross

Dennis — Tue, 27 Jul 2010 16:06:03 +0000

Anthem Blue Cross has a plan called the "Smart Sense Plan" which I would recommend to anyone. The Smart Sense plan is a newer PPO plan to Blue Cross that gives you lots of different options to choose from. The plan is great for anyone at any age. The rates are very competitive with great coverages and lower Co-Pay limits then most PPO plans.

There are 8 different ways you can get the Smart Sense Plan. There are 4 different deductibles available from $5,000 to as low as $500 deductibles. Then, you can also choice if you want to have Full Drug coverage which includes both Brand and Generic Drugs or you can put just Generic drugs on your plan which usually saves you at least $20 a month.

Before you meet your deductible with the Smart Sense Plan you can have up to 3 off visits at $30. After you reach your 3 visits you will be paying 30% of the negotiated rate for the office visits. All other services you will pay 30% after your deductible is met. Services include Hospitalization, ER, Lab Work and X-Rays.

The coverage that I feel is the most important is the CO-Pay Limit or sometimes called the Stop-Loss. The Co-Pay limit is the most you spend in one year on all medical bills, every Health Insurance Policy has one. Once you reach your CO-Pay limit Anthem Blue Cross will pay 100% of your medical bills. Your CO-Pay limit restarts each calendar year.

Your CO-Pay limit with the Anthem Blue Cross Smart Sense Plans is $2,500 plus your deductible. You typically don't see a PPO plan with a Stop-Loss as low as $3,000 on other PPO Medical Plans. You usually see them more with HMO plans, which is a huge advantage.

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High Risk Pools ("Pre-existing Condition Insurance Plan") update

Dennis — Fri, 23 Jul 2010 22:47:22 +0000

The Patient Protection and Affordable Care Act called for the formation of a new high risk pool in each state within 90 days after its enactment. States were required to notify HHS by the end of April if the state would establish its own high risk pool or defer formation of the high risk pool to the federal government.

Earlier this month, HHS announced the creation of these "Pre-existing Condition Insurance Plans" (PCIP) that will offer coverage to uninsured Americans who have been unable to obtain health coverage because of a pre-existing health condition. The PCIP is a temporary program to help provide access to coverage until 2014, when coverage will be available regardless of pre-existing conditions.

Those states that decided to establish their own high risk pool must either contract with administrators or private health plans to operate and/or provide coverage in the pool.

HHS is running the high risk pools in the following states where our affiliated health plans do business: Indiana, Georgia, Virginia, Kentucky and Nevada; the other states where affiliated health plans do business are developing high risk pools run by the state rather than HHS.

Ultimately, high risk pools include those who have been unable to obtain health coverage because:
1. A pre-existing health condition
2. Private insurance being "unaffordable"

High risk pools that are run by HHS will require a denial letter for health insurance which requires underwriting.

• The denial letter must be dated within 6-months of the application to a PCIP and be from an insurance company or health plan showing that an individual has been denied completely due to a pre-existing condition, or the individual was offered coverage but was denied certain benefits (for example, by a rider to an insurance policy) because of a pre-existing condition.

We support the development of the high risk pools as a method to increase access to health care coverage. We are focused on providing up-to-date and accurate information to our members, customers and brokers and are committed to continuing to work with federal agencies and the Administration as the implementation timeline moves forward.

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Interim final rules for Preventive Care

Dennis — Fri, 23 Jul 2010 22:45:38 +0000

There is a provision in the health care reform legislation that requires private plans to cover preventive services with no copays or deductibles. This provision is required to be implemented with plan years beginning on or after September 23, 2010 and is not required of grandfathered plans.

Under this provision, prohibition of cost-sharing on preventive benefits applies to those services defined by the U.S. Preventive Services Task Force, American College of International Physician recommended vaccinations, and Health Resources and Services Administration recommended screenings and preventive care for infants, children and adolescents.

To help ensure our members have access to high quality health care services, we will add the new preventive services to our existing list. No services that are currently considered preventive will be removed from our plans as a result of health care reform legislation.

This week interim final rules were released that provide additional guidance on how the preventive care provision should be implemented. We are currently working to review this new guidance and will provide you with additional information on what impact this will have to your clients in an upcoming Health Care Reform Update.

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Patient Protection, Preventive Care, and Pre-existing Conditions

Dennis — Fri, 23 Jul 2010 22:44:04 +0000

In this week's Health Care Reform Update, we're sharing new information about three provisions: "patient protection" regulations, new preventive care regulations, and high risk pools ("pre-existing condition insurance plans"). While there's a lot of information to digest, we're working hard to make sure you and your clients get the most from the law.

Patient Protection Provisions
The Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury filed a 4-part interim final rule (IFR) on June 23, 2010 that provides further detail on requirements related to pre-existing condition exclusions for kids, lifetime and annual limits, rescission, and other "patient protections". Below is an overview of key points:

Pre-existing conditions
The recently enacted health care reform legislation prohibits health plans from using pre-existing conditions to deny health care coverage to an individual beginning in January 2014. Under the IFR, the Department of Health and Human Services requires health plans to implement this provision for children under the age of 19, beginning with plan years on or after September 23, 2010.

Annual limits
The new legislation also prohibits contracts from having lifetime limits and limits a health insurer's ability to have annual limits on "essential health benefits" (which have yet to be completely defined). Regardless of whether the plan is grandfathered, our plans will no longer include lifetime dollar limits for plan years beginning on or after September 23, 2010. We will also be removing certain annual limits. While we continue to wait on additional guidance from HHS that will further define "essential health benefits", we are making a good faith effort to comply with the regulation prohibiting annual limits on these benefits.

Rescission
Rescission is now limited to fraud or intentional misrepresentation of material fact. Based on the recent IFR, a health insurer may only terminate a member's coverage in the event of a mistake in eligibility (without fraud or misrepresentation) prospectively, not retroactively. We were the first health insurer to implement the rescission provision, implementing federal legislation regarding individual market rescissions effective May 1. This was well ahead of the effective date contained in the legislation, building on our leadership in the early implementation of reform legislation.

"Patient Protections"
The legislation also contains a number of other provisions that the Administration is calling "patient protections." This group of provisions includes:

Primary care physicians - For plans that require a primary care physician, allowing all members to choose any available in-network provider as their primary care doctor, including a participating pediatrician for children
OB-GYN providers - Allows individuals to seek care from an in-network OB-GYN provider without requiring pre-authorization or referral from a primary care physician
Emergency room services - Emergency room services protection including no pre-authorization for emergency services and limited cost-sharing for out of network services

As another example of our leadership in implementing these provisions, we will be including the patient provisions in all of our plan offerings, including grandfathered plans.

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More information about pre-existing conditions, limits, rescissions and other patient protection provisions

Dennis — Fri, 23 Jul 2010 22:34:48 +0000

More information about pre-existing conditions, limits, rescissions and other patient protection provisions
Interim final rule regulations have been published and offer more information about the following health care reform provisions:

Pre-existing conditions: Implementation for children up to age 19 will start with plan years (or policy years for individual products) beginning after September 23, 2010.
Lifetime and annual limits: Some annual limits are permitted in limited circumstances.
Rescissions: Limited to fraud or intentional misrepresentation of material fact.
Other patient protection provisions: Includes designating primary care providers and changes to how emergency room services are covered.

Here are the highlights of each provision and what we are doing to meet these regulations:
Pre-existing condition exclusion for children

The prohibition on pre-existing condition exclusions, which also prohibits denial of health care coverage due to a pre-existing condition, begins January 2014. However, health plans must implement this provision for children under the age of 19, beginning with plan years or policy years beginning on or after September 23, 2010.
Grandfathered individual plans are exempt from this provision.* All other health plans, including grandfathered group health plans, are required to implement this provision.

* There may be limited exceptions to this exemption.

