Now I Know Newsletter (51+)
In this issue:
- Blue Shield of California Highlighted for Innovation
- Policy Cancellation Drama Plays Out in California
- Blue Shield Mobile Apps for iPhone and Android Are Now Available!
- 51 to 100 Small Group Transition Plans Are Now Available
- Medical Identity Theft: Protect Your Employees
- Benefits Update: Outpatient Mental Health Opioid Treatment
Blue Shield was selected for its innovation and vision along with five national brands by Salesforce.com to be featured as a Customer Success Story during the Dreamforce event in San Francisco this past November. Blue Shield was joined by Hewlett-Packard, Virgin America, Nissan, NBC, and Trunk Club. The opportunity to participate in Dreamforce showed how Blue Shield is changing its business to be more efficient and build stronger connections with its customers, employers, and producers.
During Dreamforce, crowds of people stopped by the Blue Shield booth and had the chance to see firsthand how using Internet technology (the cloud) has helped Blue Shield become more efficient.
We are the first California health plan to connect our plan members to their health benefits using social media channels. Instead of calling a customer service number, customers can go to Facebook or Twitter for answers.
With Salesforce.com and the cloud, we’re ready to support you during enrollment and beyond.
By Tom Epstein, Vice President Public Affairs, Blue Shield of California
The public and media uproar over policy cancellations associated with the Affordable Care Act (ACA) has generated an extraordinary political response, capped by the president’s public mea culpa and announcement last month of a new administrative policy to stem the cancellations. Because the furor has also generated a lot of confusion, we’re taking this opportunity to illuminate some of the key issues.
Why the cancellations are necessary. Most reporting has attributed the cancellations to the ACA mandate that health coverage meet minimum standards. Most policies in the individual market today have less comprehensive benefits than the new law requires. But that’s just a partial answer that ignores another important reason – the requirement that plans in the individual market enroll all applicants, regardless of their health.
This reform requirement – one of the most popular provisions of the law – will guarantee coverage for those with pre-existing conditions without causing premiums to skyrocket only if a balanced pool of healthy and sick people enroll in coverage. That’s why the law includes an individual mandate. It’s also why the cancellations are necessary: to move people into coverage that pools together everyone in the individual market.
The politics of policy cancellations. Washington policymakers understand the essential connection between guaranteed-issue insurance coverage and balanced risk pools that include both existing policyholders and new ones. But disrupting the coverage of current policyholders has always given the political advisers heartburn. Many old Washington hands, for example, blame the defeat of the Clinton healthcare plan in 1994 on the failure to allow people to keep their current coverage if they liked it.
That concern produced the “grandfather” provision in the ACA, which allows people with coverage on the bill passage date (March 23, 2010) to keep their coverage indefinitely. That means these relatively healthy individuals who have passed medical underwriting will be kept out of the reformed market risk pool. The provision, thus spares this group from having to share in the expense of covering those with pre-existing conditions who will gain coverage in 2014.
When the law’s implementation rules were being written, the political concern about future cancellations led to a further modification. While all newly issued policies have to meet the minimum benefit requirements, under the federal rules, insurers can extend existing, non-grandfathered policies past the January 1, 2014, ACA implementation date, all the way until the end of 2014. (California did not exercise this option, as explained below.) This expands, at least temporarily, the number of people who will be protected from sharing the expense of covering those with pre-existing conditions. The flip side, of course, is that it promises to raise costs for those who enroll in the new, reformed market in 2014.
Last month, in response to the political firestorm over cancellations, the Obama administration proposed an even greater expansion of this protected class and narrowing of the pool of people who would share in the expense of covering those with pre-existing conditions. Under the policy announced last month, states and insurers were encouraged to offer existing enrollees the opportunity to renew their policies through 2014 and even well into 2015. The decision on whether to permit these extensions was left to the states.
