2017 Individual and Family Medical Plans Require a Primary Care Physician

Beginning January 1, 2017 all individual and family health plans in California will require that members select a Primary Care Physician (PCP) or have one recommended by their health plan.

The terminology used in this case is confusing. A PCP has historically been a physician who is associated with an HMO which limits your choice. This is not the case in this instance.

You must choose a general physician who is in the network of your insurance company. If you do not choose a physician the insurance company will assign one to you. I know that at least one company will review your claims history in order to assign a physician that you have seen in the past.

YOU DO NOT EVER NEED TO SEE THE PHYSICIAN CHOSEN

YOU CAN CHANGE THE PHYSICIAN AT ANY TIME

The thought behind this is that if one is attached to a name of a physician, it is less likely that one will go to Urgent Care or the Emergency Room. An office visit or a phone call supposedly will lower health care spending.

In Summary, choose a physician or have one chosen for you.

Anthem Blue Cross Individual Grandfathered Plans

Over the next several months, Anthem Blue Cross will be increasing rates on their individual Grandfathered Plans. As a result of this increase, Anthem Blue Cross will allow for a temporary Special Enrollment Period to change to Affordable Care Act or Obamacare plans. Once a change is made, your Grandfathered status will cease and is no longer available.

The main advantages of a Grandfathered Plan is a larger provider network and a larger drug formulary. The advantages of an Affordable Care Act or Obamacare plan is the benefits may be better and the premium may be lower.

If you would like to discuss a change in plan, please let me know. I will need the following information:

Full name, address and phone number of any doctors you wish to keep.

Name of all prescription medication taken.

 

IRS Form 1095

The Affordable Care Act requires that everyone been enrolled in a qualified health plan or a penalty will be assessed at your tax filing. The method used to verify your enrollment is with a 1095 tax form. The form is to be mailed to all enrollees in a qualified health plan and submitted with your tax filing for IRS confirmation.

If you are receiving a subsidy through Covered California, the subsidized premium will be included on the 1095. The IRS will verify that the income reported on your Covered California application matches your actual income. If your income is less than what is listed on the application, you will receive an additional credit. If the income is more, you will be required to pay back a calculated amount.

Most insurance companies have sent out the 1095 to enrollees. If you have not received yours, it should arrive soon. Please review the form for its accuracy in terms of premium paid and subsidy allowed.

The above pertains to the 2015 tax year.

The companies that offered policies through my agency in 2015 were:
Anthem Blue Cross

Blue Shield of California

Cigna

Assurant Health

Aetna

United Health Care

Health Net

Kaiser

 

Anthem Blue Cross Rebates

Anthem Blue Cross will not be issuing rebates for the 2014 insurance year.

Anthem Blue Cross files report on MLR rebates for California: No rebates

August 4, 2015

The Affordable Care Act (ACA or health care reform law) requires health plans to meet a minimum medical loss ratio (MLR), which varies according to market. Health insurance issuers must meet a minimum MLR of 85% in the fully insured large group market and 80% in the fully insured small group and individual markets. (States that received waivers to have a lower threshold for the individual market are required to meet that percentage, not the 80% in the ACA.)* The health care reform law also requires health plans to file an MLR report each year with the Department of Health and Human Services (HHS).

On July 31, we filed the required MLR report with HHS for the 2014 calendar year.

We met the required loss ratio for all lines of business in 2014 for our Anthem Blue Cross Life and Health Insurance Company products under the California Department of Insurance (CDI) and our Blue Cross of California products under the Department of Managed Health Care (DMHC). As a reminder, medical loss ratio requirements do not apply in the ASO market and short-term medical insurance is excluded from rebates.

View this fact sheet for more details and FAQs. For all other health care reform needs, please visitwww.makinghealthcarereformwork.com.

*NoteThere are no waivers in effect for the 2014 year. However, the MLR calculation uses a 3 year average. Therefore, the waiver impacts the 2014 rebates being paid in 2015.

This article applies to:

  • California
  • Small Group, Large Group, and Individual (under 65)

Background The Affordable Care Act (ACA or health care reform law) requires health insurers to report medical loss ratios (MLR). MLR is the percentage of premiums that insurers spend on medical care (including claims and activities that improve health care quality). Health insurance issuers must meet a minimum MLR of 85% in the fully insured large group market and 80% in the fully insured small group and individual markets. (States that received waivers to have a lower threshold for the individual market are required to meet the percentage as described in the waivers.)* *Note: There are no waivers in effect for the 2014 year. However, the MLR calculation uses a 3 year average. Therefore, the waiver impacts the 2014 rebates being paid in 2015. As required by the health care reform law, we filed the MLR report with the Department of Health and Human Services (HHS) by July 31 for the prior calendar year. If rebate checks are due for the prior calendar year, they will be received by September 30. Questions and answers Q. Who is eligible for a rebate?* A. Any fully insured individual or group who had an active health insurance policy during the prior calendar year is eligible for a rebate, including individuals or groups who ended their coverage or started their coverage at any point during the prior plan year. However, not everyone gets a rebate. Q. Are rebate amounts a matter of public record? A. The total amount we must pay in rebates becomes public information after we file an MLR report with the HHS. Because we have already filed a report for the prior year, that information is now public. Please note that the rebate amounts paid to each employer or individual are not made public. Q. How did you determine how much the rebate checks would be for? A. Check amounts were calculated based on the rules from the government. In general, we took the amount we paid in medical care and quality programs and divided that by the amount of money we earned in premiums minus state and local taxes. That number was then distributed proportionately to all people in the specific product line in a state. Based on the rules set by the federal government, we calculated the rebate amount for groups or members. For specifics on these rules, please visit http://www.healthcare.gov. Q. My client recently got their rebate check and said that when they calculated the rebate themselves it was different than the amount on their check. Why is the check amount different from what my client calculated if they used the MLR percentage that was given on their notice? A. The MLR percentage that was provided on notices does not include state and federal tax adjustments. According to the MLR rebate calculation formula provided by HHS, a certain percentage is deducted for taxes from the original MLR percentage, which impacts the final check amount customers received. Individual example: In the individual market we are required to meet 80% of premium spent on medical costs and quality programs. If we only reached 77.8%, or 2.2% less than what was required, we would rebate 2.2% minus .09% in state and federal taxes. So the final rebate percentage would be 2.11%. Group example: In the large group market we are required to meet 85% of premium spent on medical costs and quality programs. If we ended up spending 84.1%, or .9% less than what was required, we would rebate .9% minus .04% in state and federal taxes. So the final rebate percentage would be .86%. Q. Can you provide the exact calculations you used so I can walk my client(s) through their exact rebate amount? A. Unfortunately no. The calculations are extremely complicated. However, the data that was reported to the federal government and the amount received is accurate based on the formula provided by HHS of what is required to meet the medical loss ratio requirement. Q. In what situation would a group receive two rebate checks? A. As stated by HHS, if the employer group has both HMO and PPO products it is possible that they will receive two rebate checks if we did not meet the minimum MLR requirement for both plans. Rebate checks are being issued at the subgroup level which could also result in multiple checks. Finally, some of our products are underwritten by two different legal entities. This could result in multiple checks being issued. Q. What information are we making available to members? A. Under the law, notices will only go out to fully-insured members and employer groups that will be getting a rebate. Also, our member portals will have a comprehensive questions and answers document that members and others can access. *Only health plans regulated by the Department of Managed Health (DMHC) are eligible for rebates in the state California. This content is provided solely for informational purposes. It is not intended as and does not constitute legal advice. The information contained herein should not be relied upon or used as a substitute for consultation with legal, accounting, tax and/or other professional advisers. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.

