In the absence of a federal commitment to continue funding cost-sharing reduction (CSR) reimbursements through the upcoming year, Covered California health insurance companies will add a surcharge to Silver-tier products in 2018. However, because the surcharge will only be applied to Silver-tier plans, nearly four out of five consumers will see their premiums stay the same or decrease, since the amount of financial help they receive will also rise. Those who do not get financial help will not have to pay a surcharge.
As you may be aware, Cigna Individual and Family Plans has notified California regulators that Cigna Health and Life Insurance Company will not offer or renew Cigna LocalPlusIN (EPO), California LocalPlus (PPO), or California LocalPlusIN (EPO) medical plans in California in 2018.
The California Court of Appeal has rejected health insurers’ lawsuit against Insurance Commissioner Dave Jones challenging regulations he issued to protect consumers from unlawful cancellations of their health insurance. The Association of California Life and Health Insurers (ACLHIC) sued Commissioner Jones to invalidate his regulations that protect consumers from having their insurance unfairly terminated, claiming the commissioner lacked the authority to adopt them and that they were inconsistent with statute.
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.
For 2017, Anthem Blue Cross will offer a new Silver Pathway HMO 2650 plan for Individual business. This plan meets Affordable Care Act (ACA) rules and will be sold off the exchange only. We also will expand our Pathway HMO network in Los Angeles County for members who buy plans on or off the exchange.
On or about August 17, 2016, a departing CalOptima employee downloaded data, which included protected health information, to an unencrypted USB flash drive. Shortly after, the departing employee returned the USB flash drive to CalOptima. While we are still investigating the contents of the flash drive, we do not believe the information was shared.