New Enhanced Quoting Engine, MLR Rebates, Individual Marketplace Training, News Updates and More!

Blue Shield’s Trio Network grows in LA County

Blue Shield is excited to announce that effective January 1, 2021, PIH Health medical group will join Blue Shield’s growing network of Trio ACO providers. The expansion is effective for all lines of business that offer Trio HMO.

This is how PIH Health will add network depth to the south and east Los Angeles areas:

  • 390 full time physician providers, plus 300 more physicians in their affiliated network
  • With the addition of PIH Health, Trio HMO covers 38% of HMO Access+

PIH Health is a nonprofit, regional healthcare network that serves approximately 2.5 million residents in Los Angeles County. Trio HMO is Blue Shield’s fastest growing plan, and the addition of PIH Health to Trio’s network means that Blue Shield is increasing access to care in a highly populated area of Los Angeles.

For more information on this network expansion, please contact your Dickerson Account Executive.

Health Connect – Exporting Reports Just Got Easier With EBix!

Q4 is here, which is why we’re excited to share that we’ve enhanced our quoting engine. Check out Dickerson’s improved quoting engine and begin quoting groups with us today!

Please reach out to your Dickerson Account Executive for more details.

Health Net finalizes 2019 Medical Loss Ratio, announces plan closures for 2021

Health Net recently announced that they finalized their 2019 Medical Loss Ratio rebates, and that they would be closing and replacing a couple of plans with updated versions.

MLR Rebates

The Affordable Care Act (ACA) requires health carriers to maintain a Medical Loss Ratio (MLR) of at least 80% for Individual and Small Group Plans and 85% for Large Group Plans. The MLR is the percentage of premium dollars a health plan spends on physician, hospital, and other medical services and activities that improve healthcare quality.

This requirement is referred to as the MLR standard, and if these standards aren’t met, the health plan or insurance carrier must refund part of the premium.

For California Individual and Large Group Plans in 2019, Health Net met or exceeded the MLR standards. In 2019, Health Net’s California PPO plans met or exceeded the 80 percent MLR standard, but Health Net’s California HMO plans 2019 did not meet the Small Group MLR standard.

Health Net is required to provide this rebate by September 30, 2020. Small Employer Groups with an active policy will have their rebate applied to their monthly premium due on or after September 30, 2020. Small Employer Groups who no longer have an active policy will receive a rebate check. The rebate amount and the method of rebate may vary by state, family size and/or amount of premium paid.

There aren’t any changes to the current premium, deductible, or copay amounts as a result of the rebate. Broker commissions are also not affected by this transaction.

2021 Plan Closures

In 2021, Health Net is replacing a few plans with similar new plan options. The updated portfolio offers more small business-focused solutions. Health Net will mail plan closure letters to employer groups and members impacted by these changes.

Health Net is closing these plans and replacing them with updated versions:

  • Bronze 60 HDHP PPO 5600/20% + Child Dental Alt
  • EnhancedCare Bronze 60 HDHP PPO 5600/20% + Child Dental Al

Stay tuned for more information on Health Net’s 2021 SBG portfolio and Covered California Small Business plans coming in early October.

For more information on Health Net’s MLR rebates and 2021 plan closures, please contact your Dickerson Account Executive.

Join Dickerson’s Dave Fear Jr. at CAHU’s Annual Summit

Dickerson is serving as a sponsor at CAHU’s Annual Summit, and Dickerson’s Dave Fear Jr. will be offering a CE course on Self Funded Employee Benefits. We’d love to see you there! This year, the summit will take place virtually.

October 6th & 7th
Register here

Training sessions will cover State and Federal Legislative updates, ways to improve customer service skills, finding new technology that helps grow business and streamline your life, sales skills, and more!

There will also be many CE courses like Dave’s and other critical information delivered in Knowledge Tracks, two-hour sessions designed to let attendees learn about topics most important to them. Most sessions will be recorded and available after the event is over.

For more information, please contact your Dickerson Account Executive.

Dickerson Individual Market

Dickerson invites you to Camp Molina

Gear up for Open Enrollment and attend Camp Molina, which is Molina’s 2021 CA Marketplace Training.

These sessions will cover Molina updates, competitive pricing, provider networks, product design changes, new technologies, and process improvements/resources.

There are four training sessions to choose from. Once you register, you’ll receive a confirmation email with a WebEx training link and instructions on how to add the training to your calendar.

Here are the available options:

  • Wednesday, September 30th from 9:30 AM to 10:30 AM PST
  • Wednesday, October 7th from 9:30 AM to 10:30 AM PST

For more information, please contact Sally Saracay (

In the news

COVID presumption signed, effective immediately

Governor Newsom signed SB1159, which created the presumption that cases of COVID-19 are related to work. The law requires certain conditions be met, such as testing positive for the virus. This bill codifies the governor’s earlier executive order that created a presumption for essential workers, and expanded with two new presumptions: one for healthcare and public safety officers, and another for private workplaces that experience an outbreak of COVID-19 infections.

As an emergency measure, the bill took effect with Newsom’s signature. It includes a sunset date of January 1, 2023. Employers with less than five employees are exempt from presumption under the statute. Employers have three days to report a case to their claims administrator. The report must include the date of a positive result, where the employee works, and how many employees work at the site. The Cal/OSHA Standards board is approving the creation of new reporting regulations as well.

For the full story, click here.

Potential impact of Supreme Court’s decision in California v. Texas on key provisions of the Affordable Care Act

This November, the Supreme Court is scheduled to review the constitutionality of the Affordable Care Act (ACA) in California v. Texas. Late last year, a federal appeals court ruled that the ACA’s individual mandate is unconstitutional since Congress set the mandate tax penalty to $0. The Trump administration previously argued that only the ACA’s pre-existing condition protection should be overturned, but now argues that nearly all of the ACA should be invalidated.

The ACA’s reforms affect nearly every American in some way, and the Supreme Court’s decision in this case would have complex and far-reaching impacts on the healthcare system. The number of uninsured Americans decreased by 20 million from 2010 to 2016 as the ACA went into effect, but increased by 2.3 million from 2016 to 2019. A KFF analysis examines key provisions of the 2010 law that changed the nation’s health care system, including what’s known about their impact on people’s access to affordable care and coverage, as well as state-by-state data where available.

Click here to read the full story.