Reminder: Anthem Blue Cross Cancellation of IFP Plans in Certain CA Counties

Reminder: Anthem Blue Cross Cancellation of IFP Plans in Certain CA Counties

(Note: This information concerns those who are on Individual & Family health plans.  It does not concern you if you are on Medicare or an Employer or Employee on a Group-sponsored or Government-sponsored health plan.  This information pertains only to California and does not apply to other states.)

This is a reminder that if you are currently on an Anthem Blue Cross Individual or Family (IFP) health plan (not Medicare or Group plan), and you received a notice from Anthem that your health plan will not be renewed on Jan. 1, then you need to take action by Dec. 15.

On Jan. 1, Anthem will be withdrawing IFP plans from all regions in California EXCEPT for 3. Those 3 regions and the affected counties are listed below.  These include 22 sparsely populated counties in N. Calif., Santa Clara county and 5 counties in the Central Valley.

The IFP plans that are affected include plans within the Covered CA Exchange (On-Exchange), as well as plans outside the Covered CA Exchange (Off-Exchange). They include Subsidized plans as well as Non-Subsidized health plans.  Those who are on Grandfathered IFP plans are not affected.

If you need help securing a plan from an alternate insurance carrier such as Blue Shield, Health Net or Kaiser, please contact me at plee@health-insurance.com or call 925-284-2000 Ext. 101.

Anthem Blue Cross IFP Plans will be discontinued on Jan. 1 from all CA Counties EXCEPT the following:

  • Northern California: Alpine, Amador, Butte, Calavaras, Colusa, Del Norte, Glenn, Humbolt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Toulumne, Trinity, Yuba.
  • Santa Clara
  • Central Valley: Mariposa, Merced, San Joaquin, Stanislaus, Tulare.

Sincerely,

Phil Lee Lee Health Insurance Services

925-284-2000 Ext. 101

plee@health-insurance.com

http://www.Health-Insurance.com

www.linkedIn.com/in/philwlee

Employee Benefits & Health Insurance

Reminder: Annual Open Enrollment Period

(This information concerns those who are on Individual & Family health plans, and Medicare health plans. It does not concern you if you are an Employer or Employee on a Group-sponsored or Government-sponsored health plan. This information pertains only to California and may or may not apply to other states.)

This is a reminder that we are in Open Enrollment season for several lines of health insurance plans.

(A) For Those Under Age 65 on Individual & Family Plans
Annual Open Enrollment period (AEP) this year runs from Nov. 1 through Jan. 31.
• You may enroll into or change Covered CA On-Exchange (with subsidy) as well as Off-Exchange (no subsidy) plans.
• Competitive Rate Comparison Proposals for On Exchange as well as Off Exchange plans are now available for Jan. 1, 2018. Please let us know if you would like one prepared for you.
• On Jan. 1, Anthem Blue Cross will be terminating their Individual plans in most counties in California except for some in rural Northern California.
• If you received a cancellation notice from Anthem Blue Cross, please contact us for a proposal to show you alternative plans from Blue Shield, Health Net, Kaiser, etc.
• If you received a large rate increase, ask us for a proposal showing alternatives.

(B) For Those Seniors Over Age 65 on Medicare
• For those on Supplement plans, there is NO Open Enrollment Period. Your supplement plans do not require renewal and continue uninterrupted until you cancel it.
• For those on Supplement Plan F, CMS (Center for Medicare Medicaid Services) will prohibit new sales after Jan. 2020. But those who are already on Plan F at that time will be grandfathered indefinitely.
• For those wishing to switch from a Medicare Advantage HMO plan to a Supplement Plan, there is no Open Enrollment and no Guarantee-Issue (GI) unless you have a Qualifying Event (QE), such as a move from out of state. You will wish to review the 13 Guarantee-Issue (GI) situations in CA that you may possibly qualify for. Even if you don’t qualify, there is no penalty for applying and going through the non-GI underwriting (approval) process. Chances are good that you may still qualify based on your health. The process for this type of transition is tricky and the timing very tight. If you think you may want to do this, start this process early to give yourself enough time to receive approval. We recommend that you seek professional assistance from an experienced agent knowledgeable in this area.

