State Exchange Finds Most Buyers Have Lawful Presence

Covered California, the state’s public health insurance exchange, announced last week it has cleared the citizenship/lawful presence status of the vast majority of individuals who were sent notices in September seeking verification documents.

“While we hope that in the end no one who is eligible loses coverage, we are appreciative that so many individuals submitted documents to verify their citizenship or immigration status, meaning their coverage will remain in place,” Covered California Executive Director Peter V. Lee said. “For the remaining group, we are required by law to begin the process of termination. Even for them, we are establishing processes so they can keep their coverage if they demonstrate their legal status.”

Of the 98,900 families, representing nearly 150,000 individuals, who received multiple notices starting in September informing them of the need for citizenship or immigration status verification, 9,645 families did not provide documentation. This means the state exchange is initiating termination of health coverage for the 10,474 people in those families. The notices will give individuals information about how they can have their coverage reinstated if they can prove their citizenship/lawful presence status. Final termination notices will be sent by the health plans in which they enrolled.

Covered California received proof of legal status for more than 82,000 families, representing 130,105 individuals, and it continues to review case information involving 6,670 families (totaling 7,629 enrollees) who have attempted to verify citizenship or immigration status. Lack of verification does not necessarily mean that the individual is not lawfully present, only that Covered California does not have the documents it needs to verify the person’s status. 

Google Piloting Telehealth Services Program

Google has confirmed a pilot program launched in connection with its web search service that will offer telehealth services. Telehealth involves the delivery of health-related services and counsel through telecommunications technologies such as telephone, video, and web conferencing.

Web users searching for a particular symptom on Google will be given the opportunity to “talk with a doctor now” to discuss their health questions. The telehealth services are a part of the Google+ Hangouts and Helpouts programs, which connect people with others who can provide help over live video.

“When you’re searching for basic health information, from conditions like insomnia or food poisoning, our goal is to provide you with the most helpful information available,” a Google spokesperson told Modern Healthcare and other media. “We’re trying this new feature to see if it’s useful to people.”

Google is working with Scripps Health, San Diego, and One Medical Group, a San Francisco-based physician network, for its telehealth program. Google users will be offered the service at no cost, at least initially. It’s not known how long the pilot program may last or if a subscription or fee-based service may be considered in the future.

Telehealth is a growing part of the health care industry. Earlier this year, Northern California-based Sutter Health announced an investment of more than $8 million in MDLive, a national telehealth company. Many traditional health insurers, such as Aetna, Anthem, Cigna, and Kaiser Permanente currently offer or have offered telehealth services through some of their health plans. A recent report by Deloitte estimated approximately 75 million e-doctor visits will occur this year across North America.

Could Baby Photos Pose a Threat to Health Care Privacy?

While it’s been an accepted -- and fairly standard – practice for decades for doctors to proudly display photos of infant and children patients in their offices, you might not see as many images in the future according to a New York Times article and White Paper. The reason is a change in the Health Insurance Portability and Accountability Act (HIPAA).

“What has changed is an increased level of HIPAA enforcement at the state and federal levels,” explained Mike Egan, Senior Vice President at Kansas City-based Lockton Companies, a risk management advisor and insurance broker. “While it appears that no clinic or health care organization has been fined over the unauthorized posting of patient photos, the increased enforcement concern has led many health care providers to be more cautious.”

Even if parents submit the photos on their own, that won’t be enough to protect the health care entity. The posting of a photo identifies or potentially identifies an individual. The posting in a medical office implies the provision of health care to that individual. As a result, a photo – as cute as it may be – is “individually identifiable health information” that may not be disclosed under HIPAA’s privacy guidelines without specific patient consent.

In his recent White Paper, “What, No More Baby Pictures?”, Egan offers three tips to health care professionals to help them implement a HIPAA-compliant process: 1) obtain consent with a HIPAA-compliant consent form completed by a parent or legally authorized decision-maker; 2) create a log with an expiration date to track when a photo is posted and removed from display; and 3) establish a proper destruction process that follows the same precautions for photos as with any other protected health information.

Number of ACA Enrollees Paying Premiums Remains High

More than 90 percent of those signing up for health insurance through the federal and state health insurance exchanges created by the Affordable Care Act (ACA) continue to pay for their coverage according to information released in September by Marilyn Tavenner, the administrator for the Centers for Medicare & Medicaid Services.

About 7.3 million of the eight million who enrolled in ACA plans continue to be insured through the federal- and state-run exchanges. Another seven million people have signed up for health insurance through Medicaid, the federal social health program for individuals and families with limited incomes and resources.

“A new wave of evidence shows the Affordable Care Act is working to make health care coverage more affordable, accessible, and of high quality for families, seniors, businesses, and taxpayers alike,” Tavenner said is a statement prepared for a House Oversight and Government Reform Committee meeting last month.

