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
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.
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…
A number of new provisions under the new health care legislation go into effect January 1, 2011. Guaranteed coverage for children under the age of 19 is now available in California, and parents may add adult children up to age 26 to their plan.
ABC News offers a good summary, text here and video below.
More than eighty percent of my small business clients offer an HSA-compatible health plan as an option to their employees. Some of them partially fund accounts for the employees to help offset the high deductibles, and still find that this is the most cost-efficient way to finance employee health care.
Ditto for individuals and families. It is particularly pleasing to help a family paying $1,000 – $1,500/month on COBRA or a small business plan realize that they could save $10,000/ year in premiums by switching the family to an HSA-compatible plan from their choice of carriers.
More on this trend, from the Kaiser Family Foundation, here.
Even if you are not an Anthem Blue Cross subscriber, it would be hard not to have heard about the recently announced rate hike for many California subscribers. If not, you can read about it here (LA Times, 2/14), here (SF Chronicle, 2/14), and here (NY Times, 2/16).
For additional perspective, here is the full letter of explanation written by Brian Sassi of Anthem Blue Cross in response to Health and Human Services Secretary Kathleen Sebelius’s inquiry into the rate increases.
A couple of key points, without getting into the meat of the debate:
We understand that a number of our individual clients may be experiencing an increase in rates — and not necessarily just from Anthem. Please remember that we are always here to assist you. Contact our office via email or call (888) 992-2244 to schedule an an appointment to discuss whether a different plan or a different carrier is the right choice for you.