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After extensive negotiations, Blue Shield of California and Stanford Medicine — including Stanford Hospital, Lucile Packard Children’s Hospital, Tri-Valley Hospital, Stanford Medicine Partners, and Packard Children’s Health Alliance — have reached a new agreement. Effective September 1, 2024, all Stanford Medicine providers and hospitals are in-network for Blue Shield Commercial HMO and PPO members. Stanford Hospital and Stanford Medicine Partners are out of network for Blue Shield’s Individual and Family Plan (IFP)/Covered California PPO and Trio HMO networks. Blue Shield pleased to announce that Lucile Packard Children’s Hospital, Packard Children’s Health Alliance, and Tri-Valley Hospital are in-network for these plans. Additional information will be provided as it becomes available. For More Information or Help Quoting Blue Shield, Please Contact Your Dickerson Sales Rep.

Health Net is pleased to share their January 1, 2025 underwriting guidelines for Small Group. Please click on the following links to view or download the documents: • Enhanced Choice Underwriting Guidelines • Life Underwriting Guidelines • Dental and Vision Adult Buy-Up For More Information or Help Quoting Health Net, Please Contact Your Dickerson Sales Rep.

this Health Net has announced that its closing the following California Small Business group plans After careful review, Health Net is closing the following California Small Business group plans: • Gold PPO 1600/0 • Community Care HMO Silver $2250/$50 • Community Care HMO Bronze $6300/$60 As a result, Health Net will mail plan closure letters to employer groups and members impacted by these changes. Letters will mail on a monthly basis at least 90 days prior to the impacted group’s renewal date. January 2025 employer group and member letters will begin mailing on September 20, 2024 For More Inofrmation Or Help Quoting Health Net, Please Contact Your Dickerson Sales Rep.

Kaiser Permanente Northern California’s health plans have been recognized as the highest rated in California — and among the highest in the nation — for providing expert, coordinated care, and exceptional service. Kaiser Permanente’s Medicare and commercial health plans in Northern California each received 4.5 out of 5 stars, according to the National Committee for Quality Assurance 2024 Health Plan Ratings. This is the ninth ratings period that Kaiser Permanente Northern California has been the highest-rated plan in the region and among the highest in the country. Nationally, only eight percent of the health plans are rated 4.5 stars or higher. The organization also ranks Kaiser Permanente Northern California health plans as best in the state for overall treatment, prevention, equity, and patient experience. To Read More Click Here For Help Quoting Kaiser Permanente, Please Contact Your Dickerson Sales Rep.

The Internal Revenue Service (IRS) has released Rev. Proc. 2024-35, which contains the inflation-adjusted amounts for 2025 used to determine whether employer-sponsored coverage is “affordable” for purposes of the Affordable Care Act’s (ACA) employer shared responsibility provisions and premium tax credit program. As shown in the table here , for plan years beginning in 2025, the affordability percentage for employer mandate purposes is indexed to 9.02%. This is a slight increase from 2024. Employer shared responsibility payments are also indexed and decreased for the first time in 2025. Under the ACA, applicable large employers (ALEs) must offer affordable health insurance coverage to full-time employees. If the ALE does not offer affordable coverage, it may be subject to an employer shared responsibility payment. An ALE is an employer that employed 50 or more full-time equivalent employees on average in the prior calendar year. Coverage is considered affordable if the employee’s required contribution for self-only coverage under the employer’s lowest-cost, minimum value plan does not exceed 9.02% of the employee’s household income in 2025 (prior years are also shown above). An ALE may rely on one or more safe harbors in determining if coverage is affordable: W-2, Rate of Pay, and 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. Since 2019, the individual mandate penalty imposed on individual taxpayers for failure to have qualifying health coverage was reduced to $0 under the Tax Cuts and Jobs Act, effectively repealing the federal individual mandate. A previous lawsuit challenging the constitutionality of the ACA due to this change to the individual mandate penalty was unsuccessful. The employer mandate has not been repealed, and the IRS continues to enforce it through Letter 226J. The IRS is currently enforcing employer shared responsibility payments for tax year 2022 as well as enforcing the reporting requirement itself. The IRS aggressively enforces the ACA reporting requirement, notifying applicable large employers via Letter 5699 if the IRS has not received the employer’s form 1094-C and forms 1095-C. To Read The Full Alert Click Here

(September 18, 2024) By Kristen Hwang - California’s cap on health care costs is the nation’s strongest and most aggressive. It aims to limit how much consumers pay over time by first constraining how much the health care industry spends. Research suggests up to 30% of health spending is wasted on overtreatment and administrative inefficiencies. By 2029, California hospitals, doctors and insurers cannot increase spending by more than 3% annually. This means they will need to find ways to cut costs to keep from exceeding the target. If they do exceed it, state regulators with the Office of Health Care Affordability have the authority to levy fines and other penalties “commensurate with the failure of the health care entity to meet the target,” according to state law. The law also has guardrails preventing health care entities from saving money by reducing services. The cap, which was set in April, is modeled on the work of eight other states, including Massachusetts, that have tried to curtail runaway health spending. California went further by allowing the state to compel public testimony from health care facilities, require performance improvement plans and impose unlimited financial penalties on businesses that exceed the cost cap. Massachusetts, by contrast, has ordered just one performance improvement plan and it has not levied a fine on any health care provider since it created its own cost control target in 2012. It also has the ability to fine facilities that spend too much, but regulators there say penalties are too small to be meaningful. Health insurance premiums there have climbed 43%, outpacing wage growth over nine years. To Read More Clck Here