Eight million people used the federal marketplace and state-run exchanges to sign up forACA coverage. Their enrollment wasn’t confirmed until their first month’s premium was submitted to their insurance carrier. Previously, two of the country’s largest insurers, Anthem (formerly known as WellPoint) and Aetna, reported premium submissions from between 80 and 90 percent of ACA customers.

In 2015, Oregon and Nevada will join with more than 30 other states to offer ACA coverage through the federal marketplace. Both states offered coverage on their own in 2014, but due to problems with their state-run websites, they are joining the federal exchange in year two.

One state – Idaho – that was part of the federal marketplace in 2014 is opening a new state-run exchange for 2015. New Mexico had previously planned to move from a jointly managed marketplace to a state-run exchange; however, the New Mexico exchange’s board voted in July to delay enrollments for another year.

California Regulators Don’t Oppose Exchange Rate Hikes

Just in time for the start of open enrollment for the 2015 plan year, the California Department of Managed Health Care (DMHC) and the California Department of Insurance (DOI) announced they won’t challenge rates increases proposed by the health plans taking part in Covered California. As initially reported by the Los Angeles Times, rates for the state’s public health insurance exchange are climbing 4.2 percent on average for 2015.

“After careful and in-depth analysis, the DMHC found the health plans’ proposed premium rates are actuarially sound,” said Director Shelley Rouillard.

The insurance department reached a similar decision on a rate increase requested by Health Net Inc., the sole carrier the DOI was reviewing at this time.

It’s important to note, however, that health insurers are still under pressure for their narrow health care provider networks for some of their plans marketed through the state exchange marketplace. Consumer complaints to the DMHC and DOI have increased and multiple lawsuits have been filed alleging Anthem Blue Cross, a unit of WellPoint, and Blue Shield of California violated California law by misleading consumers about what doctors and hospitals are part of their plan networks.

The Times reported in late September that Health Net is replacing its PPO plan offered through Covered California with an alternate, more restrictive plan with 54 percent fewer physicians statewide. For the 2014 plan year, Health Net ranked third among the state’s leading health plans for Covered California enrollees, trailing Anthem and Blue Shield, but edging out Kaiser Permanente according to an April analysis. 

Blue Cross Plans Opening New Retail Stores

After launching its first health insurance retail store in June of 2012, and a second location in October of last year, Blue Cross of Northeastern Pennsylvania (BCNEPA) is opening a third “Blue Cross Store” this fall – just ahead of the mid-November start of open enrollment for Affordable Care Act (ACA) coverage in 2015.

Under the ACA, consumers can shop for health insurance coverage on the federally facilitated marketplace and state marketplaces during open enrollment and special enrollment periods for qualifying life events like marriage, divorce, loss of employment, or a move (outside the service area of their current health plan).

“In this area, it’s been our experience that people want face-to-face encounters,” said A. Paul Holdren, senior vice president and chief sales and marketing officer for BCNEPA. “So we felt an important channel for us to reach people was to open retail stores in key areas.”

“When consumers enter a Blue Cross Store, they sit down with a licensed representative who can help them choose the most appropriate individual coverage for their needs and budget,” explained Holdren.

Meanwhile, Capital Blue Cross, which does business in the central and Lehigh Valley regions of Pennsylvania, has announced the 2015 opening of its second “Capital Blue” health and wellness store. The new location will offer a fitness area, private individual and family customer service offices, a community meeting space, a Kids Zone, and a full-service healthy café with free Wi-Fi and a seasonal menu of sandwiches, salads, soups, and beverages.

The successful expansions in the Keystone State have not gone without notice in the Midwest. Blue Cross Blue Shield of Minnesota is opening its flagship retail store this fall in the suburban Minneapolis community of Edina.

More Private Exchanges Springing Up Nationwide

While the nation’s first small group private exchange, CaliforniaChoice, continues to attract more employers and members in the Golden State in its eighteenth year of operation, more and more private exchanges are being set up across the nation.

Independence Blue Cross, a leading health care provider in southeastern Pennsylvania, announced last month it is launching a new private exchange marketplace offering medical, pharmacy, dental, and vision to employers with more than 100 employees.

The Independence private exchange will be available to new and existing employer groups for coverage effective in 2015. It is being targeted to companies headquartered in the five counties in the Philadelphia metropolitan area.

Blue Cross Blue Shield of Massachusetts introduced its My Blue Choices exchange this year for groups with more than 20 eligible employees. HealthPartners Health Plans, which serves more than 1.5 million medical and dental plan members across the country, announced a new private exchange solution in September. Cigna also expanded its health care network to include more private exchanges last month, while Blue Cross Blue Shield of Tennessee is now marketing a private exchange for groups with at least 151 employees.

Research by PriceWaterhouseCoopers (PwC) found that 32 percent of corporate decision-makers expect to use private exchanges to provide employee benefits within three years. PwC says exchanges will be most attractive to employers looking to shift health care decision-making to employees.

