Author Archives: jtdickerson

HHS issues 2019 Notice of Benefit and Payment Parameters

11 Apr , 2018,
jtdickerson
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On Monday, April 9, 2018, the Department of Health and Human Services issued final regulations for Plan Year 2019!

Why is this important? Every year, changes to parameters that govern health insurance issuers are updated as required by the Affordable Care Act – HHS is in charge of updating and implementing these parameters.

Below is some of the notable changes for 2019:

2019 out-of-pocket (OOP) maximums:
The 2019 OOP maximums increase to $7,900 for individual coverage and $15,800 for family coverage. These coverage limits apply to all non-grandfathered plans, regardless of size or funding type.

Marketplace regulations 
The final rule also includes a number of provisions (effective Jan. 1, 2019) intended to strengthen the Health Insurance Marketplace, including:

  • Deferring the network adequacy reviews for qualified health plan (QHP) certification to the states
  • Loosening the audit process for agents, brokers and issuers who participate in the direct enrollment process
  • Updating the risk adjustment model for insurers with high-cost enrollees
  • Modifying the requirements for Marketplaces to verify eligibility for, and enrollment in, qualifying employer-sponsored coverage
  • Not specifying 2019 standardized plan options (known as simple choice plans)
  • Updating special enrollment period (SEP) rules for coverage effective dates specific to SEPs that allow adding or changing dependents
  • Adding a new SEP for pregnant women who were receiving coverage through the Children’s Health Insurance Program (CHIP) but lose that access
  • Allowing Marketplaces to determine individual affordability exemptions based on affordability of the lowest-cost metal level plan available
  • Allowing enrollees to request same-day termination of coverage
  • Removing several Small Business Health Options Program (SHOP) requirements for online enrollment
  • Other market reforms
    In addition to Marketplace updates, the final rules also modify other ACA provisions, including:

Streamlining the rate review process for states and issuers, including when rates are posted by the states, increasing the threshold at which rate increases require review from 10% to 15%, and establishing a process for states to request a higher threshold
Modifying the Medical Loss Ratio (MLR) rules, including simplifying quality improvement activity reporting requirements for issuers and establishing a process for states to use to request adjustments to the 80% MLR standard in the individual market

BlueChoice Blue Option South Carolina 2018 Pharmacy Benefits!

28 Nov , 2017,
jtdickerson
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Blue Option plans by BlueChoice Healthplan provide members with a wide array of plans with multiple pharmacy options. Most Blue Option members will NOT have a separate pharmacy deductible for 2018. BlueChoice is building members’ pharmacy charges into the deductible or applying them to the maximum out-of-pocket expenses, depending on the plan selection. One plan (Silver 4002) does include a separate pharmacy deductible for 2018!

Pharmacy benefits – Tiers
For 2018 Blue Option members will continue to have six-tier copayment/coinsurance levels for their prescription drugs. This approach provides more flexibility in managing high-cost and specialty medications, regardless of whether a drug is generic or a brand. BlueChoice has taken steps to ensure members have all classes of drugs covered and spread across six tiers for better affordability. You can review the BlueChoice  Covered Drug List online to see on which tier a specific drug is located.

 

Have Questions? Call us today at 843-882-7062 for more information about Blue Option plans available outside the marketplace!

 

2018 Adjustments to age ratings

20 Oct , 2017,
jtdickerson
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2018 Age-Rating Adjustment for Individual & Group Health Insurance Plans
For 2018 BlueEssentials and Business BlueEssentials plans, Blue Cross Blue Shield of South Carolina will be implementing an age-rating adjustment as a result of the 2018 Notice of Benefit and Payment Parameters Final Rule, which was passed by the Centers for Medicare and Medicaid Services (CMS).

What’s is Changing for 2018?

Prior to this ruling, CMS required a single age band be applied to the rate for members from birth through age 20. Under the 2018 CMS final rule, beginning on Jan. 1, 2018:
One age-rating band will apply to members from birth through age 14.

Separate, one-year age bands will apply to members ages 15 through 20.

The purpose of this change is to provide a more gradual transition from a child to an adult age rating.

Questions? Feel free to call us directly at 843-882-7062. Or CLICK HERE to shop and enroll in health plans!

