Important Health Plan Information

, , , , ,

by Ron Lang, CEO of CalCPA Health

This time of the year, with most firms renewing their employee benefit plans, there is a big uptick in questions regarding managing health plans. For CalCPA members, CalCPA Health is an available resource; our tag line is “we answer questions for your firm, your clients and your family” (or at least try to answer anyway).

Health plans are a unique blend of Internal Revenue Service, Department of Health and Human Services, Department of Labor, California Department of Insurance, and other California agencies regulations. Buried in each of these, is the Affordable Care Act’s (ACA) code. Because of this complexity and liability, when providing answers and insights we always must disclose that we do not provide tax or legal advice (lol).

 

Read more

/0 Comments

Anthem Members Impacted by The California Wildfires

,

We want our members and emergency personnel dealing with the damage caused by the California wildfires to know Anthem Blue Cross is here to help. If you need direct assistance with finding available care providers, prescription refills or replacements, and/or any other health insurance related matters, please call 1-888-831-2238, Monday through Friday between 8:00 a.m. and 5:00 p.m., and weekends, from 10 a.m. to 2:00 p.m.

If you live in Butte, Los Angeles or Ventura counties, we’d like you to know we’ve made temporary changes to you benefits to help you get the care you need:

  • Relaxing time limits for prior authorization, pre-certification and referral requirements.
  • Suspending early refill limits for prescriptions.
  • Allowing replacement of medical equipment or supplies.
  • Extending filing deadlines for claims.
These medical and pharmacy guidelines are effective from November 9, 2018 until December 9, 2018, unless further extended.
They apply to members covered by Anthem’s employer group, individual plans and family plans, Anthem’s Medicare Advantage, Medicare Supplement, and Medicare Part D plans in the three impacted counties. These relaxed benefits do not apply to Federal Employees Health Benefits Program as that program has specific guidelines.
Anthem Resources for Assistance and Support
Additionally, Anthem’s EAP provides resources and support services to help with emotionally stressful situations as well as with financial and legal concerns. Anthem’s EAP tools will be offered at no cost and will be available 24/7 at 877-208-8240 through the EAP crisis line or by visiting anthemeap.com and using the login code “cawildfires.”
Free, Unlimited Online Medical and Psychology Visits Through December 31st
Consumers who need medical care can also access LiveHealth Online, Anthem’s 24/7 telehealth service, via the LiveHealth Online app and website at livehealthonline.com. LiveHealth Online offers video visits with U.S.-based board certified doctors on a mobile device or computer from anywhere for non-emergency health conditions. Anyone in California who downloads the mobile app or visits livehealthonline.com and registers will be able to visit with a doctor for free by selecting the “Help for Wildfires Medical” practice. The free visit offer will be available through December 31, 2018.
As you are working through these difficult circumstances, there are a number of organizations that can help. Contact FEMA to learn more about assistance available to the communities affected by the wildfires.
The American Red Cross is another good source of information and support resources and The Anthem Foundation is a $1 million-level member of the Annual Disaster Giving Program, providing grants to organizations such as AmeriCares, Direct Relief and Portlight Strategies, Inc. to support impacted residents.
We are committed to helping you access the healthcare you need and are hearts go out to you during these challenging times.
/0 Comments

New California Law SB 1375 – Affects Many Small Firm’s Group Health Insurance

, , , , , , ,

The new California Law, SB 1375, was signed by Governor Brown on September 22, 2018 and will affect many small firm’s group health insurance. SB 1375 changes the Health Insurance Code to reclassify certain small employer groups as individuals. The affected firms will have to obtain individual health insurance in 2019, rather than the small employer group plans they currently have. Individual health insurance is typically more expensive with less provider network and benefit plan choices than small group plan offerings.

Fortunately, for CalCPA members and their firms, CalCPA Health received certain exemptions from SB 1375, which generally allows us to treat the affected firms as groups, and not as individuals. Commercial carriers (Blue Shield, UnitedHealthcare, Anthem, etc.,) must comply with the new regulations and reclassify these groups as individuals.

SB 1375 defines groups that consist entirely of owners/partners, and/or W-2 employees that are spouses of owner/partners, as not eligible for group health coverage. Even though these entities may be classified as employer/employees by other regulations, (e.g. Workers’ Comp, payroll tax, etc.,) SB 1375 specifically states they do not qualify for group health coverage and may only purchase individual plans.

Read more

/0 Comments