To cover the added costs associated with the enhanced benefits, premiums for Individuals on the Regence Evolve Plus and Regence Evolve HSA 100 Plan increased on April 1, 2012.

The increase ranged between 0% and 2% depending upon the policy. There was no rate change for the Regence Evolve Core or Regence Evolve HSA Plans.

What were the 3 benefit enhancements that were added January 1^st?

• · Removal of Annual Dollar Limits on Prescriptions
  Specific dollar limits on Rx benefits have been removed from the Evolve Plus and HSA 100 plans. These plans formerly had the following annual dollar limits: $2,500 (Plus) and $2,000 (HSA 100).
• · Self-administered chemotherapy covered at level comparable to provider-administered chemotherapy
  With the passage of House Bill 1517, the Washington Legislature mandated that plans providing coverage for cancer chemotherapy treatment must also provide coverage for prescribed, self-administered anti-cancer medication on a basis that’s at least comparable to cancer chemotherapy medications administered by a physician or hospital.  They modified Individual products to comply with this legislation
• Rx deductible waived for diabetic insulin and supplies
  For new and existing Regence Evolve Plus plans, Regence now waives the prescription medication deductible on brand-name medications for insulin and diabetic supplies. This change, which arose out of discussion with the OIC, addresses a concern regarding benefit designs that may discriminate against those with conditions for which a generic drug is not available, especially diabetes.

Several LifeWise plans which currently offer Generic Only drugs will be changing prescription coverage August first.

The Washington State insurance commissioner’s office recently ruled that if a carrier offers ANY DRUGS on a plan they must also offer Brand Named drugs.

LifeWise of Washington was keeping costs down for its members by only offering plans with Generic Drugs.   These lower priced plans have been some of the most popular plans in Washington State.   This ruling forced LifeWise to change their plan designs and they filed for new rates because of this change.  All of this will be effective August 1^st 2012

Plans affected:

Wise Advantage- This plan currently covers ONLY generic drugs.  The Pharmacy benefit will change to include coverage for BOTH brand name and generic prescription drug coverage.  LifeWise has filed for an 8% increase in rates.

Wise Essentials RX – This plan also currently covers ONLY generic drugs.  They are removing the prescription drug benefit completely to comply with the new rules.  They filed for a 3.8% average rate decrease.

Because of the midyear changes, LifeWise must also comply with other legislative required coverage additions and these were also figured into the new rate filings.  (These changes included Women’s Reproductive services and a required revision to the Oral Chemotherapy state mandate).

We expect more information to be available from Lifewise sometime in May.

If you are a family with children insured on your individual health insurance plan, right now is a critical time to review you health insurance.  With very few exceptions after April 2012 your children will be stuck with the plan they are on until November of 2012 !

March 15th to April 30th is the new “Open Enrollment Period” due to Health Care Reform. One of the most popular and universally supported provisions of the recent Health Care Reform Law is the requirement to insure children under 19 without pre-existing conditions. The problem was that this rule actually encourages parents NOT to insure their children until they get sick. (Even I was going to drop my kids from my family’s policy!)

The Result was an Emergency Ruling by our Washington Insurance Commissioner, creating new “Open Enrollment Periods” for anyone under the age of 19. This next Open Enrollment Period is from March 15th to April 30th and is the only time (with a few exceptions) that children under 19 can purchase, or change individual health insurance in Washington. This means that if a family wishes to purchase or change insurance plans it’s allowed only during this period!

What if you miss this window? Tough Luck. Your children must stay with the insurance plan they are on now until next Open Enrollment. If they have no coverage at all, then they must wait until the fall to join a plan. The only alternative is to put kids under 19 on a temporary insurance plan (not as good) or have them apply to the Pre Existing Insurance Plan run by the State of Washington (really expensive!)  . There are NO exceptions, UNLESS one of the four exemptions occurs:

1. The child under 19 loses employer-sponsored insurance.
2. The child under 19 loses insurance coverage due to a divorce.
3. The child under 19 loses insurance coverage under Medicaid, Washington Basic Health or other Federal or State programs.
4. The child under 19 moves to another residence where their current health insurance company does not provide service.

Remember if you want to change or add children (under age 19) – to your individual health plan, do so before the end of April.  Feel free to call one of our health care open enrollment specialists at no cost to you.  We will guide you through available carriers, plan choices and enrollment deadlines.   Make your 2012 action plan for your family today!

