This is one of a series of posts designed to update clients and prospective clients with what is happening on the individual and family health insurance markets.
Blue Shield offers individual and family coverage directly, and through Covered CA for those who qualify for a federal tax credit or subsidy.
Can I keep my current plan?
No. Blue Shield is terminating all individual plans, even ones purchased prior to March, 2010 that some other carriers would consider to be grandfathered. Maybe. If your plan was purchased prior to March, 2010 and is not being terminated for other reasons. Also, just announced: policyholders will get a 3-month reprieve from cancellation, and have the option to keep their plan until March 31, 2014.
Are my rates going up? Almost certainly, and significantly – unless you were previously placed into a Tier 2 or higher risk category due to health history, or were on a HIPAA guarantee-issue plan.
Do I need to do anything to change to a new, compliant plan? Blue Shield will move you to a new ACA-compliant plan that they think maps most closely to your current plan. You are not required to accept this plan. You may consider alternate options from Blue Shield, or consider changing to a carrier that better meets your needs. As a cost-mitigation strategy, we think all Blue Shield clients should consider changing to a Cigna PPO plan before the end of 2013.
Is the network of providers changing? Yes, Blue Shield’s individual and family PPO network will be called the Exclusive network, which you can search here. This network could represent as few as half of the current Blue Shield PPO network providers. This may change in the future, but at this time, we believe Blue Shield’s network will include the Sutter hospitals (e.g., California Pacific Medical Centers), but not any of the UC hospitals, such as UCSF and UCLA. When traveling outside of CA, members will continue to have access to the national and international BlueCard network.
What is the difference between a PPO and an EPO? Depending on the county you live in, Blue Shield will offer either a PPO or an EPO plan. An EPO, or “Exclusive Provider Organization” is a PPO but without out of network benefits.
Can I view all of the new 2014 plan options and rates? Yes, please visit this page which will let you access direct 2014 quotes from all of the major carriers, as well as submit a quick-apply application when you are ready. For those who think they may qualify for tax credits, please contact us to discuss options through Covered California.
Are these the same plans that are available through Covered CA? Blue Shield will offer the same exact plans directly, as they do through Covered California, at the same rates (as required by law). There are no additional plans offered by Blue Shield outside of the marketplace.
Are there HSA-compatible options? Yes, Blue Shield offers a Basic (Bronze) level HSA-compatible plan.
I know I won’t qualify for a tax credit or subsidy. How do I apply? Please use the Quick-Apply links and select the carrier logo. Remember, there are no more health questions on individual applications. We expect many people to be pleasantly surprised at how quick and easy applying for coverage will be for 2014 and beyond. Please contact us if you need assistance with your online application, or would prefer a paper application.