Rescissions

Rescissions must be based on "an act, practice or omission that constitutes fraud, or unless the individual makes an intentional misrepresentation of material fact."
A plan may only terminate a member's coverage due to a mistake in eligibility (without fraud or misrepresentation on the member's part) prospectively, not retroactively.
In the event of a rescission for intentional misrepresentation or fraud, a 30-day advance notification of the rescission is required.
This applies to grandfathered and non-grandfathered plans.
We expect additional guidance to come.
While rarely used, rescissions help reduce fraud. We already have many processes in place. Some go beyond the requirements of the law, such as offering a binding, external, independent third-party review process, which was cited as a model in the industry. We were also the first to implement individual market rescission legislation, effective May 1, well before the effective date in the legislation.

Lifetime and Annual limits

We are making the following changes to all benefits:
1. Plans will no longer include annual or lifetime dollar limits at the plan (aggregate) level.
2. We will no longer include annual dollar limits on specific "essential health benefits."
Additional guidance will define "essential health benefits." Until then, we are making a good faith effort to comply with the intent of the legislation. If necessary, we will revise any decision based on the additional information.
Individuals who may have previously reached their lifetime or annual maximum, and, therefore, were no longer eligible for coverage, must be provided with a special enrollment period to re-enroll in benefits. We will notify enrolled members not receiving benefits and terminated individuals to tell them of this special enrollment period. For groups, this enrollment period will be during open enrollment at the time of renewal.
This provision applies to medical and pharmacy benefits only. Dental and vision coverage is not impacted.

Patient Protections

While not required for grandfathered plans, we will include the patient protection provisions in all plan offerings. Self-funded groups with grandfathered plans will be able to exclude some patient protections.
Health plans that require primary care physicians must allow member to choose any available in-network PCP, including a participating pediatrician for children.
Health insurers must allow individuals to seek care from an in-network OB/GYN specialist without requiring preauthorization or referral. Preauthorization for specific OB/GYN services is allowed.
Requirements of those seeking emergency room services (for an emergency condition defined by a "prudent lay person") include:
- No preauthorization can be required for emergency services, whether the emergency room is in or out of network. Post-treatment notification requirements are permitted.
- Insurers must cover out-of-network emergency room services. Copays and coinsurance for these services cannot exceed those for in-network emergency room services.
- Other types of cost sharing (such as deductibles and out-of-pocket limits) are allowed for out-of-network emergency room services if it is the same cost sharing used for other out-of-network benefits.
Participants can be balanced billed by the out-of-network provider.

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Anthem Blue Cross ClearProtection start at $1.68 a Day

Dennis — Fri, 23 Jul 2010 22:31:40 +0000

With the rising cost of medical care today, it's important that you have the right health care plan.

Anthem ClearProtection plans offer lower cost, solid protection that makes sense. Anthem ClearProtection plans offer:

Lower cost monthly Premiums
Coverage for the first 12 doctor visits before the deductible
Discounted rates for network covered services that apply immediately - even before meeting your deductible.
Prescription drug benefits that cover both Generic and Brand-name drugs.
A wide range of deductibles so you can find a plan that fits your budget

For a little more, consider our SmartSense plans:

Coverage for the first 3 doctor visits before the deductible
Low Copays and out of pocket costs
Your Choice of prescription drug benefits
$7,000,000 lifetime maximum benefit

Anthem Blue Cross plans offer your choice of doctors, and with 55,000 physicians in their California network, chances are your doctor already participates. Term life and dental plans are also available at an additional cost.

Why should you trust Anthem Blue Cross? Anthem Blue Cross has been serving your California neighbors for many years. Their doctor and hospital networks give you choice and flexibility - it's your health, your decision. Their financial strength and quality protection give you peace of mind - after all, your health is your most important asset.