One of only five carriers offering Health Insurance to Individuals in Washington State, KPS will be ending service effective July 1st, 2012.

03/013/2012   IMPORTANT UPDATE:

An emergency bill passed in Olympia now allows KPS members to move to another carrier plan with NO HEALTH UNDERWRITING as long as they have 24 months of continuous coverage.  There are guidelines to the bill and only certain people that were with KPS will qualify.  Contact us to see if you may benefit from this legislation.

Known as ‘KPS’ or ‘Kitsap Physicians Services’ , this company primarily covers Pierce and Kitsap counties but they do have members in King and Snohomish Counties as well.

What happened? Simply put, they went broke. One of the reasons that Washington State has few insurance companies offering individual plans here in the first place is our tough State Regulatory environment. Put another way, insurance companies can’t stay afloat if they are required to comply with rules that basically have forced them to accept almost anyone who applies. That combined with prices that are regulated by the Insurance Commissioner and set low, equaled a few years where the company lost money and were thus taken over by the State, then run by Group Health, and now going ceasing individual sales entirely.

So, are consumers now better off with one less option? Would it have been better for KPS to have been allowed by the Insurance Commissioner to have slightly higher prices, yet stay financially viable and in business? Is KPS only the first of other plans in Washington to be headed for the same fate? We don’t know.

What we do know is that if you are on a KPS health plan you need to change to a new health insurance company, and we can help.

Our seasoned brokers can help you navigate and pick through the dozens of plans offered by the remaining companies in Washington State. With just a few questions we can help you simplify your choices based on your needs. You will want to plan your move to another health plan now, to ensure a smooth transition in June.

Also IMPORTANT TO KNOW: The latest information from the Office of the Insurance Commissioner states there currently is not a health exemption for those with pre existing conditions who are being forced to change plans. That’s a problem. Stay tuned to see if the Insurance Commissioner changes this rule, as it may be your one chance to move to another carrier without health underwriting.

We will be helping our affected clients through this transition and are always available to help you make a good decision as well.

While this may sound counter intuitive, spending MORE on needed health expenses at the end of the year may actually save you money.

Because most health insurance plans operate on a calendar year, from January 1st to December 31st, your yearly deductible is usually also based on this time-frame. So, let’s say you have a $1,000 deductible. Now assume that you have spent $800 of your deductible though November, and the doctor says you will need more medical treatment in the near future. In this case, if you wait to get your expected medical treatment until after January 1st, you must start paying towards your entire $1000 deductible again! However, if you complete the needed work or procedures BEFORE December 31st, you may only pay another $200 towards your deductible, and then just the coinsurance (usually 20% of the remaining charges)! You’ll “save” $800 of your own money from having to be used towards you deductible again.

Think of a deductible as “use it or lose it”. Once you start getting close to using your entire deductible for the year you might as well get as much other medical work done as you can, as it will cost you only incrementally more!

Now, I’m not advocating having unnecessary medical procedures done just because you “can”, but if you know you must have more medical procedures done in the near future, getting as much done in one year as possible is a sure way to save money. Most though not all plans operate this way, so be sure to ask if this situation applies to you.

CLASS Act was supposed to be a major funding vehicle in the first 10 years of the health care reform bill, and the reason it “does not add a time to the deficit”. This would have provided long term care assistance to those who voluntarily paid in.  However, because benefits would not begin for about 10 years, it collected revenue ahead of time, with no expenses.  Unfortunately, as predicted by the centers for Medicare/Medicaid last year, last Friday HHS Secretary Kathleen Sebelius said it should not proceed because even she has been unable to find a way to make the program financially solvent, as required by law.

“Despite our best analytical efforts, I do not see a viable path forward for CLASS implementation at this time,” Sebelius said in a letter to congressional leaders.  Wow, and this from a staunch supporter of our president.

The CLASS Act had a problem from the start.  Unless large numbers of healthy people willingly signed up during their working years, soaring premiums driven by the needs of disabled beneficiaries would destabilize it, eventually requiring a taxpayer bailout.

On Monday, the nonpartisan Congressional Budget Office issued a ruling that cleared the way for repealing the CLASS Act, but the administration rejected that step creating confusion.  That is because if they do repeal, as suggested now by many in their own party, Kathleen Sebelius, and the CBO, it deals a crushing blow to the sustainability of the entire healthcare bill itself.