Blue Shield Rebates

Below is an explanation of Blue Shield’s rebates to clients. For more information on rebates you can read the June 24, 2013 blog on my website, dennisdavidhealthplans.com

Blue Shield’s Medical Loss Ratio Rebates and Notifications

Last week, The LA Times published an article about Blue Shield’s 2015 Medical Loss Ratio (MLR) rebates. The Affordable Care Act (ACA) requires health plans to spend a minimum percentage of premium revenue on medical expenses. This percentage is known as the Medical Loss Ratio (MLR).

Blue Shield’s report will show that we owe the following rebates to contract holders in plans regulated by the Department of Managed Health Care (DMHC):

  • $61.7 million in MLR rebates to approximately 454,000 IFP subscribers (met 76.8% of 80% threshold)
  • $21.1 million in MLR Rebates to approximately 19,000 small business contract holders (met 76.8% of 80% threshold)

As required by law, that amount will be paid by September 30, 2015 to IFP subscribers and Small Business contract holders (businesses, not individuals) in those plans with the rebates based on their premiums paid in 2014.

Blue Shield does not owe any rebates to Large Group contract holders in DMHC plans. No rebates will be owed by Blue Shield of California Life & Health Insurance Company (Blue Shield Life), which is regulated by the California Department of Insurance (CDI), for any IFP or group health insurance plans.

August 12, 2015

brokers and employer groups 2015 Medical Loss Ratio (MLR) Background and Talking Points MLR BACKGROUND: Under the Affordable Care Act, health plans are required to spend a minimum percentage of premium revenue on medical expenses. This percentage is called the Medical Loss Ratio (MLR). The ACA requires that health plans spend at least · 80% of premiums received for IFP and Small Business plans on medical care or quality improvement programs; · 85% of premiums received for Large Group plans on medical care or quality improvement programs. The MLR reporting and rebate requirements apply to all fully insured group and individual (IFP) plans, including grandfathered plans. They do not apply to self-funded (ASO) business. MLR calculations and rebate determinations are based on market segment. All plans are grouped by market (individual, small business and large group), and rebates are paid to all plans in the market if the minimum loss ratio is not met. Q&A: How will Blue Shield notify subscribers and contract holders that they are getting a rebate? Blue Shield will send a notification letter and rebate check if one is required to all subscribers and contract holders who are eligible to receive a rebate by September 30, 2015. Why are some IFP subscribers and employer group contract holders not getting a rebate? Blue Shield met or exceeded the MLR thresholds for health plans offered to Large Group plans regulated by DMHC, and for all plans issued by Blue Shield Life, which are regulated by CDI. What do members need to do to qualify for a rebate from Blue Shield or to claim a rebate that is owed? Blue Shield calculated the MLR for each of our market segments based on requirements provided by the Department of Health and Human Services. If a contract holder in a certain market segment is owed a rebate, they do not need to take any action to claim it. They will be notified by Blue Shield per HHS requirements and a rebate check will be sent to them. Is the rebate considered income/profit for the subscriber? Under certain circumstances, the rebates may be taxable to IFP contract holders (subscribers). Subscribers should consult a tax professional. If a subscriber cancelled mid-year (2014) or made a plan change, are they still eligible for a rebate if their plan qualified? Yes. An IFP subscriber only needs to be active at any point in time during 2014 to receive a rebate in 2015. However, the rebate amount will be pro-rated accordingly.

Blue Shield of California Medicare Supplements

Blue Shield is migrating all Medicare Supplement enrollees to a new computer system. By the end of 2015 you will receive a letter from Blue Shield with a new ID card and subscriber number. It is very important to give your new ID card to all your medical providers. Please shred your old ID card.

If claims are processed with the old ID number they will not be recognized by Blue Shield which will result in a denial of the claim which must be reprocessed.

My Clients Evaluate My Agency- Thank You!

Names of my clients have been removed for privacy.

Health insurance concerns can be difficult to navigate at times. Whenever I call Dennis he has always created time to patiently explain all aspects of my insurance plan. He collects all the information and addresses the pros and cons to answer my specific questions which I truly appreciate! He is wonderful to work with and I highly recommend him!

I have had the pleasure of working with The Dennis L. David Insurance Agency since 1997. Mr. David is consistently prompt, professional and thorough. He always provides me with the most up-to-date information available in the industry. No matter how tough the challenge, he works through it until he finds a reasonable solution to fit my insurance needs. Over the years, I have referred him to friends and family. He has provided them with the same level of care and attention. I truly appreciate and highly recommend the services of The Dennis L. David insurance agency.

