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Wednesday April 23rd 2014



California Exchange Selects Pediatric Dental Plans


• California Exchange Selects Pediatric Dental Plans
• DMHC Fines Kaiser Over Consumer Access to Mental Health Services
• Bill Seeks to Reduce Secrecy Over Exchange Contracts
• HSA Enrollment Reaches 15.5 Million
• Medicare Complaint Hotline Goes Live
• HHS Website Offers New Health Insurance Tools
• Consumers Rushed to Buy Before LTC Policy Changes Went Into Effect
• What Consumer Do with their Life Settlement Money
• Women in Business Conference on Friday in Newport Beach
• LIDMA Conference
• HealthCare Consumerism Radio
• Guaranteed Universal Life
• Disability Protection for Entry-Level Salaries
• Whitepaper on Private Exchanges
• Video Explains the Affordable Care Act


California Exchange Selects Pediatric Dental Plans

DentalPediatricCalifornia’s health exchange, “Covered California,” has chosen the following pediatric dental health plans for children up to 19 years old:
1. Anthem Dental
2. Blue Shield of California
3. Delta Dental of California
4. Health Net Dental
5. LIBERTY Dental Plan
6. Premier Access Dental.

Like Covered California’s health insurance plans, the pediatric dental plans underwent a rigorous screening and competitive bidding process and had to balance access to providers with affordable premiums to qualify.

All plans can be bundled with health insurance for a single premium. Five carriers are offering nine stand-alone plans while Health Net Dental is only available in a bundled option. Three product types are available, depending on where the child lives: DHMOs, DPPOs, and DEPOs.

Premiums for stand-alone plan range from less than $10 a month for an HMO plan in some areas to about $30 a month for a DPPO. Consumers are not required to purchase the pediatric dental benefit. However, Peter Lee executive director of Covered California noted that the plans offer comprehensive child dental coverage, which is particularly important for consumers of child-only coverage and family plans.

Covered California dental benefit plans feature standard copayments, deductibles, and coinsurance requirements. Unlike Covered California’s health insurance plans, dental plans are not designated by metal levels, but come in two actuarial value options. The 85% plan features higher premiums, but lower average out-of-pocket costs. The 70% plan features with lower premiums and higher average out-of-pocket costs. For more information, visit

DMHC Fines Kaiser Over Access to Mental Health Services

The California Department of Managed Health Care (DMHC) issued a $4 million fine against Kaiser for not providing enough access to mental health services. DMHC Director Brent Barnhart, said, “The Department’s actions are a result of both the seriousness of the deficiencies and the failure of Kaiser to promptly correct them.” DMHC says that Kaiser does not do the following:
• Make sure that quality assurance systems accurately track, measure, and monitor the accessibility and availability of providers.
• Monitor its provider network to ensure that appointments are offered within regulatory timeframes.
• Provide effective action to improve care where deficiencies are identified.
• Provide accurate and understandable mental health education materials, including information about  the availability and optimal use of the plan’s mental health care services.

The plan’s mental health educational materials, including frequently-asked-question  sheets, Website postings, and new patient presentations included inaccurate information that could dissuade an enrollee from pursuing medically necessary care. The DMHC also found examples of member materials that, while consistent with the law, did not convey coverage in language understandable to the average member.

The DMHC will conduct a follow-up survey in October to make sure that Kaiser has corrected the deficiencies and is complying with the law. The full survey report can be found here:

Bill Seeks to Reduce Secrecy Over Exchange Contracts

A state legislative committee approved a bill that would require California’s health insurance exchange to make more contract information publicly available. According to a report by the Associated Press, The Senate Health Committee voted 9 to 0 to pass the legislation by Republican Sen. Bill Emmerson and Democratic Sen. Mark DeSaulnier. They introduced SB332 after a story by the Associated Press revealed how much privacy is granted to the Covered California exchange. When lawmakers created California’s health insurance exchange in 2010, they gave it the authority to conceal contracts for a year and the amounts paid indefinitely. Under existing rules, exchange officials can keep secret board meeting minutes, employee training materials, and records that reveal recommendations, research, or strategy.

