We are notifying the members in the following closed plans that their prescription drug coverage will be considered non-creditable in 2017, which is a change from 2016, when their prescription drug coverage was considered creditable. This means that the coverage offered by their plan is not expected to pay out as much as standard Medicare prescription drug coverage pays.
Anthem Blue Cross Makes Changes to Acupuncture Review and Claims Process
Starting October 1, 2016, American Specialty Health (ASH) will process all acupuncture claims, in and out of the network, for our California fully insured large and small group PPO (Preferred Provider Organization) plans. ASH also will review claims for acupuncture care to make sure the services members get are medically necessary.
Continuity of Care Form Sutter Health Plans
A new member who is currently receiving treatment, or an existing member whose physician is leaving or left the Sutter Health Plus network, may request to temporarily remain with their current treating physician for certain medical conditions.
2017 Small Group Rate Changes and Expansion from Covered California
Covered California announced today the rates and expansion plans for its small group health insurance exchange, Covered California for Small Business. The statewide weighted average rate increase is 5.9 percent, for employers and their employees beginning Jan. 1, 2017, which is down from the 7.2 percent increase in 2016.
Gaining employer-sponsored health insurance and Covered California
The Center for Medicare & Medicaid Services (CMS) has released a review of the rules regarding when a family becomes ineligible for the Covered California subsidy after being offered employer-sponsored health insurance. While the presentation is geared toward health insurance agents, there is good information relevant to everyone in the file. As CMS notes, gaining employer-sponsored health insurance while enrolled in Covered California is a Common Complex Situation.
2017 Covered California Regional Rate and Plan Information
Covered California has released their 2017 Regional Rate and Plan Information summary. This summary has a more in-depth focus specific consumer market information than does their 2017 Health Plan Booklet. While the target audience is Certified Application Counselors and Agents, there is also some very useful information for consumers.
Covered California health and dental plan changes for 2017
Covered California hosted a webinar where they went over the numerous changes to the health plans for 2017. This included the expansion of some health plans into more counties, the conversion of PPO plans to EPO for one carrier, and the addition of a HMO plan for another carrier. They also reviewed the minor and major cost sharing changes to their metal tier level plans offered by all the carriers.
IRS.gov and Social Media Resources Help Individual Taxpayers Understand ACA
The IRS knows that you want to understand how the health care law may affect you when filing your taxes next year. When questions come up, IRS.gov/aca is a great place for you to begin finding the answers you need – when you need them.
Covered California Primary Care Physician Assignment Guide
Covered California has released their Primary Care Physician Assignment Quick Guide to inform agents about how health plans will be assigning a Primary Care Physician to members of PPO and EPO plans in 2017. The Primary Care Physician assignment will not apply to small employer group with Covered California health plans.
Eligible for Medicare, lose Covered California birthday letter
Beginning in August, 2016, Covered California will send a notice to those consumers approaching or are over their 65th birthday who may be eligible for Medicare. The notice advises them that they may no longer be eligible for Advanced Premium Tax Credit or Covered California coverage. If the consumer receives the notice, it will be displayed in the online application (CalHEERS).
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