 

2018 Open Enrollment for Employers: Checklist

28 Sep , 2017,
jtdickerson
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Currently, the Affordable Care Act is still the law of the land (pending action this week by Congress, of course). As such, we wanted to pass along this handy checklist for employers provided by our carrier partner, CIGNA. This is a very informative checklist of things ALL employer sponsored health plans must abide by in order to remain a Qualified Health Plan under the Affordable Care Act.

 

Link to Checklist: open-enrollment-checklist-2018

 

 

Changes to ACA: Employers affordability contributions for 2018.

27 Sep , 2017,
jtdickerson
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For 2018, the IRS announced a small adjustment to affordability parameters for employer sponsored plans. This may make it easier for SC residents to qualify for a tax credit to help pay for health insurance through the marketplace!

Have questions? Reach out to us anytime!

Earlier this year, the Internal Revenue Service (IRS) issued Revenue Procedure 2017-36 to change the contribution percentages in 2018 that determine the affordability of employer-sponsored minimum essential coverage for plans under the Affordable Care Act (ACA). For 2018, the numbers indicate a slight decrease from 2017 requirements.
For plan years beginning in 2018, employer-sponsored coverage will be considered affordable if the employee’s required contribution for self-only coverage does not exceed:

  • 9.56 percent of the employee’s household income for the year — for the purpose of both the employer shared responsibility penalty and premium tax credit eligibility rules (a decrease from 9.69 percent in 2017)
  • 8.05 percent of the employee’s household income for the year — for the purpose of exemption from the individual mandate (a decrease from 8.16 percent in 2017)

These updated percentages are effective for taxable years and plan years beginning after Dec. 31, 2017.

Additional information can be found at www.IRS.gov

BlueCross BlueShield SC: Vaccine network update

26 Sep , 2017,
jtdickerson
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Seasonal Flu Vaccines: ACA Plan Holders
BlueEssentialsSM and Business BlueEssentialsSMmembers can get seasonal flu vaccines covered at a $0 copay. This flu season, the vaccine network for ACA members is limited to CVS pharmacies only; therefore, the $0 copay is only available at CVS under their pharmacy benefits. Members may be required to pay administration fees if they receive a vaccine at any other network pharmacy. [CVS is a division of CVS Health, an independent company that provides pharmacy benefit services on behalf of our health plans.] Members can receive the flu vaccine at their primary care physician (PCP) office at $0 copay under the medical benefit, if the visit is solely for the purpose of receiving the vaccine.

The vaccines covered under the program this year are:

  • Injectable Seasonal Influenza Vaccine
  • Injectable Seasonal Influenza Vaccine-High Dose (Fluzone)

Non-Seasonal Vaccines: ACA Plan Holders
In addition to seasonal flu vaccines, ACA members also can use the vaccine network (CVS-only) to receive some non-seasonal, preventive care vaccines at a $0 copay under their pharmacy benefit, and these vaccines also may be available at the member’s PCP office:

Graham – Cassidy Health Reform Bill Update.

21 Sep , 2017,
jtdickerson
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Currently, the United States Senate is considering a Health Care Reform Bill devised by South Carolina Senator Lindsay Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), Ron Johnson (R-WI) and former U.S. Senator Rick Santorum (R-PA).

Kaiser Family Foundation has a very good summary of the bill available by CLICKING HERE or at the link below:

http://files.kff.org/attachment/Summary-of-Graham-Cassidy-Heller-Johnson-Amendment

 

There are a number of measures for market stabilization for 2018 – 2020, that could be very helpful. However, we have reviewed other elements of the bill that could have severe negative consequences for South Carolina residents, which we will outline below. It is important to keep in mind that the U.S. Senate is attempting to pass this bill via simple majority, which is only possible until September 30, 2017.

Positive parts of the bill include premium ratio flexibility and near term market stabilization funds.

HOWEVER, we have noticed a few “lesser talked about” points that could have SEVERE consequences for South Carolina residents:

 

Something to point out that will likely hurt many older and lower income SC residents:

Text of the bill:

For 2018-2019, ACA premium tax credit formula and eligibility standards are unchanged, except:

– For end of year reconciliation of advance credits, the cap on repayment of excess advance payments does not apply.