Buying health insurance isn’t exactly the most exciting thing in the world but Dennis provides great service and makes the process as painless as possible. With a new child getting good insurance was a must. Dennis helped us figure out which insurer had our doctors in their network as well as the preferred hospitals we noted. Once we chose the paperwork was easy and he took care of the rest.

Dennis David is thorough, reliable, and provides great service. My family has been with him for over 10 years and he has never failed us.

I have known Dennis David for many years and he is the most professional and honest insurance agent. I highly recommend his services for all of your insurance needs.

We are so appreciative for the experience and professionalism of Dennis. He always helps us with our health insurance questions and help us choose the right insurance for our company. We are very pleased with the services Dennis provides our company. Our company has had many changes and he has been there to make sure everything is submitted and changed for us.

I have had a great experience with Dennis. He always gets back to you in a timely fashion he knows what he’s doing he recommends what is best for you. I would never use anyone else.

Dennis David has been my insurance agent for over 25 years. I’ve relied on him to do the research and work to best serve my personal needs — and he’s never let me down. He answers my calls or emails promptly and no question is too little to ask him. He’s honest, compassionate, patient, knowledgable, straight-forward. I give him the highest recommendation.

I have known Dennis both professionally and personally for over 30 years. When it comes to my health insurance needs, he has always had my best interests in mind. He is honest and direct and caring and conscientious. I might not always say it, but I appreciate how he has kept me informed to an ever changing health care environment. As a CPA, I have never hesitated to refer my clients to him. I know he will give my clients the same personalized service that I give my clients. My clients thank me for referring Dennis and were glad he was able to help them through some very difficult situations. Even if he was unable to help my clients, he has always been available for consulting and assisting in making a decision. Whether the situation was dealing with the “normal” day to day health care needs or something more complicated like medicare, he has always been aware of and has the knowledge of the various plans in the market place. Dennis also sells business insurance and long-term care insurance. I would expect that he gives nothing less than his utmost professionalism to these sales and services as well. I never hesitate to refer Dennis. He will always be available to assist his clients in what ever manner is necessary. The client comes first..

I was recommended to speak to Dennis by my general doctor. He has been incredibly helpful in finding me the best insurance policies for my specific needs. He’s easy to reach, extremely knowledgeable, and honest. I expect to work with him for many years to come!

Dennis David is everything you would want in an insurance agent. He is knowledgeable, efficient, honest, and caring. He has worked with us through some very demanding insurance needs. Mr. David met with all of our employees individually and identified their personal budget and issues with which they could benefit the most. He took the time to research and present comprehensive plans to the administration and employees. In the end, everyone felt satisfied and had obtained the coverage which was best for them , within the appropriate budget. For me personally, he helped us find an insurance that would cover our daughter’s medication needs. I was so impressed with the attention he paid to us so that we could have a positive outcome. I have recommended him to family and friends. I highly recommend this agency to everyone.

I have been working with Dennis for the last 14 years! He is incredibly knowledgeable, patient and helpful. He always calls me right back when I leave a message, takes time to answer all of my questions, and never makes me feel rushed to make a decision. I have recommended him to other people and would highly recommend him if you are looking for someone to help you thru all the craziness of health insurance.

Dennis is extremely knowledgeable, patient and straightforward. Most importantly, he really seems to care about his clients. He has been incredibly helpful to us in navigating through the otherwise completely anxiety provoking labyrinth of selecting insurance. In fact, he seems to care more about providing a service than making a sale. I recommend him as highly as possible

Dennis is a great listener, does what is helpful to me and my friends whom I have sent to him, and in general is a fantastic resource in this space of insurance. He knows the business, what needs to be considered and guides me through it with patience and caring. Thank you Dennis!

I’ve gone through several rounds of health insurance reviews with Dennis David for our family plan and am so appreciative of how thorough he is! He is incredibly patient and explains all of the small details, and there are many these days! I would highly recommend Dennis to anyone who would like to better understand all healthcare options in this rapidly changing insurance environment.

Dennis could not have been more helpful when we spoke on the phone regarding my need for medical insurance. He was patient and explained everything very clearly, answering all my questions thoroughly and patiently. He even offered advice above and beyond what I asked him and it was very much appreciated. Highly recommend him.

Dennis David has helped me navigate through the complex, changing web of health insurance plans for many, many years. His dedicated support and patience goes far beyond the call of duty and I can always count on David for wise and excellent advice. He sincerely cares about his clients and works tirelessly to come up with the very best health insurance plan to suit their needs. I can’t recommend him highly enough.

The Dennis David Insurance Agency came highly recommended through a good friend of mine several years ago. He and his wife have relied on Dennis David for years for their insurance needs. Dennis has a gift for simplifying what could potentially be a complex process for his clients. His follow-up is timely, clear and concise. Dennis David’s Agency provides outstanding service with an integrity and excellence I know I can count on!

Dennis David has handled my family’s insurance needs for over 20 years. He is knowledgeable, thorough, and absolutely trustworthy. I consider myself very lucky to have him in my corner.

We have been Mr. David’s customer for several years now. Dennis has been very responsive and attentive to our practices needs. He initially reviewed our small business insurance coverage and found some holes in our coverage and was able to provide us the right coverage at a lower price than what we were paying. He subsequently has been monitoring our practice insurance policies and has made the appropriate changes as needed. Dennis is extremely knowledgeable, his follow-up, advice and expertise is above standard and I would definitely recommend him.

..to answer all of my questions and help me to navigate on the huge ‘ocean’ of heath insurance options, specifications, etc. He is extremely knowledgeable and looks out for MY best interest. I can’t say enough about what a gem he is!

Dennis has worked with my family and me for thirty years through various changes in our health insurance needs beginning when we were a young family and going through our going on Medicare. In all cases he was reliable, available, professional, and caring of our needs, whether or not his recommendations resulted in a premium for him. There were times when he recommended products where he was not in a position to make a fee because he felt the product was best for us. I always knew I could count on on him for insurance advice, and I have referred him many friends and family. He gets my highest rating.

