December 2011

Prescreen Simplifies CoverColorado Eligibility Process

by Louise December 30, 2011

[...] If the health insurance carrier issues a denial letter based on the prescreen, that denial letter can be used as proof of eligibility for CoverColorado. The applicant can then proceed with an application for CoverColorado and include the denial letter.

The prescreen is intended to replace the need for an applicant (with one or more of those 21 medical conditions) to submit a complete application to a private carrier in order to receive a letter of decline and thus be eligible for CoverColorado. The prescreen is definitely shorter and easier to complete than a full application.

It should be noted however that all 21 of the medical conditions listed on the prescreen questionnaire are also included on the list of medical conditions that automatically make an applicant eligible for CoverColorado. This list of conditions has long been an option for CoverColorado eligibility, and it is more comprehensive than the new prescreen list (it includes the 21 conditions on the prescreen as well as 13 others). [...]

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Interesting Reading In The HHS Bulletin On Essential Health Benefits

by Louise December 29, 2011

[...] I particularly appreciated Jaan’s link to this bulletin about Essential Health Benefits from the Center for Consumer Information and Insurance Oversight. It’s a comprehensive look at how EHB will be defined based on the current proposal from HHS, and it includes a call for public comment between now and the end of January 2012. In reading through the bulletin, I was especially interested in the bottom of page 7. They note that in states that mandate coverage for in-vitro fertilization, the mandate increases average health insurance premiums by about one percent. And in states that mandate coverage for Applied Behavior Analysis (ABA) therapy for autism, that mandate results in average premiums being 0.3% higher than they would be without it.

We’ve written a few times about infertility treatments and health insurance, and it’s always generated a lot of (usually quite polarized) comments. People tend to feel strongly one way or the other, often based on their own experiences or those of friends and family members. People who have had to fork over tens of thousands of dollars to pay for IVF tend to be more sympathetic to the idea that health insurance coverage of fertility treatments would be a good thing. Those who have been able to conceive without medical interventions and those who have no desire to have children tend to balk at the idea of paying higher health insurance premiums to cover fertility treatments for other people. But would knowing that mandates on fertility treatment have only increased premiums by about one percent make a difference in how those people feel? [...]

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Kaiser Permanente Pays Colorado Adults To Lose Weight And Keep It Off

by Louise December 28, 2011

Since last April, Kaiser Permanente has been offering cash to Colorado adults who lose weight and keep it off through their Weigh and Win program. Researchers have long known that cash is a powerful incentive, and the Kaiser program utilizes that motivation factor to encourage people to lose weight and establish a healthier lifestyle. Participants are eligible to receive quarterly checks for up to nine consecutive months after their second weigh-in at one of the Weigh and Win kiosks, as long as they continue to lose weight or keep off the weight they lost between their first and second weigh-ins.

The program is available to Colorado adults age 18 and up who have an initial BMI of at least 25. Those with a BMI of less than 25 are eligible to win prizes by completing weekly journals, weighing-in at the kiosks quarterly, and reading emails from the Weigh and Win program, but the cash rewards are only available based on weight loss for participants who start with a BMI of at least 25. [...]

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Record High Number Of Colorado Residents Enrolled In Medicaid

by Louise December 27, 2011

This short clip from Colorado Public News is well worth watching. It’s only a few minutes long but highlights the need for Medicaid among families who rely on the program, the controversy surrounding the expansion of Medicaid, and the impact that the recession has had on Medicaid enrollment in Colorado over the past few years.

The video notes that Colorado has experienced a 55% increase in Medicaid enrollment since 2007. This is likely due in large part to the recession, but Colorado has also taken active steps to expand access to public health insurance programs like Medicaid in recent years, and it’s reasonable to assume that this is driving some of the increase in enrollment. [...]

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Colorado Health Insurance Website Receives Praise From HHS

by Louise December 26, 2011

A few months ago, I wrote about the new website that the Colorado Division of Insurance has created to improve transparency in the health insurance market. I particularly liked the features of the site that allow consumers to see how the rate filing process works and track a health insurance carrier’s rate increase history. Colorado used money from a $1 million grant from HHS last year (a provision of the PPACA) to create the website, and it’s obvious that the Division of Insurance is taking the goal of transparency seriously.

I’m a bit late to this party, but I just read a news release from the Division of Insurance from back in September noting that the HHS Regional Director, Marguerite Salazar, commended the Colorado Division of Insurance for the website, calling it a “shining example of consumer-friendly and transparent information…” [...]

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When Advertising Masquerades As Journalism

by Louise December 22, 2011

[...] The days of news being disseminated once per day via newspapers and a few times a day via morning and evening TV and radio news programs are long gone. News is updated constantly now, and people expect to see brand-new stories every time they go online. There are fewer trained journalists ready to carefully research and write the news stories, and plenty of bloggers and freelance writers who are more than willing to write articles for anyone who will pay them to do so. And not all of those articles disclose the fact that the writer may have been paid for the story by a party that has a vested interest in the story getting out.

On the other hand, medical research is a hot topic. New research is constantly being conducted and not all of it is biased or funded by companies with a conflict of interest. We just have to be careful when we read medical “news”. Check the sources. If the story is about a study, look to see who funded the study. If the story openly promotes a particular product (or hospital, or health insurance policy, or a specific cutting-edge treatment, etc.), it’s wise to question whether the story is actually unbiased, researched medical journalism, or advertising pretending to be news. [...]

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HHS Allowing States To Define Essential Benefits In The Exchanges

by Louise December 19, 2011

[...] Colorado already has a comprehensive small group benefits mandate. Until this year, one of the most glaring differences between small group and individual plans was that individual policies in Colorado were not required to cover maternity. But that changed in January when all new and renewing individual policies had to begin covering maternity. I would say that the primary difference now between most of the individual plans and small group plans in Colorado is that the small group policies are guaranteed issue, whereas the individual plans are medically underwritten. But in 2014, when the exchanges get underway, the individual policies will be guaranteed issue too. Individual policies are still quite a bit less expensive than group policies in Colorado, but I wonder if that will change too once the exchanges get underway? It would seem so, since the benefits and underwriting will be virtually identical.

The small group market in Colorado is already quite structured by state mandates. The individual market also has quite a few mandates, including the new maternity benefit mandate. But it appears that the individual policies that are sold in the exchanges beginning in 2014 will have benefits at least as comprehensive as the benefits offered by the largest small group plans in Colorado. That means that “bottom of the heap” individual plans (ie, the ones with tons of fine print and huge holes in their coverage) probably won’t be making an appearance in the exchange, or at least not without a serious overhaul. [...]

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Colorado Child-Only Open Enrollment Details For January 2012

by Jay December 15, 2011

The next open enrollment for child-only policies is almost here, so I thought it might be helpful to provide some specific details in terms of what policies are available and what parents should expect when submitting child-only applications next month.

The first open enrollment window in 2012 will be the month of January. Applications for child-only policies have to be submitted between January 1 and January 31. Application not submitted by the end of January will have to wait and re-submit in July, which is the second open-enrollment period of the year. For most carriers, each child in a family will have to have a separate application.

All eligible child-only applications submitted during the open enrollment period are guaranteed issue, so the child cannot be refused coverage. However, the applications are still medically underwritten and the rate can be increased by up to 200% based on the child’s medical history (so if the standard price is $100, the policy could actually be assigned a rate of $300, which is equal to a 200% rate increase).

Colorado Senate Bill 128 requires all Colorado health insurance carriers that offer coverage for adults to also offer child-only plans during the two annual open enrollment windows. But the bill does not require carriers to provide guaranteed issue coverage for children who are eligible for health insurance from another source (other than a high risk pool like CoverColorado or GettingUSCovered – see the bottom of page 4).

Most Colorado carriers have selected one or two plan designs that will be available for child-only applications next month. To give you an idea of what is available in Colorado for child-only coverage, we’re providing information here regarding child-only options from six of the top individual health insurance carriers in the state. [...]

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Access To A Mini-Med Group Plan Does Not Prevent CoverColorado Enrollment

by Jay December 14, 2011

[...] The person I spoke with at CoverColorado checked with a supervisor and then told me that mini-meds are an exception to CoverColorado’s rule banning eligibility for people who have access to group health insurance. In order to qualify, the applicant has to provide the usual proof of eligibility along with proof that their employer’s group health plan is a mini-med. This can be the declarations page from the policy or marketing materials for the plan (which now have to include language indicating that the plan has been granted a waiver by HHS and does not meet the minimum benefit requirements defined by the PPACA).

Hopefully this will clarify things for others in a similar situation. Normally, access to a group health insurance policy (even if it’s one you don’t like or your doctor isn’t on the network, etc.) makes a person ineligible for CoverColorado. But if that group plan happens to be a mini-med and you also meet the other eligibility criteria for CoverColorado, you can submit an application to CoverColorado.

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