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Blue Cross Blue Shield Most Expensive Health Insurance

The Sept. 23 deadline for compliance with several health reform benefit mandates brought negative impacts for several Blue Cross and Blue Shield plans. Most notably, Blue Cross and Blue Shield of North Carolina agreed to refund $155.8 million to members enrolled in individual coverage, citing the health reform law’s grandfathering provisions as the catalyst. And other Blues plans have blamed the reform law for withdrawals from the child-only coverage market and for premium rate hikes in other lines of business, drawing criticism from regulators.

Under an agreement with the state insurance commissioner, BCBSNC said it will issue a one-time refund to 215,000 members. CEO Brad Wilson said at a Sept. 20 press conference that the funds are coming out of the company’s “active life reserves,” which are “portions of the premium that we set aside in the early years of a policy to keep premiums more stable over the life of the policy, as customers’ medical expenses rise.”

Under the health reform law’s grandfathering provision, “policies purchased or substantially modified after March 23 of this year will end in 2014,” Wilson said.
“Therefore, the reserves held for these products will cover a much shorter period of time, which allows for these funds to be released.” He explained that refunds will equal a little more than 1.5 times an individual’s monthly premium. A policyholder who pays $380 a month will receive a check for $690.

Yet BCBSNC also requested an average 7% rate increase for Blue Advantage PPO customers in August. The insurer said when it filed the proposed increase that it was the lowest since 2007, and that 28,000 customers would see decreases in their rates. The insurance commissioner approved a 5.37% increase.

So why the need for increases when the insurer’s pockets are overflowing? Lew Borman, spokesperson for BCBSNC, says the issues were decided in separate discussions. “The rate filing was an annual filing, an annual discussion. The premium issue was separate.” Premium increases, he asserts, “are based primarily on medical trend….The active life reserves come from 2010 and the rate filing is for 2011.”

But one analyst contends the issues are, in fact, linked. The North Carolina Blues plan “apparently has excess statutory capital,” says Brian Wright, an equity analyst at Collins Stewart LLC in New York. “There are two ways to reduce the excess. One way is to price premiums lower than they would be so that capital is degraded away.” The problem with that method is that “consumers would get a false sense of what was actually happening with underlying health care inflation,” he says. BCBSNC chose the second way to reduce excess, which is to give customers refunds on prior years’ premiums. That way, Wright says, “consumers receive the same benefit on a dollar basis, but do not get the false impression that medical inflation is lower than reality.”

There is some precedent for Blues plans returning excess capital to policyholders through premium givebacks. In 2003, a slowdown in the rate of increase in health care spending left many not-for-profit Blues plans with unexpectedly high reserves and brought intense scrutiny from state regulators. The result:

  • Blue Cross & Blue Shield of Rhode Island said in October 2003 that it would distribute $21 million to customers, hospitals and other providers via premium rebates and increased reimbursements. The insurer decided to use a “rate holiday” to return $7 million to employers. Each employer group would get a 5% discount on one month’s premium payment. Another $7 million would be used to increase physician reimbursement, and the last $7 million was distributed to hospitals in Rhode Island.
  • BlueCross BlueShield of Tennessee said in October 2003 that it would refund $67 million in premium payments to fully insured group and individual members starting in December 2003. Any enrollees or businesses that had fully insured Tennessee Blues coverage for at least one month during 2003 were eligible to receive about 4.5% of premiums back, in the form of a check mailed in December 2003 or a credit on their statement for January 2004. The Tennessee Blues plan did not include providers in the giveback program.
  • Horizon Blue Cross Blue Shield of New Jersey said in February 2004 that it would distribute $33.8 million to small businesses, $7.9 million to senior Medigap members and $8.3 million to individual enrollees under age 65. In addition, the insurer said it would commit $5 million to provide computer hardware and software to a number of New Jersey hospitals and physicians.

Meanwhile, some Blues plans and other insurers have withdrawn from child-only coverage, citing issues with reform provisions related to pre-existing condition exclusions. The insurers said they no long would sell such policies as of Sept. 23, when they may no longer reject applicants up to age 19 based on pre-existing conditions. In Colorado, for example, WellPoint, Inc.’s Anthem unit and several other carriers, including Aetna Inc., CIGNA Corp., Humana Inc. and UnitedHealth Group’s Golden Rule Insurance Co. subsidiary, said they would drop new sales of child-only policies while continuing to cover current child-only enrollees and to accept children with pre-existing conditions in new family policies. Insurers in several other states also reported that they would withdraw child-only products.

Under rules issued in June that take effect for plan years beginning on or after Sept. 23, 2010, insurers may no longer exclude pre-existing conditions from coverage for enrollees under the age of 19. In an effort to address concerns regarding adverse selection, HHS issued guidance July 27 authorizing insurers to restrict enrollment of children under age 19 “to specific open-enrollment periods,” if permitted by state law. But the open-enrollment period must apply to healthy as well as sick children, while the insurers — and some state insurance commissioners, preferred to allow acceptance of healthy children year-round. HHS signaled that it would try to adjust open-enrollment periods to address the risk of adverse selection, but no deal had been reached by press time.

