Over Age Dependent Answers – California Small Group

Many people are interested in knowing how each carrier will respond to adding over age dependents after September 23, 2010.  The following responses were received from each small group (2-50 employees) carrier for California.  Call us at 888-474-6627 if you have questions.
This document is not intended to be authoritative, and its accuracy is not guaranteed. It is believed to be correct at the time of its printing. Any questions about official interpretations of the law should be directed to legal counsel.

Will you have a special open enrollment for qualified dependents? 
AETNA No they will be able to come on when the group renews after 10/01
ANTHEM There will not be a special OE period other than OE on or after 9/23/10.  HOWEVER….Anthem did an early implementation and kept all dependents who would have normally been dropped prior to Sept 23, on the plan. These dependents were not dropped upon graduating from school.
BLUE SHIELD There will not be a special OE period for qualified dependents.  They will be eligible to enroll during the groups regularly scheduled renewal period.
HEALTHNET No, it will be at renewal or as new groups come on the plan
KAISER If they opted out of the early provision on 6/1, there will not be a special OE period for qualified dependents.  The dependents will be eligible to enroll during the groups regularly scheduled renewal period on or after 9/23/2010.
SHARP No, will only be able to re enroll at group’s renewal after 10/1/10.
UHC No, dependents up to age 26 can be added during  the group’s open enrollment period. (Upon renewal after 9/23/10)

 

 Will the parent add the dependent at open enrollment/at their renewal as usual?
AETNA Yes they will  
ANTHEM Yes they will  
BLUE SHIELD Yes, during the groups regularly scheduled renewal period the parent may enroll their eligible dependents by completing a Subscriber Change Form
HEALTHNET Yes
KAISER Yes, during the groups regularly scheduled renewal period the parent may enroll their eligible dependents
SHARP Yes
UHC Yes dependents up to age 26 can be added during  the group’s open  enrollment period (upon renewal after  9/23/10).

 

 Will the dependent extension apply to dental?
AETNA Yes, dental mirrors medical. Dependents would have to wait til OE to join the plan
ANTHEM Yes, stand alone or bundled
BLUE SHIELD Yes, BSC will also allow overage dependents up to age 26 to enroll on the dental coverage as well.
HEALTHNET Yes, to all ancillary lines
KAISER Kaiser’s relationship is with Delta and no guidelines have been finalized on this item
SHARP We do not carry dental plans.
UHC At this time it’s  only for Medical.

 

 If a dependent loses student status in September will they stay on the plan or will they terminate and need to re-enroll at open enrollement/renewal after Sep 23?
AETNA They can stay on the plan if they lose their status in Sept.
ANTHEM They weren’t dropped, but if for some reason they came off the plan, they are eligible to reenroll at the employer’s normal renewal on or after 9/23/10
BLUE SHIELD Because BSC implemented the reform guidelines early (eff 6/1/10) any over age dependents that are scheduled to drop off after 6/1/10 will remain on the coverage with no action required from the member up until age 26.
HEALTHNET Will require letter from the employer requesting early implementation. Effective date will be first of the month following date received for CURRENTLY enrolled dependents. If dependent was previously cancelled or never enrolled, dependent is eligible to reenroll at the employer’s normal renewal after 9/23/10.  
KAISER Because Kaiser implemented the reform guidelines early (eff 6/1/10) any over age dependents that are scheduled to drop off after 6/1/10 will remain on the coverage with no action required from the member up until age 26.
SHARP We are currently no longer terminating currently enrolled dependents until they reach the age of 26.  However, if the employer has opted out of this new process we will terminate them at the time they reach the max age outlined on group agreement.  They will be able to re-enroll at group’s open enrollment/renewal after 10/1.
UHC At this time, Only currently enrolled  dependents who became a “College Graduate” are eligible to remain on medical  coverage until age 26 prior to 9/23/10 (for those groups who did not  opt-out by 5/14/10).  For all others, the current contractual  dependent age limits apply and they will need to terminate if they are no  longer eligible; they can enroll at open enrollment after 9/23/10.  The  current contractual dependent ages are:1. Through age 18 for dependent and

2. Age 19 through age 24 for full-time students

“Eye” Can See If You Are Healthy

According to a recent study cited by Employee Benefit News, one unexpected benefit of a vision care program is that employees with vision benefits have eye exams more frequently than a standard health assessment or “physical.” Specifically, with an optimally-designed (but not necessarily costly) vision plan, more than half of  Americans with a vision care plan will see their eye doctor annually.  For those without a vision plan, less than 21% of Americans will get annual physicals.

What does that have to do with overall physical health? Plenty.

Eye exams play a crucial role in supporting overall health because the eyes provide the only non-invasive and clear view of blood vessels without puncturing skin.  

Because optometrists can (and do) look at blood vessels during an eye exam, they can help identify symptoms of – and manage – a variety of conditions that might not otherwise be detected until there are other symptoms.

In particular, an eye doctor can detect signs of more than 30 chronic diseases by seeing changes in blood vessels, as well as representative brain cells in the optic nerve.

By examining the eyes, an optometrist can often detect symptoms of chronic conditions such as hypertension, high cholesterol and diabetes. Indeed, in some cases, an eye exam can lead to the detection of a diabetic condition up to seven years sooner than with standard testing.

