Health care administration under the Affordable Care Act is tricky enough, but none more so than in California. Currently there are two options for the golden state – either consolidating into one regulatory agency or combining between two agencies, the California Department of Insurance (CDI) and Department of Managed Health Care (DMHC), to properly maintain a system that will ensure consumer protection. Those supporting consolidation believe that the fewer hands in the pot will avoid confusion and conflicting interpretations of federal laws. Oversight between two entities can also result in added government and administrative burdens, and difficulty in monitoring what is being purchased and sold in the marketplace.
Posts Tagged ‘health care reform’
Health Insurance Regulation in California Under Health Care Reform
Tuesday, September 13th, 2011Health Insurance Exchanges
Friday, August 5th, 2011Whether you are for it or against it, health care reform marches on. As states scramble to either fight the constitutionality of the bill, or create models for health care administration, January 1, 2014 edges ever closer and brings with it the start of health insurance exchanges. These exchanges are proposed to be implemented by January 1, 2014. In theory, these exchanges purport to provide individuals and businesses the same buying power as larger companies by pooling risks and premiums. However, how these exchanges operate remains to be seen.
Many Children Going Without Mental Health Services
Thursday, January 27th, 2011As the number of uninsured children increases, a new study shows that many of these children have the added stress of an emotional, behavioral, or developmental disorder which is going untreated due to lack of access to medical care. Low income families tend to have children with higher rates of these conditions, such as ADD, autism, or depression, but do not have health coverage to assist with the mental health services they need – including counseling and medication. According to such reports as the one done by the Health Resources and Services Administration:
Children Guaranteed Health Coverage Thanks to Assembly Bill 2244
Thursday, December 30th, 2010The Patient Protection and Affordable Care Act (PPACA) states that children must be offered health care coverage regardless of their health status. As a result, almost all carriers decided to drop new “child only” plans from their portfolio, fearing that parents would only enroll their child once they became ill. However, a new bill signed into play by Arnold Schwarzenegger will bring this practice of denying any child health insurance coverage to an end as of January 1, 2011.
Preventive Services and Your Health Plan
Thursday, December 23rd, 2010With health care reform came certain guidelines that would be implemented right away. One provision states that health plans must cover preventive care at 100% – with no cost sharing (i.e. co pays, deductibles, or coinsurance). However, does this mean you can rush out to take care of all those things you have been postponing? Well, yes and no, as many items listed under the government’s guidelines are age and gender specific. Add to that the need to ensure your provider codes the preventive care correctly so it will be covered completely, this can get tricky. Here are some important things to note once your plan has added the preventive care benefit on your plan:
Mini Medical Plans Face Extinction Due To Health Care Reform
Thursday, December 9th, 2010While the Patient Protection and Affordable Care Act (PPACA) requires that plans remove annual and lifetime limits on plans, many part time and seasonal workers are now faced with the possibility of losing their medical coverage altogether. Many large employers, such as Disneyland and McDonald’s, do make an offer of some very basic coverage for their part time and seasonal workers, such as a plan that may only offer a few thousand dollars of medical coverage. While this doesn’t sound like much, some feel it is better than having no medical coverage in place at all, as many of these employees don’t qualify for the comprehensive full time medical plan, and would not qualify for other plans due to pre-existing health conditions. A few thousand dollars, albeit no good in the event of a catastrophic illness or accident, would at least provide incentive to seek basic preventive care on an annual basis.
Calfornia First In Line To Set Up Health Care Exchanges
Thursday, December 2nd, 2010Governor Schwarzenegger recently signed two bills (SB 900 and AB 1602) which puts California at the forefront of establishing health insurance exchanges. Although these exchanges won’t be open for business until 2014, this bill will start California on the road to implementing this vital piece of health care reform. Federal guidelines do outline how the exchanges work, but each state is allowed leeway to create the exchange to work with their individual state’s needs. Proponents of this bill believe that as California becomes the first state to being the framework, it is expected that other states will be looking to California’s model for guidance in how to create their own structures. Opponents fear that this surely means an increase in taxes and fees.
Blue Shield Ends 12 Month Rate Guarantees
Thursday, October 28th, 2010
Should You Grandfather Your Group Plan?
Thursday, October 21st, 2010
Many small business owners are now facing the tough decision as to whether they should grandfather their plans, or make necessary changes to bring down their costs. There are pros and cons to both sides, and the decision should not be a rushed one. Therefore, we want to provide some guidance tools to help you make the right choice.
With the recent rate increases there may be a desire or need to choose a higher deductible plan with lower rates.
- If you increase the deductibles, coinsurance, or maximum out of pocket exposure, your new plan will be subjected all changes in the recently passed healthcare reform act.
Grandfathered Plans and Your Options Now
Friday, September 24th, 2010What does it mean to lose “grandfathered status”? This may or may not be a concern to you. In a nutshell, this means is your plan will now have to comply with all regulations mandated by health care reform. One of the most important things to know is that along with guarantee issue coverage for all applicants, premium ratios cannot exceed 3:1. Currently, most carriers implement rate variations every 4 years — i.e. 30-34, 35-39, and so on and so on. With the reduction of rate brackets (from 8 to 3), one can only imagine that premiums for younger clients will be much higher than they currently are in order to meet this requirement.