SB332 seeks to reverse those restrictions. Under the bill, only contracts with health insurance plans could be withheld for a year. Payment details in those contracts would be private for four years. The updated disclosure rules were modeled on those used by the state’s Healthy Families program.

An Associated Press survey of the 16 other states that have opted for state-run marketplaces showed that the California agency was given powers that are the most restrictive in what information is required to be made public.

Five Republican U.S. senators have asked the HHS to investigate whether California is inappropriately concealing details of how it is spending federal dollars for building and running the insurance exchange.

In response to a previous Associated Press public records request, the agency released information on a dozen competitively bid contracts issued since early 2011. They included $14 million for a contract with Ogilvy Public Relations for marketing and $327 million for a five-year deal with consulting giant Accenture to develop a web portal and enrollment system. SB332 now goes to the Senate Appropriations Committee.

Essential Benefits Regulation Approved

Insurance Commissioner Dave Jones approved an emergency regulation requiring health insurers to cover all essential health benefits for new policies in effect after January 1, 2014. The emergency regulation is a critical element of Affordable Care Act implementation. The Affordable Care Act requires non-grandfathered health insurance policies in the individual and small group markets (inside and outside of the Health Benefits Exchange) to provide coverage for a comprehensive package of healthcare benefits, known as “essential health benefits.” In the past, some policies have included very limited or no coverage for important healthcare services. Plans must cover the following essential benefits in 2014:
1. Ambulatory patient services (outpatient services).
2. Emergency services.
3. Hospitalization.
4. Maternity and newborn care.
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs.
7. Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices.
8. Laboratory services.
9. Preventive and wellness services and chronic disease management.
10. Pediatric services, including oral and vision care

For more information, visit


HSA Enrollment Reaches 15.5 Million

Nearly 15.5 million Americans are covered by health-savings account (HSA)-eligible insurance plans. That’s an increase of nearly 15% since last year, according to a census by America’s Health Insurance Plans (AHIP). The large-group market saw the biggest enrollment increases, which represents nearly 70% of all enrollment in health savings account/high-deductible health plans (HSA/HDHPs) in 2013.
The following are some key findings:
• 49% of all HSA/HDHP enrollees in the individual market (including dependents) were 40 or over; 51% were under 40.
• States with the highest HSA/HDHP enrollment were Illinois (903,000), Texas (889,364), California (808,019), Ohio (686,616), and Michigan (577,208).
• The vast majority of individuals enrolled in a HSA plan have access to a variety of tools and resources, including information for selecting appropriate providers and hospitals.
For more information, visit

Medicare Complaint Hotline Goes Live

The American Assn. for Homecare and People for Quality Care are offering the Beneficiary Complaint Hotline. Medicare beneficiaries can call 800-404-8702 to complain about a lack of access to home medical equipment and service. The line will be staffed 24 hours a day, seven days a week. With the caller’s permission, the complaints will be forwarded to a local Medicare ombudsman for resolution and added to a list of complaints, which will be presented to Congressional members. For more information, visit

HHS Website Offers New Health Insurance Tools

HHS is offering new tools at It also offers a 24-hour-a-day consumer call center to help Americans prepare for open enrollment and sign up for private health insurance. The new tools will help people understand their choices and select the coverage when open enrollment begins on October 1 for the new Health Insurance Marketplace. The Website integrates social media, sharable content, and engagement destinations for consumers. The site will also launch with a Web chat function. The call center will provide educational information between now and the start of open enrollment. Beginning Oct. 1, it will help consumers complete applications and select plans. The call center provides assistance in more than 150 languages. For more information, visit


Consumers Rushed to Buy Before LTC Policy Changes Went Into Effect

Headlines have focused on how some leading long-term care insurance carriers reduced product offerings or pulled out of the business altogether amid persistent low interest rates. But, in 2012, some of the carriers that had announced plans to reduce their offerings had the strongest year-over-year sales expansion. This suggests that consumers rushed to purchase policies before the changes took effect, according to SNL Financial.