(The above is meant to be informational. This information has not been approved by CMS or any regulatory agency. This is not sales material and should not be relied upon to make purchase decisions. We recommend that you consult a knowledgeable insurance agent before making any decisions.)

Phil Lee
Lee Health Insurance Services 925-284-2000
www.linkedIn.com/in/philwlee
www.Health-Insurance.com
plee@health-insurance.com
Employee Benefits & Health Insurance

Anthem Blue Cross to Discontinue Individual Health Plans in Most Counties in California

Anthem Blue Cross announced that they will discontinue selling Individual medical plans in CA in 2018 except for three counties, Santa Clara, Stockton/Modesto, and Redding.

I received the following email from Anthem to agents and brokers last week with details about this decision. Please click on the link below:

Anthem Announcement

Please review the following to be sure that you will actually be affected by this:

  • This change only affects those on Individual Health Plans, NOT Employer Group plans or Medicare plans.
  • It affects both On Exchange (Covered California), as well as Off Exchange health plans.  It affects both subsidized as well as non-subsidized plans.
  • It does not affect “Grandfathered” plans.
  • It will take effect on Jan. 1st, 2018.
  • This change does not affect these 3 counties: Santa Clara, Stockton/Modesto and Redding.

We might be able to help you find alternatives as soon as the insurance carriers such as Blue Shield, Health Net and Kaiser release their new rates for Jan. 1, in either September or October.

Phil Lee

Lee Health Insurance Services (BLIS Corporation)

925-284-2000

http://www.health-insurance.com

www.linkedin.com/in/philwlee  

California Wants to Replace Your Health Plan with a Government-Run Single Payer Plan (SB 562)

The California State Senate is currently working on legislation to make a Single Payer System the only source of health care and health insurance in the state of California.  The Bill is named SB 562 and it will be reviewed by the Senate Health Committee on Wednesday, April 26, at 1:30 PM in the Capitol building in Sacramento in Room 4203.

SB 562 is very bad for you, your family and the future of the State of California for many reasons:

  • Single payer insurance will provide “one size fits all” insurance to all people living in California, including undocumented residents.  One plan will be offered to all Californians for cradle-to-grave health coverage.
  • All Private Health Insurance will be prohibited.
  • The plan benefits will be determined by an un-elected board of special interest appointees of the state government who will determine which benefits will be included and how much providers will be paid.  This will result in rationing health care and force doctors and hospitals to leave the state if they are not fairly compensated for their services.
  • There will be no Medicare for Californians 65 and older. Seniors and the disabled who currently have Medicare, Advantage plans, Supplement plans and Part D plans will be dis-enrolled and enrolled on to the single payer plan.
  • There will be no employer health insurance plans. Employers will no longer be able to attract the best employees in their fields because they cannot offer them benefits that are any better than the Single Payer plan.  If you work for a company that is located in many states, your employer will not be allowed to offer any plans in CA.
  • There will be no Federal or State employee health insurance plans.
  • There will be no union health insurance plans.
  • There will be no Medi-Cal or Medicaid.
  • All people living in California, whether legally or not, will have the same health plan.
  • Doctors and hospitals will be paid for their services by the State of California, who will need to create a monstrous bureaucracy to process and pay claims.  Fraud, abuse and waste are a given.  Other government-run health plans such as Medicare, Medicaid and the Veterans Administration regularly suffer scandals in billing, payments and sub-standard care.
  • State Senator Ricardo Lara, who is sponsoring SB 562, has not revealed how the state is going to pay for “free” health care for all.  Initial estimates are that the State of California would need an increase in current income tax of $350 billion for just the first year of the Single Payer plan. This amount equates to $9,200 for each man/woman/child in addition to what he or she is already paying in income tax.  A family of four would pay $37,000 more in income tax than they are currently paying.
  • Sick people, low-income people and the undocumented from across the country would flock to California.  Healthy taxpayers would flee California.  The result would be long lines to wait for sub-standard health care with costly procedures such as heart and kidney transplants and life-saving drugs rationed or not included at all in the Single Payer plan.
  • Senator Lara and his supporters have stated that California leads the rest of the country in innovative changes and now want to oppose Federal Government deliberations on changes to the health insurance market by being the first state to adopt the Single Payer system.  However, two other states, Colorado and Vermont, recently voted against Single Payer plans in their states due to the unrealistic tax burden it would put on its residents.

