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What's New?
I hope that this newsletter finds all of you happy and healthy. I've spoken with quite a few of you since September. It's still very difficult for me to comprehend and digest the events of 9/11 and the more recent tragedies like that of the slain journalist, Daniel Pearl. I think we're all being put to the test in terms of coping. I, personally, have found great strength and comfort in family and friends. I hope this is the case for all of you as well.
On the business front, in addition to helping people obtain health insurance and acting as a Registered Investment Advisor, I have begun to help non-clients resolve their insurance matters on a fee-for-service basis. If you have a friend who is having problems with a carrier, please let them know I would like to assist them.
Premium increases and benefit changes remain the best indicators of change in the health insurance industry. Many of the changes reflect cost increases for providers such as increased use of expensive prescription drugs, retrofitting of hospitals, and changes in demographics. Medical groups themselves often contribute to this feeling of flux. In order to gain the superior position during contract negotiations with insurance carriers, a medical group might state that it will be forced to drop a given carrier if certain conditions aren't met. When subscribers hear this, they begin shopping for plans that allow them continuity of care with a chosen provider. Soon, the insurance carrier is faced with meeting the medical group's conditions for care or losing a lot of subscribers.
As you know, I am reasonably critical of the insurance companies, but I wanted you to understand that many changes aren't instigated by the carriers. Please read the info for your plans and feel free to call with questions.
Blue Shield
There are major changes going on with Blue Shield. I have listed the highlights and encourage you to review the information specific to your plan. This information came to you directly from Blue Shield.
Last year, Blue Shield decided to keep its plans at straight dollar co-pays, rather than introduce deductibles. Blue Shield will be making some radical changes to its PPO plans. These changes also affect the Preferred Savings Plan to a lesser degree.
- Hospitals
At present, providers are considered to be in or out of network. Come April 1st, Preferred hospitals will be divided into 2 categories: choice and affiliated. This stratification reflects the difference in costs hospitals charge in a given area. Affiliiated hospitals generally charge the insurance company more than Choice hospitals for the same service. I have included a list of current Affiliated hospitals. Please know that in a true emergency, you will be given the Choice rate regardless of the hospital designation.
- Deductibles for Co-Pay Plans
- The $25 Co-Pay Plan will have a $500 calendar year deductible that will be pro-rated to $375 for 2002.
- The $35 Co-Pay Plan will have a $750 calendar year deductible, pro-rated to $550 for 2002.
- The $45 Co-Pay Plan will have a $1500 calendar year deductible pro-rated to $1375 for 2002.
- Benefit changes
There are slight changes to benefits and out-of-pocket costs. Please review the info Blue Shield sent to determine the specifics.
- Age bands
New 5 year age bands have been created. This should temper major premium increases.
- Regional rates
The rating regions have been reassigned to reflect changes in demographics. Alameda and Contra Costa were in Area 3 and are now in Area 4. (Area 4 is cheaper.) Solano and Napa were in Area 2 and are now in Area 6. (Area 6 is more expensive.)
- Rates
Rates are going up. I know of no other way to say this. On the Preferred Savings Plan, individual deductibles of $1650 and $2250 are rising to $1700 and $2400. Family deductibles of $3300 and $4500 are rising to $3400 and $4800. Co-pay amounts are going up from 20-30%.
Blue Cross
I spoke with many of you about the premium increase and co-payment adjustments that were to become effective 2/1/02. The premium increase did, in fact, become effective on that date. The plan changes (including additional acupuncture visits) will not go into effect until 4/1/02 or later. If I did not speak to you following my letter announcing this change and you now want to explore other options, please call me.
Some other highlights in the Blue Cross plans include:
- Deductibles are waived for office visits for all the PPO Share Plans.
- Acupuncture is reimbursed at $25 per 12 visits in a calendar year. The deductible does not apply.
- Chiropractic care and physical therapy are subject to the deductible.
Visit the Blue Cross web site (www.bluecross.com) for current provider checks and other pertinent information.
There is a new PPO Share 5000 Plan. This plan has the same plan design as the other PPO Share Plans where the deductible is waived for office visits and acupuncture is reimbursed.
PacifiCare
If you need to order additional ID cards or other materials, please call 800.624.8822.
CalFarm
CalFarm in now officially Nationwide Insurance. There are no other changes at this time. The new web address is www.nhpcalifornia.com.
Surrogate Participants
Please be sure to forward premium statements to the agency with whom you are working. It is important that you do this promptly, regardless of the status with your couple.
Important Web Sites
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