From Blue Shield today:
From Blue Shield today:
Oscar is coming in 2017. No, not that Oscar.
A new health insurance carrier will offer plans both on- and off-exchange, in San Francisco, San Mateo, and Santa Clara counties. A little surprising it took this long, considering they are Google-funded, and we’ve heard them described as “great software – with health insurance attached.”
It appears their Bay Area rates and network will be middle-of-the-pack (current word is no Sutter Health/PAMF, though that could change). Will their customer service and user experience be enough to consider Oscar as a viable choice? Stay tuned.
This isn’t a strategy for everyone. If you feel bad for the insurance companies, you can stop reading now. And if you have any significant health issues, this won’t work for you, either. But, if you:
…then this could be for you.Read More
Covered California, the new health insurance marketplace, or “exchange” announced today that six carriers would participate in the 2014 SHOP for small businesses of 2 to 50 employees:
Rates are pending approval by state regulatory agencies, and Covered California’s release only gives examples for a single, 40-year old employee. You can download the booklet and accompanying press release here.
Yet unanswered is the question of whether these plan options will offer limited provider networks, as we have seen with the individual marketplace.
Small employers will be able to choose to purchase health coverage for employees inside the Covered CA marketplace, or they may go directly to carriers as they do today. Depending on the business demographics and needs, either may be a viable financial strategy to provide competitive benefits to employees. We look forward to helping small business owners determine the right choice for their business.
Small businesses and individuals will be receiving a rebate from Blue Shield by August 1st. Employers, please review the details here, about valid ways to return these refunded premiums to your employees. Reducing the cost of future insurance coverage is a legitimate use of the rebate.
From Blue Shield:
Medical Loss Ratio Rebates and Notifications
Last month, we informed you that Blue Shield reported its 2012 Medical Loss Ratio (MLR) by market segment to the Department of Health and Human Services (HHS). We are now sharing our rebate information with you.
Blue Shield did not meet the MLR thresholds for the following market segments:
- Individual and Family plans regulated by the Department of Insurance (DOI)
The MLR threshold for this market segment is 80%. Blue Shield reported an MLR of 78.0%. The Individual and Family plan MLR was 2% below the 80% threshold. As a result certain subscribers will receive premium rebates by August 1, 2013. The 2% of premium revenue equals $13.3 million that will be returned to 226,034 Individual and Family plan subscribers who were enrolled in the Blue Shield Life plans that did not meet the MLR threshold. The average rebate amount per subscriber is about $59.
- Small Business plans (50 or fewer employees) regulated by the Department of Managed Health Care (DMHC)
The MLR threshold for this market segment is 80%. Blue Shield reported an MLR of 76.6%. The Small Business MLR was 3.4% below the 80% threshold. As a result, certain subscribers will receive dues rebates by August 1, 2013. The 3.4% of dues revenue equals $24.5 million that will be returned to 29,232 Small Business policyholders who were enrolled in the Blue Shield plans that did not meet the MLR threshold. The average rebate amount per Small Business policyholder is about $827.
Chris Rauber is asking those questions at the San Francisco Business Times, and apparently, so is much of the San Francisco business community. Well summed up by Jim Lazarus of the San Francisco Chamber of Commerce:
Among the problem area, according to Lazarus:
- The federal individual mandate is not met by Healthy San Francisco.
- The health reimbursement accounts now used by some San Francisco businesses to comply with the local mandate won’t be available next year.
- Healthy San Francisco, after Jan. 1, will be primarily an “avenue of last resort” for individuals, including undocumented residents, who don’t qualify for other programs. “Some may be willing to stay in the program and pay the penalty” for not having individual insurance, Lazarus speculated.
Not to worry, says Mayor Lee.
In yesterday’s NY Times, it was reported that individual health insurance premiums are expected to drop by 50% in 2014, when the full effect of the Affordable Care Act (a.k.a., “Obamacare”) kick in. Here is the most shocking line in the article:
Because the cost of individual coverage has soared, only 17,000 New Yorkers currently buy insurance on their own.
New York state is home to almost 20,000,000 (that’s TWENTY MILLION) people. And 17,000 of them buy their own health insurance. According to the article, 2.6 million go uninsured. Let’s let those numbers sink in for a moment.
New York is one of a handful of states that already has guarantee-issue coverage for individuals. That is, medical underwriting does not exist; any individual can purchase individual coverage, even those with expensive, chronic diseases. How many of the 17,000 do you think are completely healthy individuals, who do not receive coverage from an employer? Right. Well, no wonder the average cost to an individual is $1,500/month for these individual policies. OK, here are a couple of takeaways:
I will do a little more fact-checking and report back…
Chad Terhune of the LA Times reports that Anthem Blue Cross and Blue Shield of California will be required to issue rebates to small businesses this August, for failing to meet the minimum 80% medical loss ratio threshold in 2012, as required under the Affordable Care Act.
Blue Shield of California insures 29,000 small businesses in California, while Anthem Blue Cross is the largest small business insurer in the state, covering 45,000 small businesses. Your Allpointe broker will be contacting you once specific dollar amounts are released.