CALL TO ACTION:

If you object to losing your right to Medicare, losing your employer plan, being taxed an additional $9,200 per family member, losing your right to choose your doctor, your hospital and your insurance benefits, then please contact your State Senator to let him/her know.  Click on the link below to find your State Senator and his/her contact information.  Then click on the name to reach their website to communicate your message: http://findyourrep.legislature.ca.gov/

Just say No On SB 562 to preserve your choice in health care and to keep California from declining into certain economic ruin.  Thank you for taking the time to read this email.

Blue Shield of California Plans to Shut Down for 1 Week in September to Save on Payroll Due to Obamacare Losses

http://www.bizjournals.com/sanfrancisco/news/2016/08/11/exclusive-losses-blue-shield-california.html

As reported by the San Francisco Business Journal, Blue Shield of California will be closed from September 3 to September 12 while its employees take the week of Labor Day off. Although Blue Shield announced there will be some customer service staff working that week we assume the phone lines will be jammed for the entire week.

It appears that Individual, Small Group and Medicare departments are affected by the shutdown.
We do not yet know whether the Blue Shield member portal, broker portal or employer portal will be accessible and will reflect current information during the shutdown.
ALL APPLICATIONS FOR BLUE SHIELD PLANS SHOULD BE SUBMITTED AS SOON AS POSSIBLE SO THEY CAN BE PROCESSED WITH AN ID NUMBER ISSUED BY FRIDAY, SEPTEMBER 2. APPLICATIONS ARE CURRENTLY TAKING 10-14 DAYS TO BE PROCESSED.
This is an unprecedented announcement by an insurance company. We will do our best to provide service to our clients during this shutdown, but if Blue Shield is closed our ability to provide customer service will also be severely impacted.

(NOTE: This information relates only to Blue Shield of California, a taxpaying non-profit insurance carrier that operates only in California. Please do not confuse this company with Anthem Blue Cross, or any other Blue Cross or Blue Shield organization in states outside of CA.)

Phil Lee

Lee Health Insurance Services (BLIS Corporation)

www.health-insurance.com

925-284-2000

How One Pharmaceutical Company Priced Its Drug

I want to share with you the following WSJ article detailing how one major pharmaceutical company took advantage of the health care system to enrich itself, its shareholders and Wall Street with drug prices that produce “99% gross profit margins”.

I hope this will give you with some insight into the behind-the-scenes forces that are driving up health care costs.

How One Pharmaceutical Company Priced Its Drug

Phil Lee

Lee Health Insurance Services (BLIS Corporation)

www.health-insurance.com

925-284-2000

www.linkedin.com/in/philwlee   www.yelp.com/biz/lee-insurance-services-lafayette-7Affordable

 

Wall Street Journal 5/2/2016:

Valeant’s CEO Was Key Force on Pricing

Documents collected during a Senate investigation provide look at how Valeant arrived at sharp price increases

Michael Pearson, chief executive officer of Valeant, lobbied for aggressive price increases on acquired drugs in recent years. PHOTO: DREW ANGERER/BLOOMBERG NEWS

By  JACQUIE MCNISH and LIZ HOFFMAN

Updated May 2, 2016 10:33 a.m. ET

​In early 2015, when Valeant Pharmaceuticals International Inc.’s top brass met to set prices on a soon-to-be-acquired cardiac drug, some executives suggested slow, staggered price increases. Chief Executive Michael Pearson disagreed.