Anthem Blue Cross of California – October 2010 Small Group Rate Action

Anthem Blue Cross has announced their October 2010 Small Group medical rate action. After a year of new business rate passes or moderate increases, Anthem Blue Cross will again have just a modest increase for new business rates in October 2010.

The total average quarterly increase is 2.8%.

 

Please note that these rates are for Small Group only. The 51-99 EmployeeElect and Small Group mental health parity compliant plan rates will no longer match small group rates. This is due to Anthem Blue Cross’ compliance with the Mental Health Parity Act, effective July 1, 2010. 

 

Here are the breakdowns:

  • EmployeeElect PPO plans will see a new business average increase of 2.0%
  • EmployeeElect HMO plans will see a new business average increase of 1.5%
  • EmployeeElect CDHP plans will see a new business average increase of 7.0%

 

  • EmployeeChoice plans will see a new business average increase of 3.6%
  • BeneFits plans will see a new business average increase of 1.2%

In addition, there will be no rate or benefit changes for Small Group Dental, Life and Vision products.

Important Healthcare Reform Benefit Changes

 

Anthem Blue Cross has updated their benefits to comply with federal and state requirements, including applicable provisions of the recently enacted federal healthcare reform laws.

The following benefits have been updated to comply with the law:

  • Removal of Lifetime Maximum on PPO plans
  • Removal of Annual Dollar Maximums
  • Preventive Care will now be covered at 100%

Grandfather Status:

  • Effective October 1, 2010, Anthem Blue Cross will be making all of their EmployeeElect plans eligible for Grandfather Status
  • The EmployeeChoice and BeneFits portfolios, as well as the Indian Tribes plans, will not maintain Grandfather Status

Specialty Product Discounts:
Anthem Blue Cross has lowered the rates on their most popular Dental Blue Gold Plus 100-80 plan by 8.5% in April…combine that sale with $25,000 of Life and the group receives an additional 6% off the rate for a total savings of 14.5%.

 And don’t forget the 1% RAF savings when a group buys at least $25,000 of Life coverage (down to a .90 RAF). In many cases, the 1% RAF savings can cover the entire cost of the life premium.

RAF Promotion Update:
Anthem Blue Cross is continuing with their current RAF promotion program through December 15th effective dates:

Groups with 6 or more enrolling medical subsribers with a renewal of 1.06 or less (with their current carrier) will receive an automatic .90 RAF.

There is one notable change for PEO groups:

Anthem Blue Cross will include PEO groups with 15 or more enrolling medical subscribers in the fourth quarter (assuming they meet all other eligibility requirements.)

How Will Health Care Legislation Affect Wellness Promotion?

New WELCOA Interview Now Available At No Charge.

Like many, you may be wondering what impact the recently passed health care legislation will have on wellness promotion. In this exclusive interview, WELCOA President Dr. David Hunnicutt sits down with   Dr. Michael O’Donnell to discuss this issue.  Dr. O’Donnell covers the short and long-term benefits of the legislation as well as what health promotion practitioners and business leaders can do to prepare for the upcoming changes.

To access your copy at no charge, simply visit this WELCOA link.

WCIRB SUBMITS FILING RECOMMENDING A 29.6% INCREASE IN PURE PREMIUM RATES EFFECTIVE JANUARY 1, 2011

San Francisco, CA August 18, 2010 – Today, the WCIRB submitted a pure premium rate filing to the California Insurance Commissioner recommending among other things a 29.6% increase in pure premium rates or “claims cost benchmark” effective January 1, 2011. Pure premium rates are a benchmark that insurers may use as a tool for determining their own rates.

The proposed increase is based upon the WCIRB’s analysis of accident year experience valued as of March 31, 2010 and reflects the loss and loss adjustment expenses expected to occur on policies with effective dates on or after January 1, 2011. This is the third increase in pure premium rates in excess of 20% proposed by the WCIRB since they were last adjusted January 1, 2009. If the full 29.6% increase is approved by the Insurance Commissioner, the January 1, 2011 pure premium rates will still be, on average, 53% lower than the approved pure premium rates in effect July 1, 2003. The proposed pure premium rates and the WCIRB’s analysis are contained in Part A of the WCIRB filing.

Also contained in the filing are a number of proposed changes to the California Workers’ Compensation Uniform Statistical Report Plan – 1995 and the California Workers’ Compensation Experience Rating Plan – 1995. Some of these changes are proposed to be effective January 1, 2011 and others on January 1, 2012. For information concerning these proposed changes, see Part B of the WCIRB filing.

The WCIRB will review accident year experience valued as of June 30, 2010 once it is received and, if appropriate, will amend the pure premium rates proposed in this filing. Similarly, if legislative or regulatory changes are adopted or judicial action is taken prior to the time of the scheduled California Department of Insurance (CDI) public hearing on this filing, the WCIRB will evaluate the estimated cost impact of these changes and, to the extent appropriate, modify the pure premium rates proposed in this filing. Additionally, WCIRB staff is gathering further information regarding the proposed changes to the standard classifications for (a) engineers, (b) land surveyors, (c) oil or gas geologists or scouts, and (d) geophysical exploration, and if appropriate, the WCIRB will amend the January 1, 2011 pure premium rate filing.

A public hearing on the matters contained in the WCIRB’s filing will be held September 28, 2010, at 1:00 PM in the 22nd Floor Hearing Room at 45 Fremont Street, in San Francisco, California.

The filing and related documents may be viewed or downloaded from the Regulatory Filings section of the WCIRB website.