Anthem Blue Cross Serencsa and Feller-Freed Dual Eligibles

It appears that there are quite a lot of Anthem Blue Cross CA Subscribers who are eligible for both Serencsa and Feller-Freed settlement options. Because this is causing quite a bit of confusion and because it is very important not to use these settlement options out of order, I wanted to clarify things for those who are dual-eligible for both Serencsa and Feller-Freed.

As always, if you have questions or need assistance contact your personal Anthem Blue Cross agent/broker first. If you don't know who your agent/broker is, you can contact Anthem Blue Cross membership at 800-333-0912 and they will tell you who your agent is and how to get hold of him/her. Those who are house accounts (direct sale) and wish to work with me need to provide me with an Agent of Record change request letter (I can send the text) before we initiate any plan changes.

How is a subscriber eligible for both Serencsa and Feller-Freed at the same time?
Some subscribers have dual eligibility for both the Serencsa and Feller-Freed settlements. This happened to anyone who was on one of the four closed PPO Share plans in September, 2009 (500 Share, 1000 Share, 1500 Share, 2500 Share). Any Anthem subscriber who was on one of the four Share PPO plans at that time is eligible under the Feller-Freed Settlement.

When those plans closed, many subscribers moved to open PPO plans registered with the CDI (CA Dept of Insurance). SmartSense seems to have been the most popular as well as the PPO Share 5000 CDI-registered version. Any subscