The Los Angeles Times (10/6, Zamosky) evaluates two health insurance options for people leaving a full-time job: COBRA and ACA coverage. COBRA (the Consolidated Omnibus Budget Reconciliation Act) allows departing employees to pay the full cost of an employer’s health plan in addition to an administrative fee.  That results in policies with premiums that are on average three times higher than paid by employees. The Affordable Care Act offers subsidies for individuals and households meeting income thresholds, and exchanges often offer more affordable premiums.  However, the piece encourages people to consider all of their options.

AB 2088: Would ban large employers from offering only limited benefit plans.

SB 1182: Would establish rate review for large employers.

SB 964: Would require state regulators to do annual reviews for timely access and network adequacy in Medi-Cal managed care and the individual market.

SB 1176: Would require insurers to track out-of-pocket costs and reimburse consumers when they hit their cap.

AB 1917: Would spread out cost sharing so high-cost patients with HIV/AIDS, cancer and other diseases won’t face thousands of dollars in one month.

AB 1962: Would require dental plans to report how much of their premium dollar is spend on dental care, as opposed to administration and profits.

AB 2325: Would create a medical interpreter program for Medi-Cal.

SB 492: Would allow optometrists to earn a certificate to treat more conditions.

AB 2062: Would establish minimum education and certification standards for surgical technologists.

Please watch this important video that effects health care in California!

No on Prop 45

Today, Covered California announced 10 health insurance plans have been tentatively selected to be in the Exchange for calendar year 2015.

Here is a link to the press release and leadership remarks regarding this announcement.  Details on the plans available in specific pricing regions can be found here.   The tentative selection of health plans is subject to rate review by state regulators and is expected to be finalized in late September.

The 10 Covered California plans for 2015 are:

• Anthem Blue Cross of California
• Blue Shield of California
• Chinese Community Health Plan
• Health Net
• Kaiser Permanente
• L.A. Care Health Plan
• Molina Healthcare
• Sharp Health Plan
• Valley Health Plan
• Western Health Advantage

Alameda Alliance for Health and Contra Costa Health Plan will not participate in 2015.

Rates for 2015 came in at a low increase over last year.  As a result, the vast majority of Covered California consumers will see a small increase in their premiums, while others will see no increase, and still others may experience a decrease.

The statewide weighted average^[1] rate of increase was 4.2 percent.  Some plans offering weighted average rates that are 8.5 percent lower than current pricing.  While premiums may be shifting for some areas and products, the benefits will not be changing.

90 percent of members currently enrolled in health insurance plans through Covered California are receiving federal subsidies, or premium assistance, to help reduce their overall costs. In most areas of the state, the amount of premium assistance that individuals receive in 2015 will either increase or remain very close to 2014 premium assistance amounts.

The Shop and Compare Tool on the Covered California website has been updated and now shows 2015 plans, preliminary estimate of costs (until rates are finalized in late September) and premium assistance.   When using Shop and Compare, it is important to use reported income amount and ask if any income changes are expected in 2015.

Also, if you are helping consumers enroll in coverage for the remainder of this year, you must use Plan Review within the application to see the available plans and cost of those plans.  2014 rates are no longer available in the Shop and Compare Tool.

Thank you for your continued participation and support.

Starting Oct. 1, Covered California will expand choice in its Small Employer Health Options Program by allowing employers to offer a choice of plans in two contiguous benefit levels.

Currently, business owners can offer only one benefit level, although workers can choose from a variety of plans at that level.  Other states generally don’t allow even that much choice.

Continue reading….

The Los Angeles Times (6/13, Terhune) reports that “industry giant” Anthem Blue Cross said on Thursday “its California premiums for individual coverage will increase less than 10% of average next year.” The article calls this “the strongest indication yet where Obamacare rates are headed.”

Trying on new shades, while visiting one of our fabulous clients!

On May 9, the U.S. Department of Health and Human Services (HHS) announced a 60-day Special Enrollment Period (SEP) for anyone who has COBRA group health benefits continuation coverage.  With this announcement, COBRA enrollees have until July 1, 2014 to change to an Affordable Care Act (ACA) compliant plan.  In California, they have until July 15, 2014 to change to an ACA-compliant plan and this SEP is also available to Cal-COBRA enrollees.

To take advantage of this SEP, COBRA and Cal-COBRA enrollees must apply for an on-exchange plan on Covered California (the state-based exchange) or for an off-exchange ACA plan by July 15, 2014.

Under COBRA (the Consolidated Omnibus Budget Reconciliation Act), people who lose their jobs can buy the coverage they had with their employer.  But they have to pay the full cost.  In many cases, and especially when they qualify for subsidies, people can get more affordable coverage through the health insurance marketplaces, also called the exchanges.  They may also find more affordable coverage options off the exchange.

When filling out either a paper or online off-exchange application, COBRA or Cal-COBRA enrollees should mark the box designated as the Involuntary Loss of Minimum Essential Coverage as their qualifying life event during the SEP.  And they should put in the date they are applying as the qualifying event date.  For off-exchange plans, the effective date will be the first of the month after the date the application is received.  Covered California determines the effective date rules for its on-exchange plans.

A big New York employee benefits shop is buying a successful – and growing – Sacramento-based dental insurance and dental services company.

The Guardian Life Insurance Co. of America has entered an agreement to buy Premier Access Insurance Co., a Sacramento-based company that serves over 5,000 employers, operates 18 dental centers and provides dental insurance to more than 634,000 members in five states and Mexico.

Continue reading…

The Elk Grove Promenade shopping mall was conceived during the boom a decade ago.  It has sat empty for more than five years, a humbling reminder of economic collapse.

Now the unfinished retail complex is being reborn as an outlet mall, an apt symbol of a cautious, post-recessionary world in which the economy is recovering but shoppers demand discounts.

Continue reading….