To reach Valeant’s internal profit targets, Mr. Pearson lobbied for a single, sharp increase. Hospitals could still make a profit at the higher price, he argued, which meant patients would still have access to the drug. The team deferred. The day it completed its February 2015 purchase of the drug, called Nitropress, Valeant tripled the cost.

The exchange, recounted in a document reviewed by The Wall Street Journal, shows in greater detail than was previously known how Valeant and its now-outgoing CEO Mr. Pearson pursued quick, aggressive price increases on acquired drugs in recent years—a strategy that sparked widespread backlash and landed Mr. Pearson in front of a Senate investigative panel last week.

A spokeswoman for Valeant, Laurie Little, said, “We heard very clearly the concerns raised by the Senate Special Committee on Aging, and the board is working to map out a new path for the company going forward. That will include consideration both of how best to set drug prices and of the appropriate role of patient assistance programs in helping to ensure that patients can obtain the drugs that doctors prescribe for them.”

At last week’s Senate committee hearing Mr. Pearson said Valeant was “too aggressive” with drug price increases.

Dozens of documents collected during the Senate investigation provide a deeper look at how Valeant arrived at sharp price hikes on some of the drugs it sells. The documents underscore the challenges Valeant faces now that it has promised to roll back some prices and rely less on acquisitions for which price increases are a major driver. That pivot has investors and analysts concerned about where Valeant’s profits will come from and how it will service the $30 billion in debt it carries.

Related Video

Valeant CEO Michael Pearson testified at a Senate hearing investigating drug pricing Wednesday that he and the company made mistakes and “Valeant was too aggressive.” Watch an excerpt of his testimony. Photo: AP

Concerns over the company’s reliance on price increases, its accounting and other business practices hammered Valeant stock, which has fallen more than 85% since its high last summer. Valeant has said it is comfortable with its liquidity.

William Ackman, a major Valeant shareholder and recently appointed director, told the Senate committee that he and other new directors have “stabilized” a company that has made “significant mistakes.” The company’s stock has gone up about 27% over the past month as the company filed a long-overdue annual report, hired a new CEO and reached an agreement with lenders to avoid a technical default.

Under Mr. Pearson, a former McKinsey & Co. consultant, Valeant earned a loyal following on Wall Street for its profitable strategy of buying existing drugs with price-increase potential rather than developing them in-house. “Bet on management, not on science,” he often said. While Valeant did have a research program, Mr. Pearson said that most of Valeant’s R&D products are reformulations of existing drugs, such as a new delivery method for a glaucoma medicine, according to the Senate documents.

Valeant’s pattern of price increases, including on Nitropress, was the subject of a page-one story by the Journal last year. That strategy drew criticism amid broader political scrutiny of pharmaceutical costs. The Senate panel last week—the third in a series of hearings on drug pricing—focused on four Valeant drugs in particular, including Nitropress and Isuprel, which Valeant acquired from Marathon Pharmaceuticals in February 2015.

The other two drugs, Cuprimine and Syprine, are used to treat Wilson’s disease, a rare ailment involving a buildup of copper in the body, and were acquired by Valeant in 2013. Months after it raised the price of the cardiac-care drugs in 2015, Valeant sharply raised its price tags on Cuprimine and Syprine.

The price of Cuprimine has risen 5,787% to $26,189 since 2013, with most of the increase occurring in the summer of 2015, according to an analysis prepared by Senate committee staff for the hearing. The cost of Syprine jumped 2,934% to $19,783 during the same period. A doctor testified at last week’s Senate hearing that a liver transplant, an alternative treatment for Wilson’s disease, is now cheaper than a lifetime of Valeant drugs.