Add to that the expected ruling that the Individual Mandate will eventually be struck down, and we have a major problem.  Without those two key provisions, the Health Care Reform bill will become a financial albatross, adding Billions and Billions in new spending, with no revenue to support it.

Without this massive Federal Revenue promised to States, States as here in Washington, now in full swing developing their Health Insurance Exchanges, will be in a dire situation.  Without the ability to borrow money like the Federal Government, they will be in essence bound by law to run their exchanges, providing billions in subsidies for those who qualify, and have no way to pay for it.  Not a good situation

“We do not support repeal,” White House spokesman Nick Papas said Monday. “Repealing the CLASS Act isn’t necessary or productive. What we should be doing is working together to address the long-term care challenges we face in this country.”

And that is the problem.  It is both good politics and good business to solve the long term care and health insurance issues facing our country.   But by not making a decision to kill the CLASS Act provision, which is fairly obvious at this point, the administration ends up kicking a brand new can that they created down the road for someone else to fix.

Effective January 1st 2012 the new overseer for Health Plans in our country, HHS, will no longer allow insurance companies to place dollar limits on prescription drug coverage. The current LifeWise WiseChoices Prime 1500 plan currently covers up to $3,000 per year towards brand name prescription drugs. Since LifeWise cannot keep in place the $3,000 limit on brand name drugs in 2012 they have elected to end the Prime plan entirely. They have asked permission from the insurance commissioner to replace it with a similar, but not exact replacement, the WiseAdvantage 1800 plan. This new plan only offers Generics, with no limit.

Because the new plan, WiseAdvantage 1800, has not yet been approved by the Insurance Commissioner, we don’t know all of the details. However, here is what LifeWise has communicated about the plan so far:
• It will still be a comprehensive plan. This means it should cover pregnancy, offer unlimited office visits for a copay and have unlimited coverage for generic prescription drugs.
• The deductible will be $1,800 vs. the current plan’s deductible of $1,500.
• As stated above the WiseAdvantage plan will not offer brand name drug coverage.

So, as I mentioned, this leaves only two plans that will offer Brand Name Drugs to people in the Individual Health Insurance Market in Washington State. Those two companies are Group Health, with their Balance 1750 plan, and the Regence Evolve Plus Plans. However, before switching to one of these two plans, we advise to wait and see what these companies response will be to the new HHS rule. The last thing you’d want to do was change plans, only to have your new plan change as well!

If you are a family with children insured on your individual health insurance plan, right now is a critical time to review you health insurance. After October you’re your children will be stuck with that plan for potentially all of 2012!

September 15th to October 31st is the “Open Enrollment Period” due to Health Care Reform. One of the most popular and universally supported provisions of last year’s Health Care Reform Law is the requirement to insure children under 19 without pre-existing conditions. The problem was that this rule actually encourages parents NOT to insure their children until they get sick. (Even I was going to drop my kids from my family’s policy!)

The Result was an Emergency Ruling by HHS, creating new “Open Enrollment Periods” for anyone under the age of 19. This next Open Enrollment Period is from September 15th to October 31st and is the only time (with a few exceptions) that children under 19 can purchase, or change individual health insurance in Washington. This means that if a family wishes to purchase or change insurance plans it’s allowed only during this period!

What if you miss this window? Tough Luck. Your children must stay with the insurance plan they are on now until next year. If they have no coverage at all, then they must wait until next year to join a plan. The only alternative is to put kids under 19 on a temporary insurance plan (not as good) or have them apply to the Pre Existing Insurance Plan run by the State of Washington. There are NO exceptions, UNLESS one of the four exemptions occurs:

1. The child under 19 loses employer-sponsored insurance.
2. The child under 19 loses insurance coverage due to a divorce.
3. The child under 19 loses insurance coverage under Medicaid, Washington Basic Health or other Federal or State programs.
4. The child under 19 moves to another residence where their current health insurance company does not provide service.

So, for the time being, make sure if you want to change or add under 19 children to your individual health plan, do so before the end of October.

My Health Insurance of Washington
www.healthinsuranceteam.com
206-356-1607

Further, the most recent ruling by Health and Human Services now also includes Women’s birth control on the list of “Preventative” items covered for no cost.

The catch? Well, you do need to have a health insurance plan that is not “Grandfathered” and our Insurance Commissioner has allowed insurance companies to raise their rates to compensate for the extra costs. But still, even the high deductible Catastrophic plans include this new provision! And though there is never a completely free lunch, it does make it more cost effective to get the preventative care you should be getting anyway.