We have found Dennis David to be an excellent broker and extremely helpful and knowledgeable. We have always referred him to our friends and clients and always with total satisfaction! A very honest and trustworthy individual.

Dennis is an excellent insurance agent. He helped us navigate all the changes that we faced during implementation of the Affordable Care Act and found the best medical and dental insurance policies for our family. He is honest, professional, well connected in the industry, and has a sophisticated understanding of its complexities. He has the ability to present complicated choices in more simple form and can answer all the tough questions facing consumers. Our family is very grateful for his guidance!

i have been with dennis for many years and he always responds quickly to any questions i have. i would highly recommend him to take care of any insurance issues you may have.

We’ve been working with Dennis for many years and he has guided us through the labyrinth of health insurance plans for ourselves and our employees. He explains things in understandable terms, is incredibly patient, reliable and we feel he always has our best interest in mind. We can’t recommend Dennis’s services highly enough.

We always know when we have any and all questions about our insurance that Dennis David is always there to help us with the best choices and decisions for our family. So nice to know Dennis is always there for us.

I have been a client for over 20 years and there has not been a time when I asked a question that Dennis has not been helpful. Dennis makes you feel that you are his most important client. He is very knowledgeable about the insurance industries.

Thank you for being so patient and explaining everything to me so thoroughly! I was so overwhelmed and you made it all so clear!

Dennis took so much time with me and my family to find the right Insurance plan for us. We have switched plans many times for various reasons and he was always so knowledgeable, patient, creative and helpful. He listened and understood our unique needs and came up with many choices for us and went through the pros and cons of each option. He knows the business so well and really has such a gentle way of dealing with people that it made it so easy to reach out and ask questions. I have recommended him to many of my friends and feel confident that anyone who works with him will be extremely satisfied.

I would have been lost without Dennis David’s help. He made sure I found a reliable health insurance provider. Strongly recommend!

I can’t say enough great things about Dennis and his expertise. He has a plethora of knowledge in this industry and with the most complicated and confusing changes within the health insurance world, it’s nice to know he keeps up with this information. I always feel reassured when I deal with him and I know he places my family and I in the best plans in a customized fashion. We are blessed to know him and call him our insurance agent! He knows his stuff so you don’t have to! That makes my life easier for me, and I’m deeply grateful.

Dennis is a true professional. I highly recommend using Dennis. He is easily accessible and very knowledgable. He helped guide us into the right health insurance for my entire family and helped me get a refund from another insurance company that owed us money. Thanks again Dennis!

I have been with Dennis for years. His service is second to none. I always get well informed and detailed information on how to make the best decisions for insurance that is cost effective for the coverage I need. He is available when I have questions and gives updates about changes in insurance programs. Nice to have an agent that keeps me current. I highly recommend Dennis.

Dennis David has helped me enroll employees in health insurance plans, has walked me through Affordable Care, and just recently held my (electronic) hand as I waded through the medicare system and enrolled in supplementary insurance. He is thoughtful, he makes sure I understand what I’m doing, he keeps me updated on changes. I absolutely trust him and I would — and have — recommend him to my friends.

Dennis advised us of our options and carefully explained the pros and cons of the different choices. We have excellent personal health insurance coverage and have been able to maintain the same policy for years. We were so pleased that we asked him to find insurance for my company. He looks at different options and price compares for us every year. We made the right decision in choosing Dennis!

Dennis is amazing! He is very knowledgeable and always up to date on the healthcare industry. He’s helped me in so many ways. I always check with him, first, before I make any decision on health insurance!

I have known Dennis for over 30 years, we met while colleagues in an Insurance Firm, and have remained steadfast friends ever since. Dennis’s work ethics have never changed, honest, truthful, responsible and accountable. He takes care of his clients, understanding their needs, always offering guidance with such kindness, which in today’s marketplace, is not easy to find. When my time came for a Long Term Health Policy, Dennis gave me options, explaining the differences in coverages and costs. A financial planner recently took a look at my policy and was so impressed with its detail, thank you Dennis. When time came for retirement and entering the Medicare world, Dennis was so very thorough in every aspect of all the Plans. I felt very taken care of and secure, thank you Dennis The insurance world is very lucky to have Dennis David with his expertise and caring ways, he will not disappoint.

Dennis David has been my insurance agent for many years. He is very helpful and knows his stuff. He is always well prepared when it comes time for me to make insurance decisions and he offers me different choices, so I can make informed decisions. I highly recommend Denis David for all insurance needs.

I found my experience with Mr. David to be an example of true expertise. He was patient and really listened to my concerns and got right to the heart of what I needed for my family. His efficient communication really assisted me in trusting the whole insurance process and made it simple not complicated. All of my questions were answered swiftly and I knew that I was in good hands, thank you again!

I have used Dennis David’s services for over 20 years and been extraordinarily satisfied with EVERYTHING! Not once has he disappointed me or not been able to help me with questions or issues. I have recommended him to all of my friends, most of them self-employed over this time period and they are all still with him. Dennis is not only proficient in his profession but he is really kind and compassionate. There is nothing at all that I have been reticent to tell him.

Dennis is very attentive and knowledgable. We have done business with him for many years and he always gets back to us in a timely and efficient manner. I am very happy we found someone we can trust and work with!

 

I had the great good fortune of working with Mr. David, just this past year. During the most confusing and high pressure time the Affordable Care Act proposed. He not only was he exceedingly professional, knowledgeable he made the process smooth and very comprehensible for a novice like me. With his guidance I feel confident that I choose the best health care plan for my budget and my needs. I have used it twice now with no surprises. I would highly recommend Mr. David’s services to anyone; businesses and individuals a like, he is very approachable, quick to respond and has many avenues of access one of which is his website.

I have bought insurance from Dennis – Health, Life and Liability – over 20 years. Insurance can be complex and Dennis is always able to explain what is important and he is able to help me make the right decision. I value his advice and look forward to continuing to do business with the Dennis David Agency

We are using Dennis for closee to 20 years. We admire his knowledge, and his devvotion to his customers. Dnnis is always there when you need him, is esponsee time is fantastic. His proffeesionlism is a 10.

