DMHC Says That Provider Directories Are Still Not Accurate Enough

Healthcare_DirectoriesThe California Department of Managed Health Care (DMHC), director Shelley Rouillard, issued a statement expressing her disappointment that health plans are still not providing accurate enough provider directories. DMHC issued follow-up reports on the accuracy of provider directories for Anthem Blue Cross and Blue Shield of California. SB 137 includes several new provisions including strict timeframes for verifying provider information. She said, “Access to care often starts with the provider directory, which is why its accuracy is so important. This legislation provides a new comprehensive framework for the regulation of provider directories and adds significant accountability for health plans and providers. We expect measurable improvement with the full implementation of Senate Bill 137.” For more information, visit

A Chance to Comment on 2017 Premium Rates
The California Dept. of Managed Health Care (DMHC) is reviewing proposed 2017 premium rates in the individual and small group markets. The public can provide comments on a health plan premium rate filing here

Orange County Insurance Pros Tee Off to Stop Child Abuse
On Tuesday September 27th, members of the local insurance industry will tee it up at the Insurance Industry Charitable Foundation’s (IICF) annual Insuring the Children Golf Tournament to raise money for child abuse prevention. This year’s tournament will be held at Arroyo Trabuco Golf Club in Mission Viejo, Calif. The annual tournament has raised over $1.5 million for Southern California child abuse prevention organizations. Here is the address and event schedule:

Arroyo Trabuco Golf Club
26772 Avery Pkwy
Mission Viejo, CA 92692

Tuesday, September 27, 2016

  • 10:30 – 11:45 am Registration
  • 11:00 am Putting Contest
  • 12:00 pm Shotgun Start
  • 5:00 – 8:00 pm Dinner & Awards Reception

To RSVP, visit

Kaiser to Expand into Santa Cruz
On July 21, 2016, the DMHC approved a request by Kaiser Permanente to expand its service area into Santa Cruz County. The expansion allows Kaiser Permanente to provide coverage for individual and family benefit plans and group benefit plans beginning January 1, 2017 in Santa Cruz County, including individual and family benefit plans sold through Covered California.

CAHU Installs New Board
The California Association of Health Underwriters (CAHU) installed its 2016-2017 board. Richard P. Coburn, CLU, MHP is CAHU president. With more than 40 years of group benefits expertise, he is in his 18th year at Word & Brown, a general agency in Orange County. Coburn has served in various leadership roles at the local, state and national level earning multiple awards including Distinguished Service and Legislative Excellence. Rick also served on the Curriculum Committee of the Licensing Bureau of the Department of Insurance. “Local agents and brokers serve as a source of truth about healthcare coverage that links the needs of citizens, business and policymakers to create a healthy, more fiscally responsible American healthcare system,” Coburn said.

Here is the complete make up of the 2016-2017 Executive Board:

  • President – Richard P. Coburn, CLU, MHP – Word & Brown, San Jose
  • Immediate Past President – Michael Lujan, RHU, CHRS – Limelight Health, Inc., San Francisco
  • President-Elect – Stephanie Berger – HLS Insurance Services, Camarillo
  • VP Legislation – Dave Fear, Jr. – Shepler & Fear General Agency, Roseville
  • VP PAC – Ryan Neace – Administrative Solutions, Inc., Fresno
  • VP Public Affairs – Bruce D. Benton, RHU – Genesis Financial & Insurance Services, Encino
  • VP Membership – John Evangelista – Colonial Life, Rancho Santa Margarita
  • VP Professional Development – Leslie Williams – Leslie Williams Insurance Services, Redding
  • VP Communication – Cerrina Jensen, CHRS, CBC – CoreMark Insurance Services, Sacramento
  • VP Finance – Juan R. Lopez – Health Care Consultant, Santa Ana
  • VP Corporate Affairs – Patrick Burns – Burns Employee Benefits, Oakland
  • VP Community Outreach – Wayne Guzman – BBSI, Ontario

For more information, visit our web site at 

Man sentenced in Worker’s Comp Scheme
Gregory Chmielewski, 46, was sentenced to three years and five months in prison for a workers’ compensation scheme he ran from September 2003 to September 2007. Chmielewski set up a professional employer organization (PEO), which he operated from Healdsburg until relocating to Roseville in 2006. He solicited an Indian tribe to provide employee insurance and other employee services for a reduced cost. Chmielewski marketed the insurance as a low-cost alternative to workers’ comp, claiming that the program was under the tribe’s sovereign system.

More than $7.3 million was paid out of the PEOs accounts to companies that Chmielewski controlled. The PEO was forced to close when it ran into serious cash flow problems, leaving 117 injured workers with $1.8 million in unpaid claims. Acting U.S. Attorney Talbert said, “Many of the victims harmed in this scheme were companies in California’s construction industry, whose employees worked as roofers, general laborers, and other jobs where injuries can occur. The defendant’s actions left many injured workers without the benefits they expected and deserved.” The case was the product of an investigation by the U.S. Postal Service, the IRS, and the California Department of Insurance.

Blue Shield Expands ACO Network in SoCal
Blue Shield of California expanded its Accountable Care Organization (ACO) network in Southern California through a collaboration with PrimeCare Medical Network, the Inland Empire’s largest network of independently contracted physicians, and with San Antonio Regional Hospital in Upland, Calif. The ACO will make it easier to share important health information so that providers who are involved in a patient’s care can support the same treatment plan. Blue Shield’s newest ACO helps transition the region’s health care system toward rewarding providers for patients’ health outcomes while making care more affordable. The network will serve more than 13,000 people in the Chino/Upland/Rancho Cucamonga region who are enrolled in Blue Shield’s HMO plans.

Former Anthem Blue Cross President Joins Limelight
Mark Morgan, former president of Anthem Blue Cross has been elected to Limelight Health’s board of directors. Morgan has held senior leadership positions at several of the nation’s largest health carriers, including Anthem Blue Cross and Health Net. As president of Anthem Blue Cross, Morgan oversaw commercial business and strategy in California, guiding Anthem through the Affordable Care Act and the Covered California exchange. Morgan started his career at Health Net, where he had leadership roles across all lines of business including large group, small group, and individual and family plans as well as product development, marketing, sales, and underwriting. Morgan earned a bachelor’s degree in finance from Cal State Northridge and a master’s degree in business administration from Pepperdine Univ. He was a licensed agent for over 10 years.


Seniors with More Continuity of Care Use the ER Less
Seniors with traditional Medicare coverage who consistently see the same physician in an outpatient setting have a lower chance of visiting the emergency room, according to a study published in Annals of Emergency Medicine. Study author David Nyweide, Ph.D, of the Centers for Medicare & Medicaid Services said, “Higher continuity of care was associated with lower risk of having any emergency department visit. However, when one occurred, the patient was more likely to be hospitalized. A possible explanation is that when a patient with a usual care physician comes to the ER, the physician may provide clearer guidance on which situations are serious enough to warrant a hospital admission.”

Nyweide said, “Visits with the same physician or a small number of physicians fosters long-term relationships for Medicare patients, which is ultimately good for their health. The critical factor seems to be consistent visits with one physician or few physicians, not lots of them. Seniors would be well-advised to maintain an ongoing relationship with the same physician for many reasons, including avoiding emergency department visits.” For more information, visit


Financial Advisors Are on Track to Implement New DOL Rules
Financial advisors are on track to comply with the new Dept. of Labor DOL fiduciary rule, according to Nationwide Retirement Institute survey. Advisors say they are at least somewhat knowledgeable about the following:

  • 82% Fiduciary requirements
  • 76% Products subject to fiduciary standards
  • 76% Fee/compensation disclosure requirements
  • 73% Best Interest Contract Exemption (BICE)
  • 69% What is considered advice vs. education
  • 64% Grandfathering provisions/conditions
  • 64% Levelized compensation requirements
  • Resources for advisors

As the industry works through this new regulatory environment, advisors are eager for information about the new rule. Only 42% of advisors are aware of their firm’s timeline for implementation, training, or support of the new rule. And only 33% are aware of their firm’s new compliance procedures. Firms and advisors are very concerned about the Best Interest Contract Exemption (BICE). Seventy-eight percent say that BICE is one of the greatest areas to affect their business. Only 23% of advisors are aware of their firms’ plans for adopting the BICE to sell variable compensation products. According to NAIFA, BICE requires a contract between a retirement investor and their advisor and between the investor and the financial institution. The contract must include the following:

Firms and advisors are very concerned about the Best Interest Contract Exemption (BICE). Seventy-eight percent say that BICE is one of the greatest areas to affect their business. Only 23% of advisors are aware of their firms’ plans for adopting the BICE to sell variable compensation products. According to NAIFA, BICE requires a contract between a retirement investor and their advisor and between the investor and the financial institution. The contract must include the following:

  • Acknowledgment of the advisor’s and financial institution’s fiduciary duty to the investor.
  • Disclosure of compensation and other fee information.
  • A warranty that the advisor and the financial institution will not make misleading statements about a transaction including  issues, such as fees, assets, and conflicts-of-interest.
  • A list of the steps the advisor/financial institution will take to mitigate conflicts-of-interest.

