California Exchange (HBEX) Shocks Insurance Industry with Selection of SHOP Administrator

April 8th, 2013

California’s Health Benefit Exchange (HBEX)  also known as “Covered California,” sent an email to agents on Friday, April 5, 2013 to announce that they had selected Pinnacle Claims Management, Inc. to run the California SHOP exchange for small businesses. This shocked many in the insurance community including carrier reps, general agents and agents because most […]

Price War for California Small Group Health Insurance

March 21st, 2013

California insurance companies are engaged in a price war for small business health insurance.  I never thought that I would ever write that sentence. However, it’s true. As I previously reported on this blog, Health Net started the war in January 2013 when they offered ANY group with 6 or more employees the lowest rate (RAF […]

Enroll in Medicare or Stay on Your Employer’s Health Plan – a Helpful Guide

March 13th, 2013

I’ve just written a helpful guide for people who continue to work and must decide whether they should enroll in Medicare or stay on their employer’s group medical plan. It turns out that the decision is a bit complicated and the answer depends on:
•who’s paying for the group plan (employer or employee);
•whether the employee also has dependents enrolled on the group plan; and – oddly enough -
•how much the employee earns…

The article is sprinkled with a few funny things – so it’s not as dry as you might imagine. If you’re in this situation or if you know someone who is, you should read the article. Learn more by clicking on the link above.

Health Net Special Offer for Low Rates to Most Small Groups in California

March 1st, 2013

Health Net of California is guaranteeing small group employers (2-50 employees) with the lowest rate possible. New groups that enroll 6 or more employees in a Health Net plan will receive the lowest possible “Risk Adjustment Factor” (RAF) of 0.90. Health Net’s RAF Special expires April 15, 2013.

Health Insurance Marketplace: the New Name for the Federal Exchange

February 12th, 2013

The Federal government has re-branded its health insurance “exchange” as the “Health Insurance Marketplace.” A video on the government’s web site suggests that shopping in the Health Insurance Marketplace will be as easy as buying food in a grocery store. The government makes some pretty bold claims

No Federal Subsidies for Families if Company offers Employees Affordable Coverage under ACA

February 4th, 2013

Unless an employer decides to contribute a portion of the premium for dependent coverage (and employers get no credit for this contribution under the ACA) then employees will shoulder the entire financial burden of health insurance for their family.

Individual Coverage for Employees: Health Care Reform (ACA) May Create Opportunities for Small Businesses

January 29th, 2013

In 2014, when the new market rules take effect, a business owner may be able to choose between the small group and individual market to purchase coverage for employees… Same product in two separate markets offered at different prices. A small business owner’s arbitrage opportunity would be to purchase health insurance for employees in the market with the lowest price.

Waive or Decline – A Huge Difference for California Small Group Health Insurance Plans under Health Care Reform(ACA)

January 28th, 2013

“The BIG, hugely impactful decision Covered California, DOI and DMHC must make is: must an insurance company consider an employee enrolled in an individual health insurance plan.. to have a valid “waiver”. or [is it] a “declination” of group coverage.”

Covered California Health Exchange Releases 2013 Report

January 11th, 2013

Covered California, the new name for the California Health Benefit Exchange, has just released a report on its activities. Addressed to the Governor and Legislature, the report describes the reasons for creating the exchange and the progress in that effort. The report states that the high cost of medical insurance is the most commonly reported reason for lack […]

New Trend in Health Insurance: Hospitals and Medical Groups Becoming Insurers

January 8th, 2013

Sutter Health, a large medical group and hospital chain in Northern California, has applied to become an HMO/insurance company. According to this article, Sutter Health submitted its application to the California Department of Managed Care (DMHC) in August 2012. The article reports that DMHC has seen a significant increase in the number of applications to establish new HMO plans saying that “the agency […]