Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
The emergency regulations force all “non-grandfathered” plans to include the 10 EHBs which means that plans offered through Covered California won’t be put at a substantial competitive disadvantage. Plans not offering all the benefits would have been priced lower than plans in the state exchange. While health insurance plans offered outside the Covered California may still be less expensive for a variety of reasons, at least they will have equivalent benefit designs.
California residents were invited to ask questions about the new Covered California health plans in a live chat held through Facebook this past Thursday. Ken Wood, Senior Advisor for Products, Marketing and Health Plan Relationships for Covered California, answered 47 questions over 90 minutes. While fourteen of the questions dealt with different aspects of the health plans being offered, the bulk of the questions focused on income requirements for the tax credits and coverage options for different family scenarios.
While the filed rate increases of Anthem Blue Cross may be unreasonable that hardly justifies their being banned from the Covered California small employer group program. There is also the prospect that Anthem Blue Cross might be forecasting a sharp drop in membership of their small group plans as small businesses abandon the plans or employees leave to purchase subsidized health insurance through Covered California.
Before Covered California can really get the IPA training going, they have to have the Assister Enrollment Entities (AEE) in place. The AEEs can be a variety of organizations that have the interest and resources to reach out to targeted populations to help enroll individuals into Covered California health plans. These might be nonprofit groups that serve specific ethnic or cultural populations, social service organizations or trade groups.
Staff did respond to an excellent suggestion regarding insurance agents not be able to pay Assisters or provide ‘in-kind support” such as free copies, co-branded material, travel expenses or reduced rent. Covered California staff agreed to the prohibitions that would allow agents or general agencies from essentially co-opting In-Person Assisters or Entities into pipeline of referrals.
Covered California will be offering 13 different health insurance plans to individuals and families. Some of the plans will be offered through large commercial insurance companies and other from smaller regional organizations. Ten of the thirteen plans have some form of easily accessible report card on their services from either a state agency or accreditation organization.
The contract to offer health insurance through California’s new health insurance market place mandates that plans pay a monthly Participation Fee per person enrolled per month for the privilege of being in Covered California. The $13.95 Participation Fee for individual members is just one of the many elements of the proposed Covered California contract that plans must adhere to if they want to be a contractor in the exchange for 2014.
It’s hard to compare the plans side by side because of the diversity populations they serve and lack of data on some of the health insurance companies. Much of the information about the different health plans and companies is spread out over several different agencies, reports and websites.
Ironically, many of the agents listening and asking questions have undoubtedly been ardent opponents of health care reform and many have actively called for the repeal of Obamacare. But here they were, listening to hear if they could make a dime off the tax-payer subsidized, guarantee issue health insurance plans that many have called the end of America and the beginning of socialism.
Only two plans, Anthem Blue Cross and Blue Shield of California will be available in all the 19 regions in California. All of the regions will have at least 3 health insurance plans to choose from. Many of the plans are region specific to areas such as San Diego, Los Angeles and the San Francisco Bay area. In addition, some of the plans have concentrated primarily in Medi-Cal and Medicare market and this will be their first push into the individual market.
