Health Net MLR, Covered CA, Employee Vaccine Status Questions, News & More!


Health Net Finalizes 2020 MLR Results

The Affordable Care Act (ACA) requires health carriers to maintain an MLR of at least 80 percent for Individual and Small Group Plans and 85 percent 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 health care quality, including wellness programs. The MLR standard was created to provide more transparency and accountability around health care costs.
  • For California Individual and Large Group HMO and PPO Plans in 2020, Health Net met or exceeded the MLR standards.
  • For California Small Group Plans in 2020, Health Net Life Insurance Company (PPO) met or exceeded the 80 percent MLR standard.
  • For California Small Group Plans in 2020, Health Net of California, Inc. (HMO) did not meet the 80 percent MLR standard.

This means that your Small Group Clients who had Health Net of California, Inc. HMO plans in 2020 will receive a rebate of a portion of the premium as required under the ACA.

Small Employer Groups who are eligible for a rebate will receive one. The rebate amount and the method of the rebate may vary. Health Net is required to provide the rebate by September 30, 2021.

Contact your Dickerson Sales Rep for more information!

Heal Visits No Longer Available in California

Effective September 1, 2021, Heal, a provider of home-visit care and telemedicine will no longer be available in California. Heal sent emails and letters the first week of July to members who had heal visits in the last 12 months. If a member in California has an upcoming Heal visit already scheduled before August 31, 2021, the appointment will be honored. If the appointment is after August 31, 2021, it will need to be rescheduled at or by calling 844-923-4325.

Click here for more information from Heal.

COVID-19 Vaccination Status and Group Health Plan Design Choices

As businesses are eager to return to the office and bring customers back on-site, many employers are wondering if they can modify their group health plan to provide richer benefits for vaccinated employees. Employers should know that although HIPPA doesn’t prevent an employer or business from asking an individual to share their vaccination status, it does prevent group health plans and insurers from discriminating against individuals regarding eligibility and health status-related factors. If employers want to offer a wellness program with health-contingent qualifications, it must meet some basic requirements.

Click here to download the whitepaper.

Mental Health Parity and Transparency Provisions Under the Consolidated Appropriations Act, 2021

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as part of the Consolidated Appropriations Act of 2021 (CAA), prohibits a group health plan from applying financial requirements, quantitative treatment limitations, or non-quantitative treatment limitations to its mental health and substance use disorder benefits that are more restrictive than those applied to the plan’s medical and surgical benefits.

Click here to download the whitepaper.


Covered California Announces 2022 Plans

Covered California announced its plans and rates for the 2022 coverage year, which will include a full year of lower premiums under the American Rescue Plan. The new and expanded financial help provided by the law has led to a record 1.6 million people enrolled in Covered California, which contributes to the state having one of the healthiest consumer pools in the nation, resulting in a low rate change for a third straight year. Covered California now has the highest enrollment in its history!

Here are some highlights for 2022:

  • The preliminary average rate change of 1.8% will apply to California Individual Market
  • Expanded carriers available with Covered California 
  • The American Rescue Plan is helping lower premiums for an estimated 1.5 million Californians
  • Covered California is committed to raising the bar on quality care and addressing disparities in care for African Americans and Latinos
  • Covered California special enrollment allows the uninsured to sign up now, no need to wait until November for open-enrollment

Click here to read about Covered California 2022 Plans and Rates.


Pandemic Unveils Growing Suicide Crisis for Communities of Color

Suicides have risen among Black, Hispanic, and other communities of color during covid. But the rates were already escalating before the pandemic struck. To read the full story, click here.

Microbiome Startups Promise to Improve Gut Health

Consumers are looking towards microbiome startups for diet regimens based on analyzing gut bacteria, but not all of these companies have the proper science and research to provide recommendations. To read the full story, click here.

Back to School: How to Keep Your Child Safe From the Delta Variant

It’s inevitable that when kids mix, germs spread. The CDC has advice for keeping your child protected from this highly contagious version of the coronavirus now and this fall. To read the full story, click here.

Moms With Migraines – 9 Things to Know

Moms are notorious for putting other people’s needs first but it’s critical for any mother suffering from chronic migraines to take care of themselves before others. To read the full story, click here.