LifeWise Health Plans of Washington announced they will be adding Brand Name drug coverage to their comprehensive health plan - WiseAdvantage 1800. This new benefit will take effect on August 1st, 2012. WiseAdvantage plan will now cover Generic AND Brand Name medications. This change will likely result in a rate increase effective August 1st. LifeWise has filed for an 8.1% average rate increase to account for the additional risk of covering Brand Name medications. The decision from OIC (Office of Insurance Commissioner) to approve that rate increase will likely happen in the next two months. Status of rate filings can be viewed on the OIC website.
LifeWise has also announced they will be removing the Generic drug coverage from their very popular catastrophic plan: WiseEssentials Rx. This change will also occur as of August 1st, 2012. WiseEssentials will no longer provide prescription drug coverage except for those medications mandated under the Affordable Care Act. This change will result in a rate decrease. LifeWise has filed with the OIC for a 3.8% rate decrease for non-grandfathered plans, and a 5.1% average rate decrease for grandfathered plans. Additionally, LifeWise members who do not have a prescription drug benefit can get a discount on their prescriptions simply by showing their LifeWise ID card at any network pharmacy. Members can save up to 50% on generic drugs and up to 15% for brand drugs.
Do you need individual health insurance coverage for your child or would you like to add them to your family plan? The first open enrollment of the 2012 year is March 15-April 30.
The open enrollment periods apply to all health plans in the individual market. During these times, children under age 19 do not have to complete a health questionnaire and cannot be denied health insurance because of a pre-existing condition.
The next open enrollment is Sept. 15-Oct. 31.
Earlier this spring, Governor Gregoire signed ESSB 6538 into law, modifying the definition of “small group” or “small employer” to include groups between one and 50 employees, effective October 1, 2010.
The new definition includes self-employed individuals and sole proprietors who meet the following requirements
• Have been employed by the same small employer for at least
12 months prior to application, and
• Can verify that at least 75 percent of their income was derived from a trade or business with documentation filed with the Internal Revenue Service (IRS) from the previous taxable year. Individuals in agricultural trade/business are required to derive at least 51 percent of their income from the trade or business in order to qualify.
On April 15th 2010, President Obama signed into law H.R. 4851, which extends the eligibility period for the COBRA premium subsidy to May 31, 2010. This subsidy covers 65% of the COBRA premium for 15 months.
This COBRA subsidy is available to individuals who were involuntarily terminated from their employment between September 1, 2008 through May 31, 2010.
Effective May 1st, 2010, KPS Health Plans will be discontinuing their current product line, and replacing those plans with a series of 3 catastrophic deductible options called "Centric" (2000, 3000, 5000 deductible), one comprehensive 1000 deductible option called "Centric Enhanced", and an 2 HSA plans (2000 & 3000 individual deductible options).
As with many carriers, KPS waives the deductible for 3 office visits per year. Unfortunately they only offer this benefit on their 3 catastrophic plans. Their comprehensive 1000 deductible plan offers no "up front" coverage for doctor visits, only preventative physicals.
KPS rates have historically been more expensive than competing carriers. This new line of products is still priced above most competing plans. Their best rates seem to be in the range of 30-40 year old smoker. See our InstantQuote Calculator to compare rates.
Starting February 1st, 2010, Regence BlueShield will no longer be offering their popular "Breakthru" and "NowSelect" individual and family health plans. Instead, Regence has announced a new line of individual and family health plans available to Washington residents, called "Evolve".
The "Evolve Plus" is the replacement for the "Breakthru" comprehensive health plans. The "Evolve Plus" product line includes deductible choices from $1000 all the way up to $7500. Some positive features of the "Evolve Plus" include 80% co-insurance instead of 70%, a lower co-pay ($25 vs. $30), Lab & X-ray coverage at 100% up to $400 with deductible waived, and no limit on preventative care (Breakthru had a $200/yr cap on preventative). Some negatives include a lower 50% coverage on "complex imaging" such as MRI, CT Scan, PET, SPECT, & bone density (all subject to deductible), a new $500 deductible on "brand formulary" drugs, and no Rx coverage for "non-formulary" medications. Doctor visits are no longer "unlimited", but now are limited to 4 visits per year with the $25 copay. The 5th and subsequent visits are covered at the 80% level after the deductible has been met.