The Senate analysis referred to wholesale acquisition costs that hospitals and other purchasers pay for drugs.

Although the four drugs made up only a fraction of Valeant’s $10.3 billion in 2015 sales, they ranked among Valeant’s 30 most profitable drugs as measured by net profit, Valeant Chief Financial Officer Robert Rosiello told the Senate committee last month in a written response to questions.

So valuable were Syprine and Cuprimine that when a senior Valeant official learned that Valeant’s customer-service group lacked a way to log inquiries from patients complaining about their rising costs, he wrote in an email that “for these…drugs we need to find a way asap.” He inquired about purchasing software to track their complaints. “These patients are too valuable to lose,” Laizer Kornwasser a former Valeant executive vice president, wrote, according to the Senate hearing documents.

Mr. Kornwasser didn’t immediately respond to requests for comment.

At the 2015 meeting on Nitropress, which was attended by Valeant’s then-finance chief,Howard Schiller, Mr. Kornwasser and other top executives, some of the executives recommended gradual price increases to avoid alienating core hospital buyers of the drug, the Senate documents show. Mr. Pearson argued it wasn’t an “exorbitant” price for a drug that saved lives and represented only a fraction of hospital costs, according to the documents.

Upon completing its purchase of the two drugs in February, Valeant sharply raised the price of both Isuprel and Nitropress.

A month later, when a Deloitte consultant studied further price-tag spikes on the two drugs, the consultant asked a senior Valeant executive in an email: “Are you ok with the above assumptions? They are leading to high gross margins (more than 99%).”

The Valeant executive replied in an email that the analysis “looks right, and I’m not surprised they are extremely profitable.”

 

 

Understanding Special Enrollment Period (SEP) and Qualifying Events (QE)

(This information concerns Individual & Family Health Plans. It does not concern you if you are either on a Medicare Health Plan or on an Employer-Sponsored Group Health Plan)

The year-end Open Enrollment Period for Individual Health Plans ended on January 31, 2016.  However, certain individuals may still be able to apply for a health plan in 2016. This special circumstance is called the Special Enrollment Period (SEP).  You need to have a Qualifying Event (QE) to qualify.  Here’s what you need to know.

You can buy health coverage outside of the open enrollment period when you have a qualifying life event—through a special enrollment period (SEP).  Most SEPs last 60 days from the date of the qualifying life event.
Qualifying life events for a SEP include:

  • Getting married or entering a domestic partnership
  • Child aging off a plan
  • Gaining a dependent or becoming a dependent through marriage, birth, adoption, or placement for adoption or foster care
  • Permanently moving to a new area that has different health plan options
  • Employer coverage not being considered minimum essential coverage
  • Losing other healthcare coverage that is considered minimum essential coverage, such as due to job loss, termination of employer health plan by the employer or expiration of COBRA coverage
  • Returning from active military service
  • Change in eligibility for advance premium tax credit or cost-sharing subsidies

Please note that voluntarily terminating other health coverage or being terminated for not paying premiums is not considered a qualifying event.

All insurance companies will require written proof that you have an acceptable qualifying event.  When enrolling during an SEP, please make sure to include qualifying events verification documents in the application.

This is a link to Blue Shield of California’s interpretation of the ACA laws regarding SEP and QE’s.  Different carriers may have slightly different interpretations and requirements.

https://bliscorp.egnyte.com/dl/QJhtXag1KT

Phil Lee

Lee Health Insurance Services (BLIS Corporation)

www.health-insurance.com

925-284-2000

www.linkedin.com/in/philwlee   www.yelp.com/biz/lee-insurance-services-lafayette-7Affordable

 

Premium Reimbursement is a Costly Violation

(This information relates only to Employer-Sponsored Group Health Plans.  It does not concern either Medicare Plans or Individual and Family Health Plans)

Re: Premium Reimbursement by Employers (outside of an ACA-Approved Group Health Plan) is a Costly Violation

Starting on July 1st, the IRS will begin assessing a penalty of $100 a day (per employee for each affected employee) to employers who continue to pay for employees’ individual health plans.  Please click below link to this article.

http://eba.benefitnews.com/news/regulation/premium-reimbursement-is-a-costly-violation-2746335-1.html?zkPrintable=true.

