The new billing system addresses many issues and complaints that have frustrated both consumers and Blue Shield for several years. The grandfathered members were moved to the new billing system in 2017. Beginning in February, Blue Shield will begin to notify off-exchange members in individual and family plans of the change. On March 10th and 11th Blue Shield will begin to transition the off-exchange members into the new billing system off-exchange.
Meeting work and community engagement requirements should take into consideration areas of high unemployment or caregiving for young children or elderly family members. States will therefore be required to describe strategies to assist eligible individuals in meeting work and community engagement requirements and to link individuals to additional resources for job training, provided they do not use federal Medicaid funding to finance these services.
The proposed rule, which applies only to employer-sponsored health insurance, would allow employers to join together as a single group to purchase insurance in the large group market. These improvements stand to open health insurance coverage for millions of Americans and their families by making it more affordable for thousands of small businesses and sole proprietors. By joining together, employers may reduce administrative costs through economies of scale, strengthen their bargaining position to obtain more favorable deals, enhance their ability to self-insure, and offer a wider array of insurance options.
The penalty also remains in effect for 2018 coverage. The only change is the tax penalty will no longer be in effect beginning in 2019.
Insurers, self-insuring employers, other coverage providers, and applicable large employers now have until March 2, 2018, to provide Forms 1095-B or 1095-C to individuals, which is a 30-day extension from the original due date of Jan. 31.
he plan selection deadline for a January 1, 2018 coverage start date has been extended to Friday, December 22 to accommodate increased interest in enrollment for the new year.
With the exit of Anthem Blue Cross in many regions of California, Blue Shield is working to make the transition for consumers who have enrolled in one of their health plans. They have released a bulletin about continuing care under a former health plan and transferring prescriptions to the new Blue Shield health plan.
The California Department of Managed Health Care (DMHC) has taken enforcement actions including a $322,500 fine against California Physicians’ Service (Blue Shield of California) and a $135,000 fine against Care 1st Health Plan for failing to identify, timely process, and resolve consumer grievances. The plans have also failed to fully and timely provide information to the Department during the investigation of these consumer complaints.
In addition, your out-of-pocket expenses will be counted separately for covered services received from network providers and non-network providers. Any expenses you pay to see a network doctor will be counted toward your network out-of-pocket maximum, and expenses you pay to see a non-network doctor will be counted toward your non-network out-of-pocket maximum.
All of the health plans Oscar offers through Covered California will be mirrored off-exchange. The off-exchange mirrored plans are called the Classic series and include the Bronze, Silver, Gold, Platinum, and Minimum Coverage standard health plan design.