Fortunately, the leadership of California’s exchange, Covered California, has kept better faith with the policy underpinnings of the reform law by requiring that insurers doing business with the exchange cancel all non-grandfathered individual policies by the end of 2013. The president’s recent proposal put tremendous political pressure on Covered California’s board to change its policy, but it voted unanimously and courageously to stay the course. In doing so, the board acted not only to protect the exchange against an imbalanced risk pool, but also to uphold a core promise of the ACA: that those with pre-existing conditions would no longer be disadvantaged.
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Now with our new mobile apps for iPhone and Android, your employees have more choices for anytime, anywhere access to their Blue Shield health plan and healthcare services information. Whether accessing through our mobile website or choosing to download our Blue Shield of California Mobile app from iTunes or Google Play, they can access key plan and benefits information when they’re on the go. After registering or logging in, our members can:
Find a provider, facility, or urgent care center with turn-by-turn directions
Download a copy of their member ID card
Access detailed plan benefits coverage and copayment information
Access processed claims
Contact NurseHelp 24/7SM and more!
No matter how your employees choose to access Blue Shield – on a computer or smartphone – they need to register only once. All they need to create their account is their member ID number, which they can find on their Blue Shield member ID card.
For more information about all the on-the-go features and functionalities of our mobile apps and mobile website, visit blueshieldca.com/mobile.
In advance of the Affordable Care Act’s (ACA) redefinition of small group size from 2 to 50 to 1 to 100 in 2016, Blue Shield has released small group plan designs. Employers, with group sizes of 51 to 100, can now offer ACA-compliant plans that conform to the requirements of the small group exchange market. These include benefits for acupuncture services, pediatric vision services, prescription drug coverage, and substance abuse treatment services, as well as standard, essential health benefits and preventive health services you have come to expect from Blue Shield. These plans may also be offered to groups larger than 51 to 100.
Contact your broker or Blue Shield sales representatives for more details.
While phone phishing scams are not new, identity thieves are becoming more sophisticated and resourceful in procuring personal information. We wanted to alert you to these scams, and provide you with information about how you can protect your employees from them.
While most scams tend to target the Medicare-eligible population, the latest phone scams are affecting a variety of demographic groups. Callers identify themselves as working for “the government,” “your insurance company,” or a social services department, but they rarely provide specific information such as the company or department name. Individuals receiving calls are being offered:
Free government grants
New healthcare/health reform identification cards
New Medicare identification cards
Supplemental benefits to existing health insurance benefits
In many instances, the caller attempts to obtain personal information, such as Social Security numbers, credit card numbers, bank account information, and health identification numbers.
We encourage you to provide the following general suggestions regarding phone scams and data security to your employees:
Never give out personal information over the phone unless you initiated the call to a known entity and they need it for legitimate verification purposes (e.g., when you call your bank or credit card company).
Never send money to a company or individual that you do not know.
Beware of “free” services/prizes/awards that require up-front payment.
Legitimate companies will not ask for your personal information unless you initiated the call to an entity with whom you have an account and they need to verify your identity.
If something sounds too good to be true, it probably is.
Numbers that appear on caller ID are not always the true phone numbers – there is software that can mask/alter phone number displays.
Ask for specific details regarding the caller or the company, including contact information, and verify the information yourself.
If you or your employees receive calls that you feel may be fraudulent or scam-related, you can report them to the Federal Trade Commission (FTC) at (877) 382-4357. If the scam is related to Blue Shield in any way, we ask that members report it by sending an email to the BlueCross BlueShield Association at acafraud@BCBSA.com. Your employees may also contact Blue Shield’s customer service telephone number, found on the back of their member ID card.
Blue Shield of California is clarifying a treatment benefit for all medical plans with a substance abuse rider, effective January 1, 2014. Due to a change in medical policy, office-based outpatient mental health opioid treatment is changing from not covered to covered at the plan copayment amount for outpatient physician office visits.
This benefit is covered only if the employer purchased the substance abuse rider with the medical plan.