Dennis is the most professional and knowledgable insurance broker I have ever known. He makes it a point to stay informed with the latest changes in the industry that effects me. He is exceptional in staying in good contact with me. His very high ethical standards are apparent at all times.

I have been very happy dealing with insurance companies because I have Dennis David to help me. I have had an awesome experience with Dennis L. David insurance company. Every time there is an issue or a billing error, they instantly attend to it and take care of it for me. I would recommend this company to everybody.

I have worked with Dennis for many years and as an Insurance Broker his knowledge and service is second to none! He provides his clients with competitive products to meet all of their insurance needs. For Dennis, helping clients is his priority!

I have worked with Dennis David for over 15 years. He always takes care of me and my needs. Now he also takes care of members of my family. Dennis has been especially wonderful during the changes in our healthcare system. I mean, who can figure it out? I am grateful to have him to explain it all. I am well taken care of.

I have worked with a number of insurance agents through the years, but without a doubt, this agency has been by far the best. Dennis David, in particular, is exceptional in his knowledge and expertise, and when he doesn’t know the answer, he researches it and in a timely manner reconnects with you. There is a true conscientiousness and concern for the client. As for me, with the dramatic and sweeping changes that occurred in health insurance, I felt very unclear as to what direction I should take. He was able to significantly help me sort through the morass of choices, and help land an insurance plan that was the best fit for me. I very much appreciated his guidance and I learned later that his suggestions were offered irrespective of the commission he could potentially receive. I highly recommend this agency.

Health insurance concerns can be difficult to navigate at times. Whenever I call Dennis he has always created time to patiently explain all aspects of my insurance plan. He collects all the information and addresses the pros and cons to answer my specific questions which I truly appreciate! He is wonderful to work with and I highly recommend him!

I have known Dennis David for many years and he is the most professional and honest insurance agent. I highly recommend his services for all of your insurance needs.

“Dennis has worked with my family for years. He’s consistent and reliable along with being very nice and easy to work with! Insurance can be complicated and costly, it’s of so much value have someone like Dennis on your side during the process. I would recommend him time and time again! I’m grateful to have him on my team. I always feel like my needs are met and that I’ve accomplished what I wanted after our phone meetings. He’s also great on email which is a plus for me!”

– Lucy F.
“Dennis is very knowledgeable, friendly and helpful when it comes to sorting through the confusing world of insurance. I highly recommendation Dennis.”
Hi Dennis, I wanted to let you know that of May 1, 2016  I need to cancel our insurance with Anthem Blue Cross. I would like to thank you again for all your help at a time we had no idea what we were going to do. You walked us through every option and helped us make the best choice and decision for our family. I don’t know what we would have done with out you. Thank you again for always being there to help with our many questions.
Thank you so much Dennis for your dedication in helping us.

Changes to Blue Shield of California Medicare Supplement Plans

Approximately 11,500 Medicare Supplement subscribers in open and closed plans were migrated to our new back-end claims system on July 1, 2015. If you have Medicare Supplement clients who are billed quarterly in January, April, July, and October, they were part of this migration and have received a series of communications explaining changes to their Blue Shield member ID cards, subscriber and group plan numbers, bill format, and billing payment address.

New ID card
Members who were migrated on July 1, 2015 have been mailed a new ID card that features new subscriber and group numbers. Please remind your clients that they need to present this new ID card on their next visit to their physician after July 1, to ensure that their new subscriber number is updated in provider records.

New billing statement
Migrated members will also receive a new billing statement with an improved format that will make it easier to read and find important information.

Their first new bill will be delayed, arriving approximately one to two weeks after its regular due date. Our standard 30-day grace period for payment will extend from the date on the first new bill. Billing will resume its regular schedule on their next billing cycle.

If a member uses their bank’s online bill-pay option or another automated payment option to pay their bill each month, they will need to notify their bank about their new subscriber number and bill payment address (found on the new billing statement) to ensure that their payment is applied to their new Blue Shield account rather than the old one.

Here is the migration schedule for the remainder of Medicare Supplement plan members:

  • September 1, 2015 migration includes those who are billed monthly and those billed quarterly in March, June, September, and December. This is our largest group; we will be migrating approximately 133,000 members.
  • November 1, 2015 migration includes those who are billed quarterly in February, May, August, and November. This group will include the remaining members – approximately 7,100.

Please visit our Medicare Supplement plan webpage to learn more about these changes and download related FAQs and member materials.

If you have any questions or concerns, please contact your Blue Shield representative.

 

 
   
 
 
  Two new hospitals added to the Blue Shield Medicare 65 Plus network
   

Effective July 1, 2015, Community Memorial Hospital of San Buenaventura and Ojai Valley Community Hospital are part of the Blue Shield 65 Plus network.

 

 

Insurance premiums spark new front in Obamacare war

In this the second year of implementation of the Affordable Care Act, premiums have not stabilized but it is probably an unreasonable expectation of the giant upheaval in a the health insurance system. The coming years will be the litmus test, hopefully the trend of large rate increases will turn around.

Below is an article from the Washington Examiner, date July 6, 2015.

Republicans target big increases as evidence that healthcare law isn’t working

Insurance premiums have quickly become a new front in the Obamacare fight, with opponents pouncing on big increases and supporters and experts countering the increases won’t be so bad.

The fight started last month when insurers were required to disclose estimated 2016 rates of 10 percent or more for Obamacare customers. Some figures grabbed headlines, especially with certain insurers calling for 50 to 70 percent increases.

The premium spikes vary by state and insurer. For instance, some plans in Florida are actually proposing reduced premiums, but 13 plans want rate increases of 10 percent or more, including Time Insurance Co.’s 63 percent hike.

Republicans say the higher rates are evidence that the law is hurting Americans and not lowering healthcare costs.

“The whole point of Obamacare was to make health care more affordable. But premiums aren’t going down; they’re going up — way up,” said Rep. Paul Ryan, R-Wis., chairman of the House Ways and Means Committee, in a recent hearing.