Find out why so many of your neighbors trust Anthem Blue Cross for health care coverage. For faster access to your personal rate quote, visit: http://www.getmymedical.com/ca-ifp-get-quote

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Important Updates on Federal Health Care Reform

Dennis — Mon, 07 Jun 2010 06:22:37 +0000

As lawmakers complete a weeklong recess in their home states, Obama administration officials move forward on implementing certain provisions of the health care reform legislation. Recent national polling shows a majority of Americans strongly favor repeal of the law.
As health care reform legislation continues to take shape this year, we encourage you and others to engage members of Congress by visiting the Health Action Network.

Health Care Reform

Young Adults Might Not Be Covered Ahead of Schedule: WellPoint's affiliated health plans and other insurers began extending medical coverage for qualifying graduating students on June 1, well in advance of the September 23deadline. However, many employers plan to wait to provide the extended coverage until they are legally required to do so, with an effective date of January 2011 for most employers.

Senate Fails to Extend Bill for Doctors: Before leaving for the Memorial Day recess, House Democratic leaders scaled back health care language from the jobs bill before passing the bill. In the package, doctors who treat Medicare patients would see a 2.2% payment increase for the remainder of this year and a 1% payment increase in 2011. Extensions of COBRA subsidies and additional Medicaid funding for states were removed from the bill. Lawmakers in the Senate will vote on the bill when they return from recess next week.

Florida Judge Denies Government's Motion: Health and Human Services Secretary Kathleen Sebelius asked a federal judge in Florida for a one-month extension to respond to the joint lawsuit filed by 20 states' attorneys general who challenged the constitutionality of the new health care reform law. U.S. District Judge Roger Vinson denied the administration's request for an extension and instructed HHS officials to respond by the June 16 deadline.

Public Opinion

Americans Want Repeal of Health Care Reform: A recently released Rasmussen report suggests that Americans are strongly in favor of repealing President Barack Obama's health care reform law. Sixty percent of those polled favor repeal, while 62% believe the new legislation will increase the budget deficit.

Majority of Americans Unhappy with Reform: According to a new Quinnipiac University poll, 51% of Americans are unhappy with the new health care reform legislation and 70% are "dissatisfied" or "very dissatisfied" with the way things are going for the nation.

Looking Ahead

Lawmakers return to Washington on Monday ahead of a contentious primary runoff in Arkansas between Democrats Sen. Blanche Lincoln and Lt. Gov. Bill Halter, with health care reform at the center of the debate. The winner of Tuesday's Democratic nomination will face Republican Rep. John Boozman in the November elections.

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What Does Health Care Reform Mean to Me?

Dennis — Fri, 26 Mar 2010 01:47:15 +0000

Clear & Simple Answers to "What does health insurance reform actually mean for me?"

Let's start with how health care reform will extend and strengthen coverage:

Starting 2010, children with pre-existing medical conditions can no longer be denied health insurance. Once the new health insurance exchanges begin in the coming years, pre-existing condition discrimination will become a thing of the past for everyone.

Starting 2010, health insurance plans will allow young adults to remain on their parents' insurance coverage up until their 26th birthday.

Starting 2010, insurance companies will be banned from canceling coverage when they get sick, and they will be banned from implementing lifetime caps on health insurance . This year, restrictive annual limits on coverage will be banned for certain plans. Under health insurance reform, Americans will be ensured access to the care they need.

Starting 2010, adults who are uninsured because of pre-existing medical conditions will have access to affordable insurance through a temporary subsidized high-risk pool.

At the end of 2010, the bill increases funding for community health centers, so they can treat nearly double the number of patients over the next five years.

Starting 2010, also will be establish an independent commission to advise on how best to build the health care workforce and increase the number of nurses, doctors and other professionals to meet our country's needs. Going forward, we will provide $1.5 billion in funding to support the next generation of doctors, nurses and other primary care practitioners -- on top of a $500 million investment from the American Recovery and Reinvestment Act.

Health insurance reform will also curb some of the worst insurance industry practices and strengthen consumer protections:

Starting 2010, this bill creates a new, independent appeals process that ensures consumers in new private plans have access to an effective process to appeal decisions made by their insurer.

Starting 2010, discrimination based on salary will be outlawed. New group health plans will be prohibited from establishing any eligibility rules for health insurance coverage that discriminate in favor of higher-wage employees.

