Blue Shield Plans and Broker Bonus, Health Net Enhanced Rate Cap Program, COVID-19 Coverage, Updates, News & More
Thursday, May 11 2023
Blue Shield is adding the Access+full HMO Network, Bronze Trio, and their most popular HSA plans to the CCSB portfolio
Effective 7/1/2023 Blue Shield is adding the Access + full HMO Network, Bronze Trio, and their two most popular HSA plans to the CCSB portfolio. Also, we have a FABULOUS broker bonus running from 7/1/23 effective dates, through 1/1/24 with some very nice incentive to sell multiple groups with CCSB. The Access + Full Network will plug the hole of the areas where some medical groups were not included in the Trio Network The Bronze Trio Plan is good for contribution strategy for employers who want to offer coverage, but might not have the budget to fund Silver or Gold HMO plans, so employees can buy up from the Bronze With the addition of BSC HSA plans, there is a solution for those who may have been on the Health Net plans, or for people who are strong supporters of banking HSA money Be sure to check out the Broker Bonus Flyer – our best bonus YET. Sell 3 groups, with 4+ subscribers and get $ 1,000 per group (or more depending on group size). Sell 6 groups, same requirements, and add 50% to the bonus. Great message to your brokers and a good way to get into some folks who may not have sold CCSB in the past. Great reward for those who already sell CCSB
It's a great time to sell Health Net with their new enhanced program , let us help you with your Health Net large group needs. Qualified new groups can take advantage of a second-year rate cap* on all Enhanced Choice plans for effective dates 1/1/2023 through 2/29/2024. The rate cap options are as follows: 8.5% if selected plans are limited to SmartCare, Salud HMO y Más, PPO/HDHP HSA-Compatible Plans, ExcelCare (HMO/EOA) or CanopyCare HMO “active” enrollment. 10.5% for our Enhanced Choice PPO-Only package to a maximum of three plans. 9.5% for the standard Enhance Choice portfolio of up to six plans and pegging employer contributions at SmartCare/ Salud HMO y Más or CanopyCare “active” enrollment. We continue to work to ensure access to quality and affordable health coverage for the communities we serve. As always, Health Net is here for you. If you have questions or need assistance, please contact your Health Net Sales Executive. *Rate cap eligibility is determined on a case-by-case basis. For qualifications and other important details, terms and conditions, refer to the New Business Rate Cap Agreement document, available from your Health Net Sales Executive. Contact your Dickerson Sales Rep for help quoting Health Net!
As a reminder, the federal COVID-19 public health emergency is ending on May 11, 2023. In California, COVID-19 vaccines, testing, and treatment (therapeutics) will continue to be provided and covered at $0 cost-share, in compliance with California law for fully insured health plans. We'll share more details on how coverage may change as they become available. CAA RxDC reporting terminated group outreach In March, we contacted current customers and brokers to request group specific information required for Kaiser Permanente to complete aggregated reports for pharmacy reporting under the Consolidated Appropriations Act (CAA), 2021. To help ensure compliance with the reporting requirements, groups were required to provide specific information via our form by April 3, 2023. We set the April 3 deadline to allow us to identify and remediate any issues with this complex process before the Centers for Medicare & Medicaid Services’ (CMS) June 1, 2023 due date. In working with the data submitted by April 3, we found that our original outreach inadvertently omitted groups that terminated their coverage with Kaiser Permanente prior to the original outreach. We will be sending emails directly to the identified groups requesting they submit the needed information for their company by 5 p.m. PT on May 18, 2023. To remain on track to meet the CMS submission deadline, Kaiser Permanente is only accepting data from the cohort previously omitted.
On March 30, 2023, the United States District Court for the Northern District of Texas issued an order in Braidwood Management Inc. v. Becerra (“Braidwood”), vacating any and all actions taken by the DOL and other federal agencies (in the past and in the future) to implement or enforce provisions of the ACA that require group health plans and health insurance issuers (“plans and issuers”) to cover certain preventive care services with a rating of “A” or “B” by the United States Preventive Services Task Force (“USPSTF”) without cost sharing. The court found that Congress’ delegation of authority to the USPSTF under the ACA violates the Appointments Clause of Article II of the U.S. Constitution. The Braidwood decision does not impact coverage of preventive care services recommended by the Health Resources and Services Administration (“HRSA”) for infants, children, adolescents or women, or immunizations for routine use in adults, adolescents or children recommended by the Advisory Committee on Immunization Practices (“ACIP”), which are also required to be covered without cost sharing. In response, on April 13, 2023, the DOL and other federal agencies released FAQs that provide guidance regarding how the agencies are interpreting the decision. The FAQs strongly encourage plans and issuers to continue covering preventive services with an “A” or “B” rating by the USPSTF despite the Braidwood decision. The guidance is summarized in the full alert.
