News

It's a great time to sell Health Net as they have introduced Q1 2024 rates. Let us help you sell and renew small business in 2024. *Rates summary: Medical: Q1 2024 small business rates will have a 2.4% increase for HMO plans, and unchanged net average rate for PPO plans. Dental: New rates available. No plan changes at this time. Vision: No rate or plan changes at this time. Optional chiro: In 2024 all plans will have the chiro rider option. The chiro rider will be an additional $3.00 PMPM for all HMO and PPO plans. *Rates quoted are pending completion of regulatory review Contact your Dickerson Sales Representative today with for help Quoting Health Net!

Blue Shield of California is proactively enhancing data security by implementing 2- Step Verification for all their external portals. This additional layer of protection requires users to verify their identity through a personalized code, reducing unauthorized access and potential data breaches. Starting in September, members, brokers, employers, providers, and third-party administrators (TPA) will experience this heightened security protocol when accessing their accounts. Broker Connection is the first portal to adopt 2-step verification, followed by the Member Portal on blueshieldca.com on September 7, 2023, and Employer Connection on September 29, 2023. For more information on 2-step verification, please refer to the FAQs .

The Affordable Care Act (ACA) requires health carriers to maintain an Medical Loss Ratio (MLR) of at least 80 percent for Individual and Small Group Plans and 85 percent for Large Group Plans. This requirement is referred to as the MLR standard or the "80/20" or "85/15" rule. If Health Plans do not meet those standards, the Health Plan must refund part of the premium. 2022 MLR Results for California IFP, LRG and SBG Plans IFP: Health Net met or exceeded MLR standards for HMO and PPO plans. Large Group: Health Net met or exceeded MLR standards for HMO and PPO Plans. SBG: Health Net met or exceeded MLR standards for PPO plans (Health Net Life Insurance Company) and HMO plans (Health Net of California, Inc.). There aren’t any changes to the current premium, deductible, or copay amounts as a result of the rebate. Broker commissions are also not affected by this transaction. California and Oregon IFP/IEX, SBG, and LRG subscribers and employer groups will not receive 2022 plan year rebates since Health Net met or exceeded the MLR targets for those market segments. The 2022 MLR results were filed with the Centers for Medicare & Medicaid Services (CMS) prior to the July 31, 2023, due date.

(By Tina Reed) - Starting next month, UnitedHealthcare says it will move forward with plans to drop prior authorization requirements for a range of procedures, including dozens of radiology services and genetic tests, among others. UnitedHealth is among the health insurance giants who have announced plans to cut back on prior authorization as federal regulators consider tougher curbs on the practice. Prior authorization is often criticized by patients and doctors, who complain they are an administrative burden or impede necessary care. Insurers, meanwhile, say prior authorization provides important guardrails against improper health care utilization, helping to keep costs down. UnitedHealth, the largest commercial U.S. insurer, previously said, its prior authorization removals will represent roughly 20% of its overall prior authorization volum e. Cigna and Aetna also announced plans to roll back some prior authorization requirement. The Centers for Medicare and Medicaid Services proposed a rule to limit the amount of time insurers have to review requests on services for which they require prior approval, BenefitsPro previously reporte d. Congress is also eyeing a plan to streamline and add transparency to the process by which Medicare Advantage plans can deny coverage for services via prior authorizatio n. Click here to read more

(By Kathryn Mayer) The 2024 health plan affordability threshold is dropping next year. The IRS announced that the 2024 health plan affordability threshold—which is used to determine if an employer's lowest-premium health plan meets the Affordable Care Act's (ACA's) affordability requirement—will be 8.39 percent of an employee's household income. That's down from this year's 9.12 percent figure. The information was detailed in IRS Rev. Proc. 2023-29 , which was released last week. The 2024 threshold is a significant decrease from 2023, and it is the lowest affordability threshold since the ACA was implemented. The affordability threshold, which affects employers' potential liability for ACA shared-responsibility penalties, is adjusted annually based on health plan premium growth relative to income growth using national health expenditure data from the Centers for Medicare & Medicaid Services. The adjusted percentage applies on a plan-year basis, so plans will continue to use 9.12 percent to determine affordability in 2024 until their new plan year begins, if it does not begin at the start of the calendar year. An applicable large employer may rely on one or more safe harbors in determining if coverage is affordable: an employee's W-2, an employee's rate of pay and/or the federal poverty level. If the employer's coverage is not affordable under one of the safe harbors and a full-time employee is approved for a premium tax credit for marketplace coverage, the employer may be subject to an employer shared responsibility payment, according to a compliance alert by insurance firm Woodruff Sawyer. Click here to read more