At the end of 2010, this bill provides funding to states to help establish offices of health insurance consumer assistance in order to help individuals in the process of filing complaints or appeals against insurance companies.

Starting January 1, 2011, insurers in the individual and small group market will be required to spend 80 percent of their premium dollars on medical services. Insurers in the large group market will be required to spend 85 percent of their premium dollars on medical services. Any insurers who don't meet those thresholds will be required to provide rebates to their policyholders.

Starting in 2011, this bill helps states require insurance companies to submit explanation for requested premium raise. Any company with excessive or unjustified premium increases may not be able to participate in the new health insurance coverage exchanges.

Reform immediately begins to lower health care costs for American families and small businesses:

Starting 2010, small businesses that choose to offer coverage will begin to receive tax credits of up to 35 percent of premiums to help make employee coverage more affordable.

Starting 2010, new private plans will be required to provide free preventive care: no co-payments and no deductibles for preventive services. And beginning January 1, 2011, Medicare will do the same.

Starting 2010, this bill will provide help for early retirees by creating a temporary re-insurance program to help offset the costs of expensive premiums for employers and retirees age 55-64.

Starting 2010, this bill starts to close the Medicare Part D 'donut hole' by providing a $250 rebate to Medicare beneficiaries who hit the gap in prescription drug coverage. And beginning in 2011, the bill institutes a 50% discount on prescription drugs in the 'donut hole.'

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Group Health Plans Are Cheaper Myth

Fri, 12 Feb 2010 21:06:14 +0000

It seems when ever I am browsing internet are reading what people are saying about healthcare reform I run in to way too many article that claim that group plans are cheaper. I just read an article on "9 Ways on How to Save Money on Your Health Insurance". In that article it said that if you have some sort of business and you get a small group plans you will end up paying less for your health insurance. The person who wrote that article obviously has no clue about health insurance industry. Group plans are never cheaper then individual health insurance. The most obvious reason is that in all 50 state group plans by law must be guaranteed issue. What that means is that everyone is accepted in to the group plans no matter what is they medical history. You need hart transplant sure you are accepted, you have cancer, need chemo therapy sure, you get health insurance. Now how would that make sense if the insurance companies charged less for those plan. The reality of it is that it does not make any sense. Individual health plans are cheaper because you HAVE to qualify medically. That means you are a good risk for insurance companies therefore you will be charged less for your health insurance. You can get a quote right now and compare, online it takes minutes to compare. Instead of reading worthless information online ask insurance agent to give you proposal side by side. (insurance agent cost you nothing, they get paid by insurance companies). The only possibility is when you might get a lower rate through group plan then individual is when you have a group of 10,000 employees or members and 98% plus are in great health.

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New Health Plans ClearProtection and CoreGuard from Anthem Blue Cross

Wed, 10 Feb 2010 00:31:56 +0000

Anthem Blue Cross just have release tow new plans to combat current rate increases. If you were part of the recent rate increase with Anthem Blue Cross then you can switch to one of the new health plans and avoid recent rate increase. Tow new plans are called ClearProtection and CoreGuard. In the Comparison below you will see me comparing ClearProtection, CoreGuard and SmartSense. Earlier in2009 when SmartSenseSmartSense was the most comprehensive and was the best value for the money in California. With new rate increases Anthem Blue Cross has some out with new even more competitive plans. You can easily switch to any of the new Anthem Blue Cross plans with no underwriting. Just fillout change of coverage form. Below is an example of a plan comparison for 35 year old female living in San Francisco (Zip Code 94134). If you have any questions or need personal assistance contact us by contact form, live chat at the top of every page or give us a call at 1-800-569-1156