For a full explanation, visit

“Advisors are considering a shift from a transaction-based business model to more of a service-oriented model,” said Kevin McGarry, director of the Nationwide Retirement Institute. Eighty-seven percent are considering changing their business practices as a result of the rule. Forty-three percent say they may offer more holistic planning and 26% may focus on non-qualified accounts. The Nationwide Retirement Institute’s new DOL website provides resources for firms and advisors wrestling with the new fiduciary rule. Nationwide is also holding webcasts and local seminars on the rule. For more information, visit


Consumers Face Steep Rate Increases for federal LTC Policies
Many federal employees face rate increases of up to 126% under the federal long-term care insurance program. Rate increases take effect November 1st. Despite premium increases, enrollment continues to grow. The Office of Personnel Management blames the rate increases on longer life expectancies, higher-than-anticipated claims, and the lower returns on the trust fund’s investments.

Jesse Slome, director of the American Association for Long-Term Care Insurance recommends investigating private market options before the September 30 deadline to make a change. “Options are available to help reduce the impact of the premium increase, but one shouldn’t wait until the last minute to explore alternatives. If you are switching, make sure you’ve been approved before dropping any existing coverage.” George Mellendorf, president of LTC Solutions said that some private options offer excellent coverage — some with no risk of future rate increases. Not all enrollees in the federal long-term care insurance plan face rate increases. Rates are increasing for long-term care insurance purchased by federal and Postal Service employees as well as active and retired members of the military and qualified families. For more information, visit

Not all enrollees in the federal long-term care insurance plan face rate increases. Rates are increasing for long-term care insurance purchased by federal and Postal Service employees as well as active and retired members of the military and qualified families. For more information, visit


International On-demand Healthcare Platform
TreatMD introduced telemedicine platform for patients and providers in more than 30 languages and growing. Telemedicine companies contract with providers who offer their services to the public at set rates, for example at $50 a consultation. In a matter of minutes, any provider, in any location, can register, set their consultation rates, set their schedule, and start conducting telemedicine to the public. TreatMD offers a premium provider signup to allow a provider to start conducting telemedicine at no risk. Any patient around the world can engage with a provider seamlessly. A patient can type in their location to find providers specializing in diseases or conditions, read provider reviews, and search for providers by criteria, such as price ranges of consultations or specialties.

Medical Second Opinion Voluntary Benefit
More Health offers a medical second-opinion service as an employee-paid voluntary benefit or as an enhancement to an employer paid benefit plan. The service connects the employee’s attending doctors to an elite physician specialist with a cloud-based platform. Specialists and attending doctors develop a co-diagnosis and treatment plan. The service addresses concerns over narrowing healthcare networks. For more information, visit, call 888-908-6673, or e-mail

HSA Learning Site
HealthEquity introduced website, that focuses on educating Americans about HSAs. The site includes videos, interactive quizzes, a qualified medical expenses tool, a future-balance calculator, and HSA investing information. For more information, visit

Hospital Coverage
Colonial Life introduced a group hospital confinement insurance plan called “Group Medical Bridge.” It provides benefits covering hospital confinement, outpatient surgery, diagnostic tests, doctor’s office visits, emergency room visits, prescription drugs and ambulance service. These benefits help pay for deductibles, co-pays, coinsurance, and out-of-pocket medical and non-medical expenses that employees face. In addition to standard benefits, employers can choose from 12 benefits to customize the coverage. Employers with multiple medical plans can offer two group medical bridge plans to provide more coverage options. The policy can also include telemedicine, prescription drug benefits and inpatient mental and nervous condition benefits. Other enhancements include a higher outpatient surgery benefit, a stronger HSA-compliant plan, a new critical illness rider, and a waiver-of-premium after 30 days of hospital confinement. For more information, visit


Private Exchange Forum
The Institute for Health Care Consumerism is sponsoring a private exchange forum on November 9 to 10 in Las Vegas. For more information, visit.