Covered California instructed health insurance companies to submit their rates assuming direct payment to fund the CSR subsidies would be continued, but to also submit a separate CSR surcharge to “load” any costs to fund this program onto Silver-tier plans for those who receive subsidies. As a result, Silver-tier consumers may see an additional “CSR surcharge” that averages 12.4 percent — ranging from 8 percent to 27 percent on the gross price of their premiums
Health Net To Drop Walgreens From Pharmacy Network
Members who have used a Walgreens pharmacy at any time in the past 12 months will receive a letter about the change 60 days in advance of the end of the year if they have an individual and family plan. Group members will receive the letter 60 days in advance of their employer’s renewal date. The first letters mail late July to members of groups renewing October 1.
Blue Cross Extends Precertification To Specialty Drugs
As part of our ongoing efforts to manage these drug costs, we are expanding our precertification program to include medical specialty edits. The expansion of our precertification program will allow clients who currently have our precertification program to benefit from these enhancements. There are two components to this expansion:
Blue Cross Out-of-Network Cost Protection
If you receive services from an In-Network Facility at which, or as a result of which, you receive non –Emergency Covered Services provided by an Out-of-Network Provider, you will pay no more than the same cost sharing that you would pay for those same non-Emergency Covered Services received from an In-Network Provider, and you will not owe the Out-of-Network Provider more than the In-Network cost sharing for such non-Emergency Covered Services.
Canopy Health Joins Western Health Advantage Provider Network
Northern California–Bay Area employers will have an opportunity to receive outstanding healthcare at an affordable cost, thanks to a new agreement between Canopy Health and Western Health Advantage. HMO benefit plans for employer group health coverage from Western Health Advantage (WHA) will offer access to the Canopy Health alliance of providers and hospitals effective January 1, 2018, subject to regulatory approval.
When Is Medicare Primary Or Secondary Payer of Health Care Costs?
Medicare can be the secondary payer in situations where they don’t provide the primary health insurance coverage or when another insurer may have the primary responsibility for covering the claim. However, even when Medicare is the secondary payer, they still may not cover all of the remaining health care costs associated with the claim.
California Insurance Commissioner Urges VA To Stop Transgender Discrimination
The California Department of Insurance also conducted the first government-sponsored economic impact assessment in the United States related to transgender health insurance coverage. The assessment concluded removal of the discriminatory exclusions would have an insignificant and immaterial impact on premiums and that the benefits for transgender Californians were significant.
New Doctor House Call With Anthem Blue Cross Small Group Plans
Members can make an appointment with a licensed doctor to come to their home or office in two hours or on their schedule. Hours of availability are from 8 a.m. to 8 p.m., seven days a week, including holidays.
Blue Shield Unexpected Out of Network Medical Billing Protection
When individuals go to an in-network facility for care but receive services from an out-of-network doctor or healthcare provider, they only have to pay their in-network cost-sharing amount that counts toward the annual deductible and annual out-of-pocket maximum limits according to their health plan.
UC Davis Set to Drop Out Of Western Health Advantage Provider Network
UC Davis Health made this unilateral decision due to today’s challenging and uncertain healthcare climate. They determined the high cost structure of their academic medical center is no longer compatible with a regional HMO like WHA, whose business strategy is to be a market leader in affordability.
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