Meanwhile, insurers in several states blamed reform for premium rate hikes. The Rhode Island Blues plan, for example, reportedly told customers it would raise premiums by a few percentage points on top of already approved rate hikes to account for additional benefits mandated by the reform law. BCBSRI and other Rhode Island insurers that planned to impose similar rate hikes came under fire from Insurance Commissioner Christopher Koller. In a Sept. 9 letter to chief executives at the state’s three largest insurers, Koller said that any changes to approved premium rates “as a result of PPACA [i.e., the reform law] will be considered material and an exception to the OHIC’s previous decision….They may not to be applied in quotes to customers unless and until approved by this office.” The insurers also must submit “analysis supporting the additional premium rate charge anticipated for each contemplated change and why it should cause average rates to increase by more than the amount approved.”
BCBSRI spokesperson Kimberly Reingold told The AIS Report that “the guidelines under federal health care reform will add cost to employers and we currently are working with them to understand the specific impact to premiums, which will vary based upon benefits selected by each employer. Every time an employer changes their coverage, or we are mandated to cover new services…rates are adjusted.” She added that “those rates could be anywhere from 1.8% to 3% more depending upon plan design.”

HHS reacted strongly to news that insurers were blaming reform for rate hikes and market exits. In a Sept. 9 letter to the trade group America’s Health Insurance Plans, HHS Sec. Kathleen Sebelius warned that there will be zero tolerance for “misinformation and unjustified rate increases” blamed on health reform. In her letter, Sebelius said that several insurers are falsely attributing 2011 premium increases to patient protections in the reform law. According to the administration’s analysis and those of some “industry and academic experts,” any potential premium impact from reform would be no more than 1% or 2%.

Two four-state boys looking to cross finish line of rare genetic






BOONSBORO, Md. –
When the Auldridges noticed that their son was showing signs of autism, they went to a genetic counselor.

 

The prognosis shook them to the core.

 

“Autism is the least of our concerns. We should be worried about epilepsy, which can cause a whole host of other problems. He could lose his ability to walk and all the other skills that took him so long to get,” said Angie Auldridge, mother of three-year-old Mark.

 

Mark has SCN2a, which can manifest in varying ways and severity.

 

“Mark has a mutation that causes autism [and] motor dysfunction. He has disorder of the central nervous system. He has regressive language disorders. So, he loses words,” Angie said.

 

Instead of keeping their struggle private, the Auldridges immediately reached out to the Families of SCN2a Foundation, where she found a friend, surprisingly close by.

 

“I found out that there’s only like 200 to 300 cases, maybe, worldwide of this rare genetic disorder, and I found the president of the foundation 20 minutes from where we live,” Angie said.

 

The Auldriges then teamed up with Leah Schust, the mother of six-year-old Ben, to create Color for the Cure, a 5K race where all proceeds will be donated to SCN2a research.

 

“Whether it will benefit Mark or not, at least children who are diagnosed later will benefit from whatever cures they find,” said Isaac Auldridge, Mark’s father.

 

Despite the lack of concrete research due to the mutation’s rarity, the Auldridges are hopeful that Mark will live a life without the burden of SCN2a.

 

“We’re really encouraged that he will become verbal. There are some children with SCN2a who are a little bit older, and they are verbal — not all of them — but some of them are. We see a lot of encouraging signs from Mark,” Isaac said.

 

The Color for the Cure 5K will be held on April 29 at 10 a.m. Registration will be open until the day of the race. 

Blue Cross and Blue Shield Staying Competitive

We do more than just cover health care needs when members are sick. We help members prevent illness and identify problems before they become serious. One way we work to achieve this goal is to provide our members with health-related resources and information.

Health

Its one of the industry most comprehensive health services programs.

Preventive Care

Recommendations for precautionary Screening, Immunizations and Counseling for Anthem Blue Cross Members and Guidelines in preventing Influenza

Health Programs

Health Management Programs offer an innovative approach to help members better self-manage serious chronic conditions such as asthma, congestive heart failure, and diabetes. Health professionals provide members with a variety of health education resources depending upon their health status and condition. The health professionals serve as a “health coach” motivating and encouraging members to adopt behaviors that lead to a healthier lifestyle.

Health Resources

Anthem Blue Cross is pleased to share valuable information with you and your family on how to live a healthy lifestyle. We encourage you to visit the “Healthy Living” health resource list and health articles section within the Goodhealthquotes.com website to learn more about your overall health. With these resources you will be able to take the next steps in living a well-balanced life. In addition to the Healthy Living information, please contact your local hospital, medical group, YMCA, health club and/or community parks and recreation for further information on local wellness services in your area.

KICK Program

Kids in Charge of Kalories is a free of charge program for Anthem Blue Cross members who want to help their families learn about eating healthy and the benefits of exercise. According to the American Academy of Pediatrics, good nutrition and exercise are the best ways to keep kids healthy. They may prevent childhood obesity.

Special Offers

Special Offers is a program that provides Anthem Blue Cross members information about a wide range of products and services, available at a discount, to help them meet their individual health, fitness and wellness goals.

Companies like Blue Cross and Blue Shield must stay competitive especially with the imminent changes in the health care system. By offering better coverage, they can still compete with what the government will be offering. There are also hot issues around abortion and Medicare that the government will have to deal with before anything can be passed. A health insurance company can take advantage of whatever market the government leaves behind.

A large corporation, like Blue Cross Blue Shield, can choose to cover abortion costs however their directors please. If Blue Cross Blue Shield finds that most of their customers would prefer it to be covered then they can do so without any repercussions. If there are more conservatives on the board of directors and they choose not to offer coverage, then customers are free to stay or leave. It all depends on how the company feels.

Incredible Blue Cross Blue Shield is already used to, is offering plans with Medicare benefits. Medicare is an area that will be changing but already having some previous experience with handling Medicare will be a big advantage. Many seniors are upset that they may get rid of some of the Medicare options that they like the most.