Blue Shield of California appoints Krishna Ramachandran as senior vice president of Health Transformation and Provider Adoption
OAKLAND, Calif. (May 1, 2023) – Blue Shield of California today announced Krishna Ramachandran as senior vice president of Health Transformation and Provider Adoption to lead the nonprofit health plan’s bold strategy to reimagine health care. In this role, Ramachandran is responsible for leading partnerships and innovations to improve healthcare quality for members, bring tools and support that benefit providers, and promote health equity and healthier communities throughout California. “At Blue Shield of California, our goal is to come together with a diverse group of providers to improve the quality of patient care for our members while lowering healthcare costs to ensure that all Californians have access to the care they deserve,” said Peter Long, executive vice president of Strategy and Health Solutions at Blue Shield. “Krishna’s experience, talent and leadership will help us make that a reality for our members and communities throughout the state.” Ramachandran brings more than 20 years of experience to Blue Shield, offering unique leadership experience in technology, provider, and health plan organizations. Most recently, Ramachandran served as regional senior vice president of Illinois Health Care Delivery at Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma and Texas. Previously, he began his healthcare career at Epic Systems before moving to Duly Health and Care. He is also a lecturer and scientific advisor at the University of Chicago. "California is a big, beautiful state rich with diverse people, geography, and cutting-edge technology,” said Ramachandran. “It is thrilling for me to step into this role and continue the trailblazing work Blue Shield of California has started to support healthcare providers and transform the system to make it worthy of family and friends and sustainably affordable.” Ramachandran earned a Bachelor of Engineering degree in Electronics and Instrumentation Engineering at the Birla Institute of Technology and Science at Pilani, India, a Master of Science in Electrical and Computer Engineering at the University of Illinois in Chicago, and an Executive MBA at Northwestern University’s Kellogg School of Management. Read the release here
May is Mental Health Awareness month and it’s never been so critical to focus on employee mental wellbeing. Employees are struggling and they’re looking to their employers for help. While employers have always cared for their employees in this area, they’re getting more intentional about how to best support them. And while mental health challenges continue to rise, the good news is that people are increasingly interested in recognizing, talking about and taking steps to improve their mental health. Our upcoming webinar: The Mindful Workplace: Addressing Employees’ Mental Health , is chock-full of tips, strategies and resources to help address mental health concerns in the workplace. Our experts will also introduce Alera Group’s 2023 Mental Health Awareness Toolkit , brimming with new tools and templates to make it easier to engage your employees in their mental health. You won’t want to miss this webinar on May 18. Register now !
Starting in April DHCS will be sending letters to those who no longer qualify for Medi-Cal. LA Care weighs in with their expertise, what you can be doing right now, and clarifies on previous announcements made by the DHCS and Covered CA. Affected members will be transitioned to the lowest cost silver plan on Covered CA.You can get in front of these transitioning members and become their agent of record during the switch. Starting in April DHCS will be sending letters to those who no longer qualify for Medi-Cal. When you attend this webinar, you'll learn what steps are being taken to notify these members, and what you can do to help them. You'll also learn more about: PCAP – New Enroller Portal Updates Covered California’s SB260 Auto Plan Selection, and LA Care's clarification on the process and the member's responsibility. Department of Health Care Services’ Medi-Cal Continuous Coverage Requirement and more! Click here to register.
Alera Group's quarterly compliance roundup will help you stay current on the latest regulatory developments impacting employee benefits from coast to coast. Don't miss this ongoing opportunity to ensure you comply with current regulations and are prepared for what's ahead. Click here to register.
April 25, 2023 – Earlier today, the Self-Insurance Protection Act (SIPA), H.R. 2813, was re-introduced in the U.S. House of Representatives by Rep. Bob Good (R-VA), chair of the Education & Workforce Health Subcommittee. The Subcommittee will be holding a legislative hearing examining H.R. 2813, in addition to several other healthcare-related items, on Wednesday, April 26th. Initially drafted by the Self-Insurance Institute of America, Inc. (SIIA) nearly a decade ago, the Self-Insurance Protection Act clarifies existing law to preserve choice when it comes to offering self-funded health benefits to workers, and to ensure that self-insured group health plans can access stop-loss insurance to protect against catastrophic risk. Nationwide, nearly 60% of consumers receiving health benefit coverage through private-sector plans are covered under a self-insured group health plan. Blue Shield is adding the Access + full HMO Network, Bronze Trio, and their two most popular HSA plans to the CCSB portfolio. The legislation would also pre-empt State laws that prevent self-insured group health plans from “insuring against the risk of excess or unexpected health plan claims losses.” The addition of this pre-emption provision is particularly important in strengthening the foundation of ERISA, as a number of State proposals continue to be introduced that seek to regulate stop-loss insurance, which SIIA has and will continue to fervently oppose. Unlike health insurance, stop-loss insurance does not cover individual participants, nor does stop-loss insurance pay health care providers directly. Rather, stop-loss insurance is utilized by private- and public-sector employers with self-insured plans, along with self-insured Taft-Hartley Plans, to provide a financial backstop to reimburse the employer or the plan for catastrophic losses and to protect the plan and plan sponsor from financial insolvency. This is the hallmark of stop-loss insurance, and this is the quintessential feature that distinguishes stop-loss insurance from health insurance. SIPA was last passed by the U.S. House in 2017 by a bipartisan vote of 400 –16. Although SIPA was never acted on by the U.S. Senate, it continues to serve as a legislative marker to ensure that self-insured plans have access to affordable and ongoing stop-loss insurance coverage. As the health insurance market continues to evolve, and as policymakers remain focused on reforming the health care delivery system, Congress must act now to ensure that stop-loss insurance coverage is duly and appropriately protected for consumers across the country, and that small- and medium-sized American businesses are able to continue to access to stop-loss in order to provide affordable health coverage options. SIIA is a national trade association dedicated to protecting and promoting the business interests of companies involved in the self-insurance industry, including sponsors of self-insured health plans, third-party administrators, stop-loss insurance carriers, employers, and other participants. If you have questions about self-insurance, or the Self-Insurance Protection Act specifically, please contact Ryan Work, SIIA senior vice president of government relations, at email@example.com .