California Health Care
by John Hansen
A health insurance agent complained to Assemblyman Jim Wood at the CAHU Capitol Summit 2016 about California carrier networks. The agent mentioned a client who left his California group health insurance and switched to an individual plan with the same carrier. However, once he did, he found that his doctor was no longer in network. This consumer stayed with the same carrier, but the change from a small business to California individual health insurance coverage caused the provider network to change.
So this agent questioned, “Should California carrier networks be the same for individual and family as they are for small group health coverage?”
Assemblyman Jim Wood had no response to the question, but seemed to think it was an interesting comment. Obviously, CA provider networks wasn’t a hot topic in Sacramento. But a good question none-the-less.
ACA has standardized the health plans so people can look at Covered California’s metallic plans and do apples-to-apples comp...
by John Hansen
Many California health plans now include marijuana insurance. Doctors can prescribe it as a pharmaceutical prescription like many other Rx drugs. Assemblyman Jim Wood, from the 2nd District, commented on two bills related to marijuana, insurance and the regulation of cannabis.
Assembly Bill AB 2243 has been called the Meth and Marijuana Regulation Safety Act. It deals with medical cannabis taxation, production and environment mitigation. Should this bill pass, additional taxation may apply to those utilizing marijuana insurance.
Assemblyman Wood pointed out that the bill hits close to home for him. “60-70% of marijuana is grown in the Emerald Triangle in my district,” he says. The bill was introduced in February this year, went through some amendments, and was approved to go to the suspense file on May 11.
The tax portion of the bill for those with and without marijuana insurance would include a $9.25/ounce tax on medical cannabis flowers, a $2.75/ounce tax on leaves...
by John Hansen
Rob Bonta (Democrat), State Assemblyman from the 18th District, responded to this question on May 17th. He suggested ideas toward getting low cost health insurance in California. He commented on the prices of prescription drugs, Medi-Cal reimbursements and his bill AB 533 aimed at protecting consumers from surprise medical bills.
New specialty drugs are driving up health care costs. There is much debate in Sacramento as to how to fight this trend. Bonta commented that we need to go after the “bad actors” that are putting out high priced specialty drugs without first doing the proper research and development.
These super drugs, some effective and some not, are making it difficult to achieve low cost health insurance in California.
Bonta is actually the author of this bill which is now on the Assembly floor. Despite the fact that this bill has been challenged by California health plans, it enjoys wide support from Democrats, Republicans and health care experts, so it will...
by John Hansen
California Commissioner, Dave Jones, commented on May 17 in Sacramento, “I’m skeptical. All the literature says that big mergers haven’t helped, but have caused premiums to go up.” Health care mergers mean less competition and less competition often means higher prices and lower quality of care.
The Centene-Health Net merger involves two California health plans, so the approval for the health care merger had to come from the California Department of Insurance (DOL). The DOL and Dave Jones, the California Commissioner of Insurance, imposed certain conditions on the merger.
Centene-Health Net required a commitment to the distribution network, namely the California health insurance agents. Jones added, “I said Health Net must sell health products in California commercial markets including individual, small group and large group.” Also, they were required to make financial commitments toward growing their block of business in California.
The other two mergers, Anth...
by John Hansen
In California, the Department of Insurance is responsible for licensing new agents and renewing the credentials of agents every year. Presently, the California Department of Insurance license renewal program allows about 136,000 agents to get their licenses renewed annually.
Through a carefully monitored registration and renewal process, the DOI ensures that you and other health insurance plan enrollees enjoy the benefits of a more competitive market. The DOI is currently under the direct supervision of California Commissioner, Dave Jones.
Agents that deal with life and health insurance need to complete mandatory testing to obtain their licenses. The DOI has increased the number of testing centers from the original three locations to 24.
The process of getting your license as an agent begins with providing your fingerprints. This first step triggers a background check to ensure you have no previous misdemeanors and you’re qualified to receive a license. You also must compl...
by John Hansen
CAHU is a support organization for agents and brokers of health insurance in California. The legislative arm of this organization is called PAC, the Political Action Committee. This organization fights for agent commissions and legislation that helps agents and consumers in California.
CAHU has 2200 members throughout California. It is a subsidiary of NAHU, the National Association of Health Underwriters.
The California Insurance Commissioner, Dave Jones, said to a room fool of agents on Tuesday, May 17 at the CAHU Captol Summit, “You are ably represented by CAHU. They are smart, thorough, get back to us and do a great job on your behalf.”
Juli Broyles and Michael Belotte operate as lobbyists for CAHU in Sacramento California. They are well versed in state law related to health care, and they are well respected at the state capitol.
by John Hansen
In 2013, United Health Care (UHC), America’s largest insurer, played it safe and withdrew from the California Exchange. So Covered California offered no California health plans from UHC in 2014. Later, the United Health Care Insurance Plan came back to Covered California asking to enter the Health Insurance Marketplace for the 2015 Open Enrollment.
Dave Jones, Commissioner of the California Department of Insurance said, “They should embrace them coming back in.” However, it seemed that top level officials at Covered California wanted to punish the United Health Care Insurance Plan for dropping out the first year. So they only let UHC enter the market in the least populated counties in the most remote areas.
“They were willing to do all of California,” says Dave Jones. “It was a mistake not to let them. I hope they’re still interested, but they might not be.”
Jones who said “I’m not shy” spoke very strongly against Covered California’s treatment of t...
by John Hansen
The California State Insurance Commissioner, Dave Jones, came out strongly in favor of California health agents in a talk to the California Association of Health Underwriters on Tuesday, May 17th. He argued that since the implementation of the Affordable Care Act, agents and brokers have enrolled “the lion’s share” of newly insured Californians in the State Exchange, and for that he was truly grateful.
The Honorable Dave Jones spoke to a room full of California health insurance agents along with representatives from California health plans, United Health Care, Anthem Blue Cross, Blue Shield of California and Health Net. He said, “You are trusted advisors to individuals, families and businesses helping them make one of the most important decisions they’re going to make, which is how to secure their health and who to secure it with. You provide excellent advice and counsel to help them find products that meet their needs at their price point. And then help make sur...
by John Hansen
During Open Enrollment 2015, the Obamacare California Health Plan market grew by 500,000 new members. However, during Open Enrollment 2016, Covered California enrolled only 200,000 new members. Along with these new members, there were 300,000 switchers, people who changed plans during the Covered California Open Enrollment Period.
Top reasons for switching plans included doctors and price. Some people wanted to go to a specific doctor who didn’t take their old coverage, so they changed plans to get coverage that their physician would accept. Or, they wanted to be part of a larger network that offered more choices in medical providers.
Those who did not receive government subsidies tended to switch plans in order to find coverage their doctor would accept. Those enrolled on Obamacare California Plans through the Exchange more often changed plans due to price. Others decided to change because their medical coverage was too expensive.
Health insurance premiums keep rising fo...
by John Hansen
Californians are becoming more and more tech savvy, and as a result they don’t want to mess with billing. Many young people have never written a check, and they don’t intend to. They get bills and they immediately set them up on autopay. However, if not set up correctly autopay can cause problems.
There are two main ways to do autopay. Individuals can sign up through their California health insurance carrier by giving them a credit card or banking information. Or, they can have their bank automatically send a check to the carrier each month.
If individuals use bill pay through their bank, they choose the date that they want the check to be sent to the carrier. However, many California insured do not realize that the date the check is sent is not the date the check is received. This can result in a late pay notice every month.
Monthly late pay notices by mail, email and sometimes phone can be frustrating. “But I have it set to autopay,” the client says with irritatio...