The Health Net PPO, not to be confused with the EnhancedCare PPO offered through Covered California, is the only plan that will give plan members access to both the Stanford doctors and hospital. These plans are only sold off-exchange or directly from Health Net. Plan enrollment is limited to certain regions and counties within California.
Health Net is making it easier to add adult dental and vision to their off-exchange plans. They call the added dental and vision benefits the Plus package. For the EnhancedCare PPO, PureCare EPO, and PPO plans the Plus package of dental and vision benefits is $14.42 per adult. The maximum dental benefit per year is $1,000. Instead of a member cost-sharing percentage these plans have a fee schedule. For example, a filling on one tooth would be $22.
Health Net is bringing primary, preventive and urgent care right to our members — literally. Starting May 1, 2018, your PPO clients — individuals and all group sizes — will have a new way to connect to care with a Heal doctor who can make house calls.
Both Health Net and Blue Shield have wasted thousands of hours of time for consumers, agents, and their customer service staff. Tempers have become short and patience has run thin. And as of December 21st, a month after some people have applied for health insurance, 10 days before the plans are to become effective, many families don’t know if they will have insurance on January 1, 2018.
The health plans don’t recognize the invoiced amount of the health care services from out-of-network providers as either accruing toward the deductible or for their cost-sharing of 50% before the maximum out-of-pocket amount is met. The health plans apply a Usual and Customary Rate (UCR) or the Allowable Amount. This limits their responsibility for payment and increases the health plan members costs.
The health plans and Covered California may give lip service to the value of the agent community, but it is not reflected in the compensation we receive. I’m not trying to get rich as an insurance agent. My net revenue listed on my Schedule C for 2016 was $34,000. If the new compensation schedules significantly erode my insurance revenue then I will have to find other income streams. Maybe Covered California will hire me to answer phone calls; I hear they have a great benefits package.
The Department of Managed Health Care (DMHC), who regulates most of the individual and family plans offered through Covered California, has developed a website to allow consumers to compare health insurance companies. The Health Plan Dashboard website does not assign any performance review ratings. But it does give consumers a high level view of some of the data collect on the health plans such as enrollment, complaints, and enforcement actions for medical, dental, and vision plans.
2017 was my best year yet for commission income from health insurance enrollments. I realized $53,000 from commissions paid on IFP, small groups, Medicare, dental, and vision enrollments. Approximately 80% of the commission income was from the IFP market and the rest split between small group and Medicare. The revenue from advertisements on my website increased and I actually made a little bit of money on a book I published in 2016.
California Department of Insurance Commission Dave Jones excoriated Aetna in a news release on December 18th over Aetna’s planned small group premium increases but he was noticeably silent when Health Net submitted a similar rate increase for individuals and families. The average increase for the 2015 Health Net IFP PPO plans is 10.8% while the Aetna small group […]
Health Net is reporting that Covered California has cancelled 4,100 members for no apparent reason. This information was sent to all Health Net brokers on December 19, 2014. The coverage for these members will end December 31st unless the member or agent takes action to renew the health plan by Sunday December 21, 2014. Health Net […]