Individual grandfathered members enrolled in Anthem Blue Cross Life & Health Insurance Company (CDI regulated) policies at least one day in September of 2016 will be receiving a refund as a result of funds left over from a 2013 settlement of a class action lawsuit (Kreuzhage v. Anthem). This includes the majority of the grandfathered members. Members on Affordable Care Act (ACA) On and Off Exchange plans, and grandfathered members on Anthem Blue Cross (DMHC regulated) plans are not included.
Blue Shield of California and Sutter Health Have Signed a New 2017 Agreement
We are pleased to announce that Blue Shield and Sutter Health have signed a new 3-year agreement effective January 1, 2017. This means that Sutter Health hospitals and providers are part of Blue Shield’s statewide network.
Covered California Calculates Incorrect 2017 Monthly Subsidy for Consumers
During the 2017 renewal process the incorrect Advanced Premium Tax Credit (APTC) amount was sent to the health plan for some consumers. The eligibility determination and notice the consumer received from Covered California displayed the correct APTC amount. However, because the incorrect APTC was sent to the health plans, they invoiced the consumers with overstated APTC and understated premiums owed.
Covered California Extends Enrollment Deadline to December 17th for January 1, 2017 Start Date
Consumers now have until midnight on Dec. 17 to sign up for health care coverage that will begin on Jan. 1, 2017, Covered California announced.
Blue Shield and Health Net Alert Agents to Potential Loss of Sutter Hospitals and Doctors
Blue Shield of California and Health Net are two of the health plans that are currently in negotiations with Sutter Health regarding contracted in-network doctors and hospitals for 2017. Both health insurance companies are alerting agents to the potential that Sutter hospitals and doctors may not be covered in many of their health plans in 2017 if they don’t come to an agreement soon.
Oscar Health Plan Information for 2017
Oscar is expanding their health plan availability into San Francisco County for 2017. They will continue to serve part of Los Angeles and all of Orange counties. They have notified members enrolled in some of their 2016 off-exchange plans that they will no longer be offered. The Simple Silver, Simple Gold, Simple Platinum, and Simple+ Platinum will not be offered in 2017. Individuals and families in these health plans must select a new health plan no later than December 31, with Oscar to maintain coverage.
Owners of sober living facilities arrested for health insurance fraud
California Department of Insurance detectives, assisted by multiple law enforcement agencies, arrested Chris Bathum and Kirsten Wallace on multiple felony counts of grand theft, and identity theft for allegedly conspiring to defraud patients and insurers out of more than $176 million through an elaborate conspiracy. Simultaneously, search warrants were also executed at 15 locations throughout Los Angeles and Orange County.
Kaiser Releases 2017 Individual and Family Health Plan Information
Kaiser Permanente has released information pertaining to their individual and family health plans for 2017. Most of Kaiser’s health plans are available through Covered California and are eligible for the monthly tax credit subsidy. These standard benefit designs are also offered off-exchange, in addition to several non-standard benefit design plans only offered direct through Kaiser.
Department of Insurance Receives Health Plan Compliance Grant
The Centers for Medicare and Medicaid Services at the U.S. Department of Health & Human Services announced today it awarded a $1.84 million grant to the California Department of Insurance to enhance enforcement of key market reforms under the Affordable Care Act.
Beware of deceptive sales practices during Medicare’s enrollment
The California Department of Insurance is alerting seniors and their advocates to be on their guard against improper sales practices during the annual open enrollment period for Medicare Advantage plans (Part C) and the Medicare Prescription Drug (Part D) Program.