Plan Name:	ClearProtection ClearProtection 3300	CoreGuard CoreGuard 2500	SmartSense SmartSense 2500 ded 70/50 w/ Comprehensive Rx
Monthly Premium:	$91.00	$96.00	$137.00
Plan Type:	PPO	PPO	PPO
Annual Deductible:	$3,300/$6,600 single/family	$2500 single/$5000 family	$2,500/$5,000 single/family
Annual Out-of-Pocket Maximum (in addition to deductible):	$3500 single/$7000 family	$3500 single/$7000 family	$2,500 / $5,000
Coinsurance (In-Network):	Inpatient: 40%; Outpatient 100%	50%	30%
Office Visits (In-Network):	$40 copay for first 2 visits per member per year, deductible waived	50%	$30
Drug Coverage:	Generic/Limited Brand	Generic/Limited Brand	Brand and Generic
Benefit Highlights:	2 Year Rate Guarantee

Note: Please note that premium rates may be subject to change based on responses to application questions, age of applicant(s) and/or scheduled rate adjustments.

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Health Insurance for Writers

Tue, 02 Feb 2010 01:08:44 +0000

There was a time when working for a reputable company provided health insurance, vacation, sick days, a retirement plan, and maybe even life insurance. Some companies offered these benefits as part of the employment package, others as a co-pay option far below the cost of individual insurance. These days, however, having a job doesn’t guarantee coverage. While many freelancers choose self-employment with its inherent risks, many have only recently been pushed into it.

ARE YOU A STATISTIC?

If you don’t have medical insurance because your “day job” company has made cutbacks, or you’ve been without healthcare throughout unemployment, freelancing, or part-time employment, you’re not alone. Even before this most recent economic downturn, there was a health crisis in America. Freelancers and those who are self-employed, such as writers, artists, photographers, and graphic designers are at an even greater risk for being uninsured than those in other professions.

According to the Bureau of Labor Statistics, the percentage of self-employed workers nationwide has increased since 1996. Most self-employment statistics, however, are centered in the New York metropolitan area, which is one of the few cities that keep accurate self-employment statistics. The 2005 report put out by Freelancers Union, which uses those statistics, cited an increasing freelance class as well. They also pointed out that unstable income and lack of health insurance were the two basic issues freelancers face that other regularly employed Americans do not.

In this economy where greater unemployment means more potential competition in the freelance pool, and therefore lower prices, freelancers who may have more experience than those just entering the market are making less money. Yet the cost of health care has increased beyond what is affordable. Factor in self-employment and social security taxes and the freelancer ends up struggling to pay for her own healthcare. According to that 2005 report by Freelancers Union, 28% of freelancers simply lived without any healthcare insurance at all.

In researching this article, I decided to do a casual poll of my own to ask freelancers I know how they attend to their own health care. Do they have insurance? If so, how did they get it and what was the cost? Or did they just cross their fingers and hope they didn’t get too sick? Here are the numbers:

Out of 48 total freelancers polled, there were 37 responses. Three of them were from out of the country. Of those living in the United States, two were from the East Coast, 22 from the West Coast, and 11 from the Southern/Midwestern states. There was an almost even mix of men and women with ages ranging from mid-twenties to mid-seventies.

Twelve freelancers polled, or about 31.5% (greater than the percentage quoted in the Freelancers Union report), have no health insurance at all and either pay out of pocket, hope they never get sick, or try to take advantage of any public health facilities available to them. Nine of those self-employed, or about 24%, are also working “day jobs” or some other type of work through which they obtain health insurance, while eight, or about 21%, of those who work from home have purchased private health insurance. Four freelancers (10.5%) have health coverage through their spouses. Two freelancers were on COBRA at the time of the original polling, but have since moved on. One now has no insurance at all, and the other has found a job where the employer provides health insurance. Two freelancers have access to socialized medicine. And one writer is on Medicare. See pie chart below.

These are pretty grim statistics, whether from Freelancers Union, or my own poll. A full third are without healthcare. Period. That number can easily go up as insurance companies increase rates, which can lead to people who can no longer afford to cover spouses on their insurance, or can no longer afford to pay for their own medical insurance or who lose that (probably part-time) day job that gives them just the slightest amount of stability.