The "Evolve Core" is the comparable catastrophic replacement to the "NowSelect" catastrophic plan, offering the same range of deductible choices from $2,500 to $10,000. Evolve Core is keeping the $35 copay for the 1st 4 visits (deductible waived) which made the NowSelect so popular, and is also keeping the 100% no deductible lab & xray benefit, although the benefit is lowering from $400 to $200 per year. One positive change is a "no limit" on preventative care instead of the $200 limit that NowSelect and Breakthru 70 plans offered. Like the Evolve Plus, Evolve core will only offer 50% coverage for complex imaging. However Evolve Core also includes a $1500/year maximum benefit for complex imaging that can pose a serious problem with the high costs of complex imaging.
For rates and more detailed benefit information about these new plans from Regence, feel free to call our office to compare all of your individual & family health insurance options.
Last week, the Senate passed H.R. 3326, the Department of Defense Appropriations Act, which includes an extension of several programs that were set to expire at the end of the calendar year. One such program is an extension of the federal COBRA subsidy program that was originally created in the American Recovery and Reinvestment Act. President Obama passed the bill into law on December 21st and it includes:
- An extension of the 65% subsidy for COBRA coverage from 9 months to 15 months
- An extension of the subsidy eligibility by two months so that it ends on February 28, 2010
Because of increasing supplies, restrictions on H1N1 flu vaccine have been lifted and the H1N1 vaccine is now available for those 6 months and older.
There are two types of flu vaccine: the injectable flu shot and FluMist, the nasal spray vaccine. FluMist is made with live, weakened viruses that cannot grow at normal body temperature and is given via a nasal sprayer. This vaccine was approved for seasonal influenza viruses in 2003 and tens of millions of doses of the vaccine have been given in the United States.
Flu Mist cannot be given to:
- Children younger that 2 years
- Adults aged 49 years and older
- Pregnant women
- People with underlying health conditions
"Working to prevent and contain the spread of the H1N1 virus is an important priority at Regence. This includes educating our members on facts about the virus, prevention of illness and information on the vaccine. To remove financial barriers associated with administration of the H1N1 vaccine and to encourage members to seek vaccination, Regence will provide coverage for the costs associated with the administration of the H1N1 vaccine, waiving co-pays and deductibles for all members covered by its insured plans."
"There is no charge for Group Health members. The cost of the H1N1 vaccine for non-members is $22."
"Through June 30, 2010, Premera is waiving the cost of administering the H1N1 vaccine to all its fully-insured group and individual members. However, if the provider charges an office visit fee, you will be responsible for the applicable benefit and cost shares for the office visit. The H1N1 Serum is provided by the federal government, so you shouldn't be charged for the serum itself"
Legislation changes or rulings by The Washington State Office of the Insurance Commissioner will sometimes mean higher premium costs for Washington residents. Usually because of a new mandate increasing the coverage your health insurance provides. Whether you want the new coverage or not, the mandates increase the risk to the insurance carrier, thus increasing your costs.
This go around, the increase is not much (not like the 3% increase a couple years ago). For many clients of the Washington Health Insurance Agency, they'll see only a slight $1 or $2 increase. Some will not see any increase at all.
The increase is due to a couple of changes to the Organ transplant coverage:
-Organ Transplant Lifetime Maximum-SB 5725 requires health plans to limit transplants to a separate lifetime maximum of not less than $350,000. (up from $250,000)
-Organ Transplant Waiting Periods-HB 1308 requires health plans to reduce organ transplant waiting periods by the amount of time a person had prior creditable coverage.