Let’s look at someone age 63, who worked hard their entire life, saved for retirement, and retired at age 63, but still works part time to help pay the bills and get out of the house. I see these folks every day at the grocery store, etc.

Someone age 63 working as a part time cashier making $15k/year, currently gets an $817/mo. tax credit to help afford health insurance (remember, they’re working part time, so employer doesn’t offer a group plan to them). Lets say that person gets laid off of the job in September and cannot find new employment. NOW, due to circumstances beyond that persons control, they fall below the tax credit eligibility threshold for the year (currently ~$11,880) so must pay the full premium for the remaining months ($785/mo for the cheapest bronze plan – $841/mo for cheapest Silver plan in Charleston County SC) AND repay the tax credit they were previously receiving – an extra $7,353 owed immediately to the IRS when they file taxes the following year, due to NO fault of their own.

Currently, the ACA provides clawback protections that limit the repayment amount to something reasonable in these situations.

Some may say “but health insurance was cheaper be fore ACA/Obamacare”, keep in mind, prior to the ACA we had 5:1 age banding – most people age 60 – 65 were paying ~$1200/month for a policy IF they could purchase one at all due to pre-existing condition limitations. And if they had a Pre-Existing condition, the South Carolina High Risk pool is EVEN MORE EXPENSIVE – to the tune of $1900 – $2400/month at age 60-65. Don’t believe me? You can view South Carolina High Risk pool rates by CLICKING HERE.

The ACA/Obamacare certainly isn’t perfect, but we would be better off FIXING ACA issues rather than passing bad legislation like this……

 

 

SChealthconnector in the Post and Courier today!

2 Aug , 2017,
jtdickerson
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Great article by Lauren Sausser of the Charleston Post & Courier today! CLICK HERE to read the article. Spoiler:

If Congress fails to extend the discounts which significantly lower the amount of money Obamacare customers spend on their health care, Affordable Care Act premiums in South Carolina may jump by more than 33 percent next year, new federal data shows.

 

Link: http://www.postandcourier.com/features/your_health/bluecross-blueshield-of-south-carolina-proposes-dramatic-rate-increase-for/article_e29a6ffa-779e-11e7-89c6-eb4b03a2fa46.html

Senate fails to pass “Skinny” ACA Repeal in early morning vote.

28 Jul , 2017,
jtdickerson
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As reported by The Hill this morning, we have learned that a late Thursday night / early Friday morning vote in the Senate to pass a “Skinny” ACA repeal bill has failed, by a vote of 49-51. Multiple sources are reporting this as a final blow to GOP efforts to repeal the Affordable Care Act. We hope Congress will now work to make changes needed to sustain the individual health insurance markets for South Carolina (and all other states, too!). Stay tuned to www.SChealthconnector.org for more breaking Health Insurance News!

BlueCross BlueShield release framework for market stability

24 May , 2017,
jtdickerson
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As reported by multiple news sources, the BlueCross BlueShield Association recently released a framework for market stability. This press release was in response to the White House seeking a 90 day delay in the House vs. Price lawsuit. The House vs. Price lawsuit appears to be a central issue for insurers planning to participate in the Health Insurance Marketplace for 2018, as this lawsuit may determine the fate of $7 billion in Federal funding for Cost Sharing Reductions (CSRs) – money used to reduce co-pays, deductibles and out-of-pocket amounts for Americans that fall within certain income parameters. As insurance carriers scramble to file rates for 2018, the availability of CSR funding may be a linchpin for actuaries responsible for determining how much insurers will charge for coverage, or whether some insurers will participate at all in the individual health insurance marketplaces. Below are the key points released by the BlueCross Blueshield Association:

-Continued protections for people with pre-existing medical conditions and sustained federal funding to offset the cost of care for the sickest patients.

-More leeway for states to experiment with health insurance benefits, with a basic floor of federal standards.

-Preserving ACA consumer safeguards including no lifetime caps on benefits, no higher premium for women based on gender, and a requirement that insurers spend a minimum of 80 cents of every premium dollar on medical care.

-Penalties such as waiting periods for people who fail to maintain their coverage. Republicans want to repeal the Obama-era tax penalties on uninsured people deemed able to afford coverage.

-Significant federal funding to subsidize premiums and out-of-pocket costs.