- New medical and pharmacy deductible updates to some off-exchange Bronze PPO plans for Q3 and renewing groups
- Groups enrolled in Bronze PPO 4000/70 or Bronze PPO 6000/65 plans will move to the updated plans at their renewal, starting with Q3
- Groups that prefer separate medical and pharmacy deductibles may consider the Silver PPO 2000/45 plan.
- Extended 25% relaxed participation requirements for small business to December 31, 2019.
- Anthem Blue Cross is adding two new HMO options, Gold HMO B and Silver HMO B, for 9/1/2019.
- Kaiser Permanente is adding a new HMO option, Silver HMO A, for 1/1/2019. It includes the Full Network.
- UnitedHealthcare is adding a new HMO option, Gold HMO D, for 1/1/2019. It includes the Advantage Network.
- Delta Dental PPO Rate Decrease: Platinum -2.7%; Gold -10.6%, Silver -14.2%.
- 3-year rate guarantee for new groups and renewing groups between July 1, 2019 and December 1, 2019.
- Groups starting January 1, 2020 through December 1, 2020 will receive a 2-year rate guarantee.
- New Bronze DHMO Plan Through DeltaCare available. Basic and Preventative services still covered at 100%.
- Q-3 Rate Updates – +2.8% for PPO & EnhancedCare PPO Plans; +0.2% for HMO & HSP plans.
- Dental, Vision, Life, Optional Chiro: No rate changes at this time.
- Latest Underwriting promotion lowers participation percentages for HMO and Salud HMO y Más Network. Both offers expire December 31, 2019.
- HMO available for 6 active subscribers and Salud HMO y Más Network available for 2 active subscribers.
- Small business groups can mix and match any plans that come with the Salud HMO y Más Network.
- New Silver HMO 1900/55 + Child Dental Alt plan, which connects the gap between their current bronze and silver offerings. The biggest impacts with this plan are the out-of-pocket maximums.
- New and easier requirements for sole proprietorship and LLCs. In California, brokers now only need to submit a Schedule C Form 1040, not the U.S. Individual Income Tax Return Form 1040.
- Relaxed underwriting rules for LA/OC through December 15th, 2019 effective dates. Employees within Oscar service areas 15,16, and 18 to count toward participation so long as number of employees is under 100 in all locations.
- Updated split carrier participation rules. If 60% of eligible employees enroll in a plan offered by the employer, Oscar will only require three eligible employees to enroll with Oscar.
- No DE 9C required with five or more enrolled employees!
- IFP coverage is a valid waiver. An individual does not need to be receiving a subsidy (APTC) to be considered a valid waiver.
- Click here for all pertinent details.
In the News
California Legislature Passes Health Insurance Mandate
On Monday, the California Legislature voted to pass tax legislation reminiscent of President Barack Obama’s health care law, which taxed people who didn’t buy health insurance. This tax was eliminated at the federal level by Republicans in 2017 via their overhaul of the tax code. If the bill becomes law, California would join Massachusetts, New Jersey, Vermont and Washington, D.C. as the only states in the U.S. to penalize people who don’t buy health insurance. The proposed penalty excludes illegal residents, members of an American Indian tribe, and people in prison.
Law makers also approved a bill on Monday that would expand government-funded insurance to low-income adults living in California illegally. It’s likely that both laws will be signed by Governor Newson, since he had previously indicated support for both plans. Proponents of both laws hope to use moneys collected from the penalty tax to pay for Medical coverage for illegal, low-income residents.
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States and Local Governments Nationwide Suing Drug Companies Over Opioid Crisis
In 2017, the Centers for the Disease Control and Prevention found legally-prescribed and illegally-obtained opioids responsible for 48,000 deaths in the United States. Because this has been such a widespread national public health issue, state and local governments are suing the drug industry for their role in the opioid crisis.
However, who should have the power to strike a settlement and how a national settlement should be distributed among nearly 25,000 local and county governments is still under question. Lawyers representing local governments asked Judge Dan Polster, who is overseeing lawsuits from about 2,000 various governments, for additional time to formulate a plan. Judge Polster is urging all parties involved to reach settlements rather than go to court. Only one case over opioids has gone to trial in Oklahoma, where the state sued Johnson & Johnson. Additionally, Oklahoma reached settlements with Purdue Pharma and Teva Pharmaceuticals.
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