“The model we’re on in the Affordable Care Act is not sustainable,” said Rep. Mike Kelly, R-Pa., at the same hearing.

This is the first time since Obamacare’s passage that insurers can look at a full year’s worth of claims data and calculate premiums, Rep. Pete Roskam, R-Ill., said at the hearing. He added that the premium spikes are not growing pains.

“The law created a number of temporary programs to pay out billions in taxpayer funds during the first few years to lower costs seen by individuals and to protect big insurance companies against financial losses,” he said. “But those programs are beginning to phase out, and as the government is slowly taking off the training wheels, Obamacare is looking pretty wobbly.”

Supporters counter that any increases aren’t finalized and will have a modest impact overall.

“We have just the bad news,” said Kathy Hempstead, who directs coverage issues for the Robert Wood Johnson Foundation.

One analysis found that Obamacare customers as a whole may only see a modest increase.

The research firm Avalere looked at proposed rate filings in seven states and the District of Columbia. The average premiums for silver plans, the second cheapest option and a popular choice for Obamacare enrollees, will increase nearly 6 percent, Avalere said.

Avalere also noted that the low-cost silver plan options are likely to be smaller than the silver plan as a whole. Premiums for the lowest- and second-lowest silver plans in the seven states and D.C. will increase on average 4.5 percent and 1 percent.

A separate analysis from the nonpartisan Kaiser Family Foundation found that in 11 major cities the cost of a regular silver plan would be on average 4.4 percent higher in 2016 than this year.

Premiums must be finalized by October. That way customers facing a high premium can choose a different plan during the next open enrollment this fall.

Another reason why the rates could change is states need to conduct reviews themselves.

Obamacare requires states to report on any premium increase trends and recommend whether certain plans should be excluded from the exchanges, according to the National Conference on State Legislatures.

In 2011, the federal government started to work with states to strengthen or alter their rate review programs. If a state doesn’t have the resources to conduct the required review, the Department of Health and Human Services will do it, the National Conference on State Legislatures said.

“The carriers really have to be able to explain their rates, and that is part of the point of the whole medical loss-ratio regulations,” Hempstead said.

The medical loss ratio is another new regulation installed under Obamacare. It requires insurers to devote 85 percent of the cost of a premium on medical care and the other 15 percent on administrative costs.

The ratio ensures that insurers don’t devote too much of their costs to overhead.

Amid the rhetoric over the premium increases are certain trends that could affect the insurance market as a whole.

Many Blue Cross Blue Shield insurers kept premiums in marketplaces comparatively low with small increases from year to year, but that varies considerably across the country, according to a study of trends for market place plans done by the foundation and the left-leaning think tank Urban Institute.

The report looked at the cheapest silver plans in 30 states. Some insurance companies were reluctant to enter the Obamacare marketplaces in 2014 and when they did the plans were more expensive.

However, the report projects insurers will lower premiums to keep prices low to attract enough customers buying insurance through the Obamacare marketplaces.

But for opponents of Obamacare, the proposed increases represent a long-standing criticism about the law’s ability to battle healthcare costs, which was levied even before the exchanges opened in 2014.

Centene to Combine with Health Net in Transaction Valued at Approximately $6.8 Billion

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Investor Relations – News Release

The article below has been copied from the St. Louis and Los Angeles Business Wire Dated July 2, 2015

Centene to Combine with Health Net in Transaction Valued at Approximately $6.8 Billion

Creates Leading Platform for Government-Sponsored Programs and One of the Largest Medicaid Managed Care Organizations in the Country

Broadens Presence to Build Scale and Drive Diversification

Transaction Expected to be Significantly Accretive to Centene’s EPS in the First Year Following Close

Estimated to Achieve up to Approximately $150 Million in Annual Synergies by the Second Year Following Close

Companies to Host Conference Call at 8:30 AM ET

ST. LOUIS & LOS ANGELES–(BUSINESS WIRE)–Jul. 2, 2015– Centene Corporation (NYSE: CNC) and Health Net, Inc. (NYSE: HNT) announced that the Boards of Directors of both companies have unanimously approved a definitive agreement under which Centene will acquire all of the shares of Health Net in a cash and stock transaction valued at approximately $6.8 billion, including the assumption of approximately $500 million of debt.

The combination of Centene and Health Net would create a leading diversified multi-national healthcare enterprise with more than ten million members across the country and estimated 2015 pro forma premium and service revenues of approximately $37 billion. Centene is expected to continue to deliver attractive growth by offering a more comprehensive and scalable portfolio of innovative solutions focusing on uninsured and under-insured individuals, including participation in Medicare Advantage, TRICARE, and Veterans Affairs programs. The companies believe that the addition of Health Net’s high-qualityMedicare platform to Centene’s Medicaid programs provides an opportunity for additional growth across the combined company’s markets. Health Net’s demonstrated commitment to risk-based provider arrangements is reflective of the market shift from volume to value and is anticipated to enhance Centene’s leading position in high quality, low cost access to government-sponsored programs. With increased scale and diversification, Centene expects to deploy its full portfolio of specialty services and provide an integrated offering that benefits its members, providers and other stakeholders.

Under the terms of the agreement, Health Net shareholders would receive 0.622 shares of Centene common stock and $28.25 in cash for each share ofHealth Net common stock. Based on Centene’s closing stock price on July 1, 2015, the implied consideration of $78.57 per share represents a premium of approximately 21% over Health Net’s closing stock price on July 1, 2015, and of approximately 26% on June 1, 2015. Upon completion of the transaction,Centene shareholders would own approximately 71% of the combined entity, with Health Net shareholders owning approximately 29%. The transaction is expected to be significantly accretive to Centene’s diluted earnings per share in the first year following closing.

“We are pleased to have reached this agreement with Health Net, which we believe will create value for both Centene and Health Net shareholders and will enhance our ability to serve our members and work with our providers and government partners,” said Michael F. Neidorff, Centene’s Chairman, President and Chief Executive Officer. “Over the past five years, Centene has achieved record performance and today’s announcement is a significant next step in our strategy to increase scale and drive geographic and product diversification. This transaction ensures that we extend our competitive position as one of the largest plans covering government-sponsored programs in the country. Health Net’s presence in California and other key western states is complementary to our offerings, allowing us to bring additional innovative solutions to the healthcare market. With Health Net, we see opportunities to leverage our local approach more broadly to enhance our members’ access to higher quality healthcare services on a cost-effective basis and ensure measurable quality outcomes.”