NEVER SAY DIE

One of the traits of a freelancer or self-employed person is they tend to be tenacious and creative. You have to be to survive. There are ways to find some of the health necessities you need, or to even become insured without going broke. And if you live on the East Coast, you are at a greater advantage, since there are more programs than in other parts of the United States.

For example, aside from the Freelancers Union, which works for freelancer equity across the U.S., but is mostly centered in New York, there is also Media Bistro (mediabistro.com). Both of these organizations have been able to sell the idea of freelancers as a collective guild to insurance companies. Insurance companies give a lower group rate to anyone who signs up for health insurance through these two organizations. Applicants may need to be paying members of these organizations and meet certain eligibility requirements to be eligible for this insurance.

Another online source, can also point researchers in the direction of special self-employment insurance plans such as Blue Cross’s Anthem and Kaiser Permanente that may have more affordable health insurance options. In any of the above cases, for me—a single, middle-aged woman, the average insurance quote for adequate health insurance, not including dental or vision, was at least $300/month, usually closer to $400. The primary concern is determining specifically what is needed and how much you can afford to pay. I’m pretty sure I can afford to pay about $50/month. So, I need to look at other options.

If you have just recently lost your job where you had healthcare insurance, you can sign on with COBRA, of course, which usually comes with a certain amount of sticker shock.

LOOK FOR THE FREEBIES

Yes, there are freebies out there. But, like looking for more freelance gigs, you always have to keep your ear to the ground.

Drugstores and pharmacies frequently have blood pressure machines available for anyone to use for free. If you know that’s a trouble area, take advantage and make that free machine one of your stops.
Look for programs like RxAssist, an online patient-assistance program that helps you find some of the medications you may need but can’t afford.
If you are paying a lot for medication, ask your pharmacist about generic replacements that may be available.
Every winter there are public service announcements about locations where people can receive free flu shots. Sometimes, there are even medical personnel available to give you a mini-check up while you’re at it.
If you are on the brink of losing your healthcare insurance, but need to continue care somehow, talk to your doctor. There are doctors out there who, once they know your circumstances, can direct you to programs that can help. If you need medication, they can offer free samples. Don’t be afraid to ask.
If you’re in good health, consider getting insurance that only covers emergency medical care or catastrophes. While these policies won’t cover doctor visits or medication, they will tide you over should you have a major medical problem, and their monthly premiums are typically less expensive.
If you’re income has fallen below a certain amount (and many freelancing incomes have), you may be eligible to receive healthcare through free clinics or public health programs. While it may take you a few months and several eligibility forms to get an appointment, once in, you will receive medical attention.

IN THE END, IF IT SOUNDS TOO GOOD TO BE TRUE…

It probably is. Do your due diligence when researching what appear to be cut-rate physicians, medical offices, or insurance companies. In addition, when paying medical bills, pay close attention to what is listed on those bills. If you have a question about a charge, call and ask. Be your own advocate, learn the language, and fight for people to listen to you because no one else is going to do it for you.

Sources:

COBRA Continuation Coverage Assistance under the American Recovery and Reinvestment Act of 2009. United States Department of Labor. Accessed online at: http://www.dol.gov/ebsa/cobra.html

Horowitz, Sara; Buchanan, Stephanie; Alexandris, Monica; Anteby, Michel; Rothman, Naomi; Syman, Stefanie; and Vural, Leyla. 2005 Report: The Rise of the Freelance Class – A New Constituency of Workers Building a Social Safety Net. Freelancers Union. Access at www.freelancersunion.org.

Vanderkam, Laura. The Promise and Peril of the Freelance Economy. City Journal. Winter 2009. Vol. 19, no. 1. Accessed online at: http://www.city-journal.org/2009/19_1_self-employment.html

Rachel V. Olivier is a freelance proofreader, copy editor, and writer. In addition, she works part-time as a Girl Friday at the Larchmont Chronicle in Los AngelesHealth , California and is a regular contributor to Chocolate Zoom and Tyrannosaurus Press' The Illuminata. For more information, check out her website at www.puttputtproductions.com.

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