In force group long-term care lives increased 3% while individual lives increased.0.6%. Northwestern Long Term Care Insurance Co. posted the industry’s largest year-over-year increase. In force individual long-term care lives grew 22.2% in 2012 as the company saw a surge in sales activity. The company had moved to suspend the lifetime benefit period and limited payment options for all of its long-term care products. The company cited updated industry morbidity data and the fact that those policy features are most susceptible to challenges associated with low interest rates. It also made pricing changes on new long-term care business, which first took effect in March. For more information, visit


What Consumer Do with their Life Settlement Money

Coventry analyzed 100 insureds who sold their life policies to Coventry First in the past year; Sevent-seven percent primarily used the proceeds to pay for immediate medical or healthcare needs, long-term care services, or to increase retirement income. Another 14% used the proceeds to fund a new life insurance policy or retain a portion of their existing policy without the requirement to pay ongoing premiums.

Alan Buerger, CEO and co-founder of Coventry said, “We’ve seen a steady shift in the use of life settlement proceeds to address healthcare and long-term care needs over the past few years. The downturn of the economy combined with the increase in the number of seniors in need of long term care and rising healthcare costs is a major reason people are selling their policies.” Buerger also noted that a number of the largest insurance companies have left the long-term care insurance market or have significantly raised rates for these policies, placing seniors in more dire straits when faced with immediate long term care needs. For more information, call 877-836-8300 or visit


Women in Business Conference on Friday in Newport Beach

California State University, Dominguez Hills in Carson, Calif. will be the site of a gathering of women in business. More than 1,800 participants are expected to attend. The Honorable Hilda Solis, former Secretary of Labor under the Obama administration, will deliver the keynote address. Her inspiring story includes tips for women in the private sector on how to overcome the many challenges they face. For more information, visit

LIDMA Conference

The Life Insurance Direct Marketing Association will hold its Fall Meeting & Showcase September 22 to September 25, 2013 at the Balboa Bay Club in Newport Beach, Calif. For more information, visit

HealthCare Consumerism Radio

Telehealth, HSAs, and wellness will be the features of this week’s HealthCare Consumerism Radio. It will be held Friday at 8:00 a.m. (PT). The show will cover telehealth, account-based plans, consumerism, and health advisory. The first guest will be Victor Adefuye, president at Wellness Rebates, a wellness-consulting firm for mid- to large-sized businesses. Next on the program will be Mark McLaren, president at M2 Benefits, discussing M2′s subsidiary Virtual Health 24/7. The final guest will be Brian Tolbert of Bernard Health Consulting, who works with employers and individuals to offer HSA, brokerage and consumerism advice. For more information, visit


Guaranteed Universal Life

American General is offering its Lifestyle Income Rider for guaranteed universal life policies. It’s designed for who people who need the financial protection of life insurance along with a source of retirement income. For more information, visit

Disability Protection for Entry-Level Salaries

MassMutual is offering a new rate structure to help those with entry-level salaries to purchase disability income insurance. Initial premium payments are less than the traditional or fixed level premiums in the early years of the policy. Premiums gradually increase each year until they become level at age 50 for the duration of the policy. There is also an option to purchase permanent life insurance over time without medical tests. For more information, visit

Whitepaper on Private Exchanges

Health Partners America is offering a white paper, titled “Private Exchanges 101: The Essentials on Understanding, Using, and Selling Them.” For more information, visit

Video Explains the Affordable Care Act

EPIC, an insurance brokerage and consultancy, released its video, “Understanding Healthcare Reform.” The video provides an overview of the Affordable Care Act, simplifying its many elements into a straightforward, easily understood review. To view the video, visit