First I would like to clarify something from last week’s column. It should have cited my colleague, Michael Appaneal, was the source of a prototype document. Please see comments on Redding.com for further clarification.
Some GOOD new laws!
I am pleased to report on some legislation recently signed by the governor that will help consumers in our state.
SB 137: Requires Accurate Provider Directories
Sen. Ed Hernandez (D-West Covina), Effective July 1, 2016
This law will require health plans to update their provider directories weekly. The updates will include office location; whether the provider is accepting new patients and which languages, other than English, are spoken by the provider and staff. Also requires the Department of Managed Health Care and the Department of Insurance to develop a standard template for these directories. This helps protect Californians from higher-than-expected bills from out-of-network doctors and other providers due to inaccurate or outdated directories.
I suspect most agents and consumers will be very grateful once this law takes effect and the insurers are in compliance. One of the most frustrating tasks is to try to determine if a physician is a member of the insurance plan network. Since insurers are fine tuning their rates and networks, it is even more of a challenge.
Insurers are presenting different networks for different products. So it is not as simple as asking if your provider is a member of Blue Shield or Blue Cross. You need to be specific about the network. This has become all too apparent since Anthem introduced the Pathway PPO network for all of its individual products in CA. There are still too many providers that will say “we don’t take Covered CA”, not understanding that it is the same network whether the individual is insured through the Exchange or not.
My greatest hope is for some good software developer to extract this data and be able to do network comparisons by zip code. There is already such a system in the large group market called a Geo Access Report. But for some reason the insurer’s refuse to release this comparative analysis to the small group and individual market. Importing this to an excel worksheet for comparison has been an onerous task to say the least.
AB 1305: Limits Cost-Sharing on Family Plans
Assemblyman Rob Bonta (D-Oakland), Effective Jan. 1, 2017
This law closes a loophole in some plans that requires individuals, who are part of a family health insurance policy, to meet the much larger family deductible before their insurance coverage kicks in. It requires family policies to include both an individual deductible and a per-individual out-of-pocket limit.
I am interested to learn more about this law, since it appears that many plans are already ahead of this one. Starting with plans effective 1/1/2016 some HSA eligible high deductible plans will do just what this law requires. They will return to an embedded deductible with a family maximum. This means that if the plan says it’s a 4500/9000 deductible, an individual in the family will begin to collect benefits after that individual has accrued $4500 in claims. They do not have to wait until the $9000 family deductible is met. Further, all family members eligible claims will “go into the pot” toward the family deductible, so the family will not exceed the $9000 in deductibles.
While it is not the intent of this column to be political, it is critical that one understands the high regulatory intervention in the insurance industry. As organizations lobby the legislatures their self-interest is typically primary. While I do not always agree with the positions of our professional organization, I must say that in general the Association of Health Underwriters, often carries the interest of our policyholders to the forefront, not just the issues effecting agents. That is one of the reasons I continue my memberships as well as contribute to the PAC.