Mr. Neidorff continued, “We have tremendous respect for Health Net’s management team and employees, and for all that they have accomplished. Given our scalable model and record of successfully integrating acquisitions, we expect to achieve a smooth transition. Together, we will build on both companies’ shared commitment to working with providers and key community stakeholders to achieve better results for members and drive shareholder value.”

Jay Gellert, Health Net’s President and Chief Executive Officer, said, “Centene has an impressive record of serving populations that have been traditionally underserved in a high-quality and consumer-centered manner. Our successes complement Centene very well and will lead to better offerings in line with new consumer and payer demands. After closing, we will be a leading provider of managed health care services very much aligned with the future. We expect thatHealth Net associates will play a critical role in the future of the combined company.”

Strategic and Financial Benefits of the Transaction

  • Addition of Incremental Scale: The addition of Health Net’s complementary network is expected to strengthen Centene’s presence in the California Medicaid program, which is the country’s largest with more than 12 million individuals. The transaction will provide Centene with access to California’s dual demonstration program and expansion in other Medicaid and Medicare programs in the Western United States, including Arizona, Oregon andWashington. The combined company expects to have approximately six million Medicaid members, making it one of the largest Medicaid managed care organizations in the country. The combined company anticipates driving profitable growth by leveraging Centene’s local approach that provides members access to high quality and culturally sensitive health care services.
  • Increased Product Diversity Provides Ability to Create a More Comprehensive Portfolio: This transaction would extend Centene’s offerings in government programs including Medicare, TRICARE, and U.S. Department of Veterans Affairs. The combined company would be positioned to provide its members access to more solutions, with opportunities for integrated specialty services across the entire enterprise. In particular, the combined company believes that Health Net’s high quality Medicare platform, including its presence in Medicare Advantage, has the potential to be applied across the combined business thereby enhancing the growth strategy. Centene also believes there are opportunities to scale Health Net’s programs that reach underserved communities and extend its business lines for this constituency. Both companies have demonstrated success focusing on the subsidized portion of the Health Insurance Marketplace. The companies believe that by focusing on these government programs, the combined company will enhance its innovative provider relationships that enable it to deliver affordable, accessible healthcare.
  • Strong Financial Profile and Significant Earnings Accretion: Combined, Centene and Health Net are estimated to have 2015 pro forma annual premium and service revenues of approximately $37 billion. The transaction is expected to generate diluted earnings per share accretion of 10% and adjusted diluted earnings per share accretion of 20% in the first year following closing.
  • Significant Synergy Opportunities: The combined company is estimated to achieve approximately $150 million of annual cost synergies by the second year following close with 50% achieved after year one following close. Synergies will come from areas including efficiencies in core G&A, integration of a range of specialty services and leveraging capabilities in IT systems and process management.

Organization and Management

Upon closing of the transaction, Mr. Neidorff will lead the combined company as Chairman, President and Chief Executive Officer. Mr. Gellert will assist to achieve a smooth transition. The combined company will be headquartered in St. Louis, Mo, the location of Centene’s current headquarters, with operations throughout the country.

Financing and Approvals

Centene intends to fund the cash portion of the acquisition through a combination of existing cash on hand and debt financing. The transaction is not contingent upon financing, with Wells Fargo, N.A. providing $2.7 billion of financing commitment.

The transaction is expected to close by early 2016. It is subject to approval by Centene and Health Net shareholders, the expiration or termination of the applicable waiting periods under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended, approvals by relevant state insurance and healthcare regulators and other customary closing conditions.

Advisors

Allen & Company LLC and Evercore are serving as financial advisors to Centene, with Skadden, Arps, Slate, Meagher & Flom LLP serving as legal counsel. J.P. Morgan Securities Inc. LLC is serving as financial advisor to Health Net with Morgan, Lewis & Bockius LLP serving as legal counsel.

Conference Call

Centene and Health Net will host a conference call today, July 2, 2015, at 8:30 a.m. (Eastern Time) and will simultaneously broadcast it live over the Internet. The conference call can be accessed by dialing (866) 610-1072(866) 610-1072 FREE (domestic) or (973) 935-2840(973) 935-2840 (international). An investor presentation, to be reviewed during the conference call, can be accessed via each company’s investor relations website at www.centene.com/investors orwww.healthnet.com/InvestorRelations. A telephonic replay of the conference call will be available immediately after the call and can be accessed by dialing (800) 585-8367(800) 585-8367 FREE, or for international callers, (404) 537-3406(404) 537-3406. The passcode for the live call and the replay is 77042984. The archive of the call replay will be available until July 16, 2015. The live webcast and archived replay can be accessed on both companies’ investor relations websites. The online archive of the webcast will be available until July 2 of 2016.

About Centene

Centene Corporation, a Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government-sponsored healthcare programs, focusing on under-insured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children’s Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs and Medicare (Special Needs Plans). The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.

About Health Net

Health Net, Inc. (NYSE:HNT) is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. Health Net provides and administers health benefits to approximately 6.0 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as “Part D”), Medicaid, dual eligible, U.S. Department of Defense, including TRICARE, and U.S. Department of Veterans Affairsprograms. Health Net also offers behavioral health, substance abuse and employee assistance programs, and managed health care products related to prescription drugs.

For more information on Health Net, Inc., please visit Health Net’s website at www.healthnet.com.