So, what is covered?

“Preventative” Screenings covered will vary depending on your gender, age and risk factors but will include:
• Immunizations for children and adults, if those shots have been approved by the CDC
• Well Child/Baby visits
• Colorectal cancer screening for adults over age 50 (colonoscopy’s)
• Mammograms
• HIV screening
• Depression screening
• Bone Density for women aged 65 and over
• Hepatitis B and tobacco counseling for pregnant women
• Childhood vision and hearing screenings
• Blood pressure, diabetes and cholesterol tests
• Smoking cessation and obesity/weight loss counseling
• In general, once yearly physicals for adults and children will be covered

Also, starting August 1st, 2011 birth control options for women including oral contraceptive pills, intrauterine devices and contraceptive patches will be included under the new regulations. Female patients will also be guaranteed copay-free screenings for gestational diabetes, human papillomavirus and human immunodeficiency retrovirus screening, in addition to an annual “well-woman” visit and counseling on domestic violence. The regulations also make available sexually transmitted infection counseling, which will be used to identify high-risk populations to whom free additional STI screenings may be offered.

Surprisingly, not all health plans need to abide by these new rules. Only Non-Grandfathered plans beginning after September 23rd 2010 are required to provide the no-cost screenings, and only plans renewing or starting after August 1st 2011 need to provide for no cost birth control (with some exceptions for Religious organizations, etc.).

Not sure if your plan offers this, or you’re confused about how to ensure your services are considered “Preventative”? Talk to us about your situation, and we’ll be glad to provide you all the details!

Recent developments in the market for prescription drugs may offer the most promising opportunities for patients to save. For example, consumers in 27 states now benefit from a new $4 for a 30-day supply of one of 150 different generic prescription drugs at many pharmacies including Wa-Mart, Target, Kroger (Fred Meyer/QFC), etc. As more patients begin comparison shopping for drugs, more retailers will compete to win their business which will send prices lower.

Here are several tips to help you save:

Put that prescription card back in your pocket! When you use your health insurance card, the pharmacy is obligated to charge you the copay listed, even if they sell it cheaper. Ask what the CASH price is. Many times pharmacies run “special” drug prices for as little as $4 for Generic Medications. However, even if your drug is on the “special” list, if you use your health insurance card they are obligated to charge you the normally higher copay!

Price Comparisons. Many people assume drug prices are uniform and do not bother to comparison shop. In fact, drug prices vary considerably from pharmacy to pharmacy. Pick up the phone and call around. My clients have found Costco to be a consistently good value.

Drug Substitution. When physicians prescribe drugs, patients should ask if cheaper alternatives are available; they often are. Doctors don’t always have an incentive to prescribe generic or alternative medications as many doctors are only compensated or incentivized to prescribe the latest “brand” medications. Newer does not always mean more effective, but it does mean higher cost! (That cool TV advertising is expensive!)

Generic Medications. For most patients, generic medications work just as well as brand-name drugs and cost 20 percent to 80 percent less. The average cost for a generic prescription was $29.82 in 2005, compared to $101.71 for branded medications. Those figures are undoubtedly farther apart in 2011.

Bulk Buying-Costco Style! As Costco patrons know, many times choosing larger packages can lower the unit cost. The same is true for drugs. Pills purchased 90 or 100 at a time usually sell for much less per dose than quantities bought 30 at a time. This is especially true for generic drugs ordered by mail.

Mail-Order Pharmacies. Although drugstore chains still provide most drugs, mail order pharmacies are gaining ground and now account for about 17 percent of the retail drug market. Mail-order and Internet pharmacies offer the best deals on prescription drugs for patients with chronic conditions.

Pill Splitting. Patients can purchase many medications in doses double the prescribed amount and split them in half. Be careful, as not all pills can be cut this way! Ask your pharmacists if they will split the pills for you. Savings of 30 percent to 50 percent are not uncommon because many medications are sold for about the same price regardless of dosage.

Over-the-Counter Drugs. As an alternative to prescription drugs, patients may find that an over-the-counter (OTC) drug does just as well. Nexium, a “Brand” drug to treat heartburn and acid reflux, is virtually identical to the older version Prilosec which is available over the counter. Americans buy more than five billion OTC drug products each year – 60 percent of all drugs used. Today, consumers have access to a market with more than 100,000 different OTC drug products; more than 600 of them were previously available only by prescription.