Anthem Revised Rules Regarding Lipitor

 Anthem Blue Cross of California has recently announced that all members with prescriptions for Lipitor will need to have their prescriptions pre-authorized effective April 1, 2012 

This change is due to the addition of atorvastatin, a new generic for the brand name Lipitor, on their covered drug list.

This change impacts all of the commercial and individual business in California and New York. Medicare Part D and state-sponsored business are not impacted.

Anthem Individual Rate Hike July 1, 2011

Anthem Blue Cross Life and Health Insurance Company (Anthem) has agreed to a request by the California Department of Insurance to modify its pending rate filing, and will move ahead with revised premium increases effective July 1, 2011. 

They will begin notifying members affected by the July 1 rate change as early as mid-April.  Anthem is doing so following the end of a 60-day postponement requested by the state insurance commissioner.   

As part of the agreement, they will delay certain benefit changes in our original filing from a July 1, 2011 implementation to a January 1, 2012 implementation. In addition, the average premium increase will be slightly lower, averaging 9.1%, vs. the 9.8% in the company’s original rate filing.  An estimated 80,000 California customers will receive rate decreases per the original filing.

New Enhancements to Anthem Program

Anthem Blue Cross of California recently enhanced its Resource Advisor member-assistance service to include Beneficiary Companion and Identity Theft Victim Recovery Services programs at no additional cost to customers.

The Beneficiary Companion not only notifies financial institutions and public agencies of a loved one’s death, but also closes accounts and places a freeze on credit reports, according to Nicholas Brecker, president of Anthem’s life and disability business.

The ID theft service assigns a fraud resolution specialist to members for an entire year to work closely with creditors, collection companies, collection law firms and credit reporting agencies in the event of an identity theft.

Health Insurance for Children – What Now?

Effective today, individual health insurers cannot deny coverage to children with pre-existing conditions.  As a predictable reaction to this change in federal law, CIGNA, Health Net Anthem and Aetna have stopped selling individual health plans to children.

 What can be done for children who need              insurance now???

 For those children who are currently covered by a child only health plan, they will remain covered as long as premium payments are made on a timely basis.  The carriers will not rescind coverage.  For those children who will need coverage as of 9-23-10, Legislation has recently been passed in California that would block California insurers from denying coverage to children with preexisting conditions, but would let them charge significantly higher premiums to those who don’t sign up during open enrollment periods each year and impose surcharges on those who try to abuse the system by dropping coverage when children are healthy. This legislation would limit how much children with preexisting conditions would have to pay if they signed up during open enrollment.  Carriers that refuse to participate would face penalties.

 This bill, AB 2244, is pending signature by Gov. Schwarzenegger. He is expected to sign the bill.

TIPS ON THE INDIVIDUAL APPLICATION PROCESS

When the Obama Administration’s health reform laws take full effect in 2014, insurance carriers will no longer be able to deny coverage to adult individuals with preexisting medical conditions. Until then, there are federally funded high-risk pools. To qualify for these, you have to be without insurance for six months and you must show you have applied for and been denied insurance in the private market.

If you have a preexisting condition and can’t qualify for the high-risk pools, it’s a smart idea to at least check out the plans available within the private insurance market. “Don’t assume if one insurer rejects you that they all will,” says Anthony Wright, executive director of Health Access California, a statewide advocacy group.   By being a smart consumer you can improve your changes of obtaining coverage. Below are suggestions that we hope will help you in finding individual coverage:

Eligibility Laws
If you’ve exhausted your  COBRA and or CAL COBRA benefits available after leaving a job, federal law guarantees you a HIPAA policy from private insurers if you apply for one within 63 days from loss of other coverage.  Please make sure to retain a copy of the prior carrier’s “Certificate of Creditable Coverage” as proof that you did have coverage and that the loss of coverage occurred within 63 days of the application date.

Underwriting

In California carriers can review your health history, age and gender in order to determine the premium to be charged if you have a history of certain medical conditions.    The carriers are looking for those applicants that may potentially charge a large amount in claims costs.   The carriers also subscribe to a service that tracks your prescription drug records, the MIB Group.  You can request a copy of your 5 year usage history at http://www.mib.com/html/request_your_record.html.

Carefully answer the application

In order to determine the premium to be charged, the carrier’s application will ask many questions about your health.  Please remember to fully answer only the question asked.  Underwriters are looking to see if a medical situation has been resolved, or there are upcoming charges or procedures that may indicate a large expense.  Remember that omitting information may actually cause the coverage to be rescinded.  Sometimes the carriers will schedule a telephone interview in order to gain a better understanding of your medical history, so it is best if you have a copy of your medical records with you during the call, so you don’t have to try to remember all the details, which may be a costly mistake.

Manage your health

Of course it is always best for you to try to maintain optimum health, not only for obtaining health insurance, but to maintain your quality of life.  If a medication is working don’t change it unless there is a generic available.  Lose weight, exercise. Commit to a healthy lifestyle.  

Ask your medical provider to review your records and correct any inaccuracies and update your health history.  Not only will this effect a health insurance application, it is important to have all records be accurate for medical and legal reasons.

Work with a knowledgeable agent

The current insurance atmosphere is in a state of flux, with many changes to happen over the next few years.  Talk to someone in the field for help.  You can contact the National Assn. of Health Underwriters’ website, http://www.nahu.org or you can contact our office at (888) 474-6627   for assistance with the application process.