We would be happy to help your company find affordable solutions to comply with local and federal requirements regarding health insurance.

Phil Lee

Lee Health Insurance Services
800-286-7445

www.linkedIn.com/in/philwlee

www.Health-Insurance.com

Last Chance to Enroll into a Health Plan in 2015

(This information relates only to Individual and Family Health Plans, not Medicare or Group plans)

If you are uninsured and do not have a special Qualifying Event, Thursday April 30th is the last day that you may enroll into an Individual Health Plan using the Govt.’s special extension by claiming that you are unaware of the uninsured penalty.

If you apply by April 30th, you will receive a June 1st effective date. Otherwise, you will have to wait until the end of the year.
In order to apply for coverage during this extended enrollment period to a plan either On or Off the Covered California health exchange, most carriers require you to do so through a certified agent. Anthem Blue Cross further requires the application to be on paper through an agent.

At Lee Health Insurance Services we would be happy to serve as your agent. As always, there are no costs, no fees for our services. The premium rates you pay are the same approved and regulated rates whomever you get them from. If you qualify, you will receive the tax subsidies that you are eligible for based on your household income.
Phil Lee
Lee Health Insurance Services
800-286-7445
www.health-insurance.com

Extended Enrollment Deadlines for Individuals

(This information relates only to Individual and Family Health Plans, not Medicare or Group plans)

For those of you who are still uninsured or who just found out from doing your 2014 tax return that you have to pay a penalty, there is still time to enroll. If you are currently uninsured and can testify that you were not aware of the penalty, you may still enroll. However, there’s not much time left. The deadlines are:

April 15th, for a May 1st Effective Date.
April 30th for a June 1st Effective Date.

In order to apply for coverage during this extended enrollment period to a plan either On or Off the Covered California health exchange, you must do so through a certified agent or broker. We at Lee Health Insurance Services (800-286-7445) would be happy to serve as your agent. As always, there are no costs, no fees for our services. The premium rates you pay are the same approved and regulated rates whoever you get them from. If you qualify, you will receive the tax subsidies that you are eligible for based on your household income.

Covered California Application Problems

We are finding that many of you trying to enroll onto Covered California online got stuck or sent off to MediCal (Medicaid). E.g. if you happen to put an Employment End Date, you would likely be sent to MediCal.
We, at Lee Health Insurance Services, have figured out the “fixes” to these issues, and would be delighted to help you resolve them in order to secure coverage from Covered California.

Very sincerely,
Phil Lee
Philip W Lee MBA
Lee Health Insurance Services
Employee Benefits and Health Insurance
800-286-7445
www.Health-Insurance.com

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Lee Health Insurance Services | Healthcare Insurance Agency, Individual Health Insurance, Family Health Plans, Group Medical Insurance, Small Business Health Insurance, Whole & Term Life Insurance, Dental Insurance, Health Care Reform Assistance, Covered California Insurance Exchange Plans, Medicare Supplement Insurance, Medicare Advantage, Medigap Plans, Anthem Blue Cross, Kaiser Permanente, Blue Shield of CA, Health Net, Cigna, Aetna, Contra Costa County CA, Pleasant Hill, Danville, Concord, Berkeley, Martinez, Albany, Oakland, San Ramon, Alameda, Santa Clara, Campbell, Milpitas, Cupertino, Sunnyvale, Saratoga, Fremont, Palo Alto, Newark | 935 Moraga Road, Suite 240, Lafayette CA 94549 (925) 284-2000 or Toll-Free, (800) 286-7445