California Health Care

by John Hansen

TRIO is Blue Shield of California’s aim at providing an affordable, high quality managed care product. It is an HMO, so the primary care physician (PCP) serves as the gateway to specialists in an effort to lower costs.

Blue Shield Covered California aims to get every patient to do an initial visit with their PCP to get their checkups. Or, as Renee Casserly, Director of Sales Operations and Business Development at Blue Shield of California, says “to get their tires checked.”

With the TRIO product, Blue Shield expects to compete with Kaiser Permanente. Top officials at Blue Shield fully admit that Kaiser is doing a lot right. They understand that Covered California Kaiser plans have a strong brand, and they are looking to similarly build a strong, trustworthy brand.

Kaiser Permanente’s integrative model with their one-stop shop with doctors, specialists, etc. all under one roof has been very appealing to many Californians. Many consumers in the state have gotten to the...

by John Hansen

When the Affordable Care Act was passed, Blue Shield Covered California hit the pause button on brand building. They focused their attention on Health Care Reform and being ready for the radical changes in the market. In so doing, they road on their reputation as it was previously established and stopped working on building their brand.

After Obama Care California was passed into law in 2010, Blue Shield turned their focus almost completely to getting ready for the implementation of Health Care Reform. According to Renee Casserly, Director of Sales Operations and Business Development at Blue Shield of California, this leading California carrier planned for three years, worked on their systems for 18 months, and spent tens of millions of dollars getting ready for 2014. They wanted to do well in the new world of Health Care Reform and they wanted to succeed in the Covered California exchange market.

With the busyness of transformation and adaptation, brand identity was almost...

by John Hansen

Things are getting shaken up at Molina Health Care. In the last month, the company terminated two top executives from the Molina Family, chief executive J. Mario Molina and his brother, finance chief John Molina. The company blamed this on “disappointing financial performance”. When you put that together with the bold moves Molina Insurance made in California in 2016 (very aggressive pricing, high broker commissions, and rapid gaining of low risk clients leading to RAF penalties), it seems that Molina may have taken a misstep that they are trying to recover from.

From 2016 to 2017 Molina Healthcare increased their Individual and Family Business from 53,000 to 180,000 members. They nearly quadrupled their book of business. Top leaders at Blue Shield of California question whether this was a mistake that could lead to rate increases of around 25% for 2018.

Any way you look at it, Molina made a gutsy move. They offered some of the highest broker commissions in the market...

by Wendy Barnett

Covered California applicants commonly wonder how much it will cost to have a baby with insurance. This is a very good question when you are choosing which plan will be your best option on the California Health Insurance Exchange.  Did you know that Covered California has provided a Cost Scenario Worksheet for Pregnancy?  It is a very helpful tool that can help you get a general idea of expected costs for Pregnancy and compares these costs across the four plan levels they offer. You can also see how much your pregnancy would cost you without any health insurance.

Covered CA has named their four different plan levels after 4 metals: the Bronze, Gold, Silver, and Platinum Plans. Cheaper premiums found on Bronze and Silver plans will mean higher expenses for you when you go to use services. Higher premiums found on Gold and Platinum plans offer no deductibles which give you considerable savings when healthcare is utilized.  It is helpful for members to know if they expec...

by Wendy Barnett

Qualifying Life Events (QLE) are big life occurrences called triggering life events that allow you to enroll in individual or family health insurance outside of the Open Enrollment Period. There is a whole list of life events that can be applicable, but this article will cover moving.

You may have a QLE if you have recently moved to California and sometimes if you have moved within California. Here are the important guidelines:

It is important to know that Covered CA does require a random selection of applicants who enroll during Special Enrollment Period (SEP) to provide verification documents for their qualifying life event.

For some people, moving occurs in stages and not on one specific day, so it may be hard to pin down the actual date of your permanent move.  In this situation, it can be helpful to review Covered California’s list of SEP verification documents. See the section that pertains to moving below. Covered CA allows you to provide any one of the followin...

by Wendy Barnett

Covered California recently sent out an e-mail to members with “Helpful Tips.” The March 2017 e-mail includes guidelines on what services are free and how to get started using the plan. As a health insurance agent I am surprised that I commonly hear from members that they have never used their plan. This is really unfortunate since there are free benefits that members can use to help them stay healthy. I really encourage members to follow the “Getting Started” steps below, that way they will be set up to use their plan much more easily if something urgent arises. For example, if a member has already gotten established with his or her primary care physician, then later on he or she will likely have easier and quicker access when trying to obtain a same day appointment in their doctor’s office. I also encourage members to understand how their network must be used and how to make sure they obtain preventive care services for free. Covered CA included helpful lin...

By Wendy Barnett

In late December of 2016 Covered California found a bookkeeping error where certain consumers were erroneously told that they would receive a tax credit for their renewed Covered CA plan when in fact their tax credit would be removed entirely. The removal of the tax credit had to do with whether or not a Covered CA applicant gave their consent to check their income taxes.

Consumers must give Covered CA consent to check their tax records at renewal time each year in order to receive their Advanced Premium Tax Credit (APTC). This allows Covered CA to verify their income to make sure they still qualify for the tax credits that help lower their monthly premiums.  Members can give this consent for up to 5 years so their APTC can be renewed automatically at renewal time. But for those who did not give consent to check their income taxes, the APTC will not get applied for the New Year, and their health insurance plan will be billed at the full charge, even if they qualified!

Ab...

by Wendy Barnett

Covered California confirmed that they gave erroneous tax credit information to insurers for approximately 25,000 policy holders. This resulted in members receiving incorrect bills for the month of January, 2017. Covered California has, since then, corrected the wrong tax credit information with the insurance carriers. They have also aggressively reached out to affected members to inform them of the error and their options.

Sources:
How to Cope with Covered California Glitches
Subsidy for Consumers

by Wendy Barnett

President Trump wasted no time in beginning his administration’s goals to repeal Obamacare. On inauguration day, he signed an executive order to begin steps to do so.  The directive states President Trump’s intention to seek the prompt repeal of the Affordable Care Act (ACA) and in the meantime proclaims its goals of minimizing the Act’s economic and regulatory burdens. It also aims to “prepare to afford the States more flexibility and control to create a more free and open healthcare market.” The executive order is a broad policy directive. It gives the Secretary of Health and Human Service and the heads of all other executive departments and agencies with authorities and responsibilities under the ACA authority and discretion available to them to reduce the above mentioned burdens to the State, individuals, families, healthcare providers, health insurers, and others.

To read the entire executive order, see: Minimizing the economic burden of the Patient Prote...

by John Hansen

Health Net has issued off cycle second quarter rate changes that will impact Covered California Small Business renewals and new business with effective dates of May 1, 2017 and June 1, 2017.

However, as a result of this delay, April rates will not be affected. 

Covered California is calling on their agents to make sure clients are aware of these new rates when selecting plan offerings for their business, either during their renewal process or when quoting new business for these effective dates. If you have any questions, please call 1-877-752-4737 and select the option 5 for our small business department.