Aon Hewitt reported in September that about 600,000 active employees and their dependents from 18 large employers signed up for major medical coverage through its private employer exchange system in 2014. That number is in line with their projection made a year ago.

Health Plans Joining and Exiting Exchanges for 2015

The start of the Affordable Care Act (ACA) 2015 Open Enrollment will bring changes to the federal health insurance marketplace and some of the state-run health insurance exchanges.

Hawaii Medical Service Association (HMSA), the largest health insurer in the island state, will not be a part of the Small Business Health Options (SHOP) exchange. The decision by HMSA means only Kaiser Permanente will be offering a plan for SHOP participants. The decision, according to an HMSA spokesperson, was based on technical challenges faced by the Hawaii exchange since it was launched.

Meanwhile, nearly 4,000 miles away, provider-owned health plan PreferredOne announced it is dropping out of the Minnesota state-run health exchange, MNSure. The exit from the state marketplace means thousands of current customers will be forced to switch their individual health plan to keep their federal premium subsidies. PreferredOne offered some of the lowest premiums on the MNSure exchange in 2014, and it was rewarded by earning more than 50 percent of the state’s individual enrollment – beating out other carriers like Blue Cross and Blue Shield of Minnesota and HealthPartners.

Minnesota-based UnitedHealthcare said previously it could be joining more than a dozen exchanges in 2015 after participating in just four for 2014. Nationally, more than a dozen insurers are leaving the federal and state marketplaces.

In the southwest and other parts of the country, many co-op health plans participating in the federal and state marketplaces are reducing rates to attract new enrollments for 2015. These consumer-governed health plans struggled in the first year to attract their target enrollment and they’re retooling to be more competitive in year two. Meritus, a not-for-profit co-op plan in Arizona, has reduced rates by 23 percent for 2015 – hoping to increase its enrollment beyond the 3,500 in the first sign-up period.

Anthem Blue Cross Creating New Health Plan

One of California’s largest health insurers, Anthem Blue Cross, is joining with seven competing health care providers to create a new health insurance plan that executives predict will enhance competition in Los Angeles and Orange counties, while also reducing health care costs.

The new Anthem Blue Cross Vivity plan will operate like a health maintenance organization (HMO). It will offer health care without a deductible; patients only have to pay a monthly premium and some treatment copayments.

Members will be able to go to Cedars-Sinai Health System, Good Samaritan Hospital, and UCLA Health, all in Los Angeles; MemorialCare Health System, which operates facilities in Fountain Valley, Long Beach, Laguna Hills, and San Clemente; PIH Health in Whittier; Torrance Memorial Medical Center; and Huntington Memorial Hospital in Pasadena.

The new plan is seen by analysts as a direct response to Kaiser Permanente, which dominates health care across California with one-third of the market. It’s also a response to other changes in the health care marketplace, including the introduction of health insurance exchanges created by the Affordable Care Act. (Anthem is one of the participating health plans in Covered California, the state’s public health insurance exchange.)

Anthem Blue Cross Vivity will be offered to large employers beginning in 2015. According to a New York Times story, Anthem estimates the plan pricing could be 10 percent less than what employers are currently paying for their group coverage. Anthem, two of the hospitals taking part in the new plan, and CalPERS (the California Public Employees’ Retirement System) have said they will offer Vivity as a health insurance option for their own employees and members. 

Tax Preparers Hoping for Business Boost from ACA

Tax preparation firms like H&R Block and Liberty Tax Service are looking forward to the tax season – and they’re anticipating a boost in business from customers who are unsure about how the Affordable Care Act (ACA) might impact their taxes.

As reported by LifeHealthPro, an insurance industry newsletter, the potential challenge for taxpayers who might otherwise do their own taxes centers around whether they purchased health coverage from a qualified health plan through the public health insurance exchange. And, most importantly, whether they used the ACA premium subsidy program – the advanced premium tax credit (APTC) – to pay for their coverage.

Under the ACA, if a taxpayer doesn’t provide information about whether he or she has the required “minimum essential coverage” – and doesn’t qualify for an exemption from the mandated penalty – then he or she is supposed to add a penalty payment to the income tax payment for the year. For most taxpayers impacted by the penalty, it will amount to one percent of income.

On a conference call with securities analysts, John Hewitt, chairman of Liberty Tax, said he expects his company to get $40 for each digital ACA Form 8962 that Liberty helps its customers complete. He also expects about one-quarter of Liberty customers to file an ACA form. On the revenue side, Hewitt is predicting a 2.5 to 3.0 percent increase in fees for Liberty in 2015 and even more in 2016.

H&R Block president Bill Cobb also sees more customers in his firm’s future. “Those who received an advanced tax credit will no longer be eligible to file their returns on the 1040EZ,” he said.