Forward Looking Statements

This press release contains certain forward-looking statements with respect to the financial condition, results of operations and business of Centene, Health Net and the combined businesses of Centene and Health Net and certain plans and objectives of Centene and Health Net with respect thereto, including the expected benefits of the proposed merger. These forward-looking statements can be identified by the fact that they do not relate only to historical or current facts. Forward-looking statements often use words such as “anticipate,” “target,” “expect,” “estimate,” “intend,” “plan,” “goal,” “believe,” “hope,” “aim,” “continue,” “will,” “may,” “would,” “could” or “should” or other words of similar meaning or the negative thereof. There are several factors which could cause actual plans and results to differ materially from those expressed or implied in forward-looking statements. Such factors include, but are not limited to, the expected closing date of the transaction; the possibility that the expected synergies and value creation from the proposed merger will not be realized, or will not be realized within the expected time period; the risk that the businesses will not be integrated successfully; disruption from the merger making it more difficult to maintain business and operational relationships; the risk that unexpected costs will be incurred; changes in economic conditions, political conditions, changes in federal or state laws or regulations, including the Patient Protection and Affordable Care Act and the Health Care Education Affordability Reconciliation Act and any regulations enacted thereunder, provider and state contract changes, the outcome of pending legal or regulatory proceedings, reduction in provider payments by governmental payors, the expiration of Centene’s or Health Net’s Medicare or Medicaid managed care contracts by federal or state governments and tax matters; the possibility that the merger does not close, including, but not limited to, due to the failure to satisfy the closing conditions, including the receipt of approval of both Centene’s stockholders and Health Net’s stockholders; the risk that financing for the transaction may not be available on favorable terms; and risks and uncertainties discussed in the reports that Centene and Health Net have filed with the Securities and Exchange Commission (the “SEC”). These forward-looking statements reflect Centene’s and Health Net’s current views with respect to future events and are based on numerous assumptions and assessments made by Centene and Health Net in light of their experience and perception of historical trends, current conditions, business strategies, operating environments, future developments and other factors they believe appropriate. By their nature, forward-looking statements involve known and unknown risks and uncertainties because they relate to events and depend on circumstances that will occur in the future. The factors described in the context of such forward-looking statements in this announcement could cause Centene’s and Health Net’s plans with respect to the proposed merger, actual results, performance or achievements, industry results and developments to differ materially from those expressed in or implied by such forward-looking statements. Although it is believed that the expectations reflected in such forward-looking statements are reasonable, no assurance can be given that such expectations will prove to have been correct and persons reading this announcement are therefore cautioned not to place undue reliance on these forward-looking statements which speak only as of the date of this announcement. Neither Centene nor Health Net assumes any obligation to update the information contained in this announcement (whether as a result of new information, future events or otherwise), except as required by applicable law. A further list and description of risks and uncertainties can be found in Centene’s Annual Report on Form 10-K for the fiscal year endedDecember 31, 2014 and in its reports on Form 10-Q and Form 8-K as well as in Health Net’s Annual Report on Form 10-K for the fiscal year ended December 31, 2014 and in its reports on Form 10-Q and Form 8-K.

Additional Information and Where to Find It

The proposed merger transaction involving Centene and Health Net will be submitted to the respective stockholders of Centene and Health Net for their consideration. In connection with the proposed merger, Centene will prepare a registration statement on Form S-4 that will include a joint proxy statement/prospectus for the stockholders of Centene and Health Net to be filed with the SEC, and each will mail the joint proxy statement/prospectus to their respective stockholders and file other documents regarding the proposed transaction with the SEC. Centene and Health Net urge investors and stockholders to read the joint proxy statement/prospectus when it becomes available, as well as other documents filed with the SEC, because they will contain important information. Investors and security holders will be able to receive the registration statement containing the joint proxy statement/prospectus and other documents free of charge at the SEC’s web site, http://www.sec.gov. These documents can also be obtained (when they are available) free of charge from Centene upon written request to the Investor Relations Department, Centene Plaza 7700 Forsyth Blvd. St. Louis, MO63105, (314) 725-4477 or from Centene’s website, http://www.centene.com/investors/, or from Health Net upon written request to the Investor Relations Department, Health Net, Inc. 21650 Oxnard Street Woodland Hills, CA 91367, (800) 291-6911(800) 291-6911 FREE, or from Health Net’s website,www.healthnet.com/InvestorRelations.

Participants in Solicitation

Centene, Health Net and their respective directors and executive officers and other members of management and employees may be deemed to be participants in the solicitation of proxies from the respective stockholders of Centene and Health Net in favor of the merger. Information regarding the persons who may, under the rules of the SEC, be deemed participants in the solicitation of the respective stockholders of Centene and Health Net in connection with the proposed merger will be set forth in the joint proxy statement/prospectus when it is filed with the SEC. You can find information about Centene’s executive officers and directors in its definitive proxy statement for its 2015 Annual Meeting of Stockholders, which was filed with the SEC onMarch 16, 2015. You can find information about Health Net’s executive officers and directors in its definitive proxy statement for its 2015 Annual Meeting of Stockholders, which was filed with the SEC on March 26, 2015. You can obtain free copies of these documents from Centene and Health Net using the contact information above.

No Offer or Solicitation

This communication shall not constitute an offer to sell or the solicitation of an offer to sell or the solicitation of an offer to buy any securities, nor shall there be any sale of securities in any jurisdiction in which such offer, solicitation or sale would be unlawful prior to registration or qualification under the securities laws of any such jurisdiction. No offer of securities shall be made except by means of a prospectus meeting the requirements of Section 10 of the Securities Act of 1933, as amended, and otherwise in accordance with applicable law.

 

View source version on businesswire.com: http://www.businesswire.com/news/home/20150702005239/en/

Source: Health Net, Inc.

For Centene
Investors
Edmund Kroll, 212-759-0382212-759-0382
or
Media
Marcela Manjarrez-Williams, 314-505-6502314-505-6502
or
For Health Net
Investors
Peter O’Neill, 818-676-8692818-676-8692
or
Media
Brad Kieffer, 818-676-6833818-676-6833

 

 

“Safe Harbor” Statement under the Private Securities Litigation Reform Act of 1995: Statements in this press release regarding Health Net, Inc.’s business which are not historical facts are “forward-looking statements” that involve risks and uncertainties. For a discussion of such risks and uncertainties, which could cause actual results to differ from those contained in the forward-looking statements, see “Risk Factors” in the Company’s Annual Report or Form 10-K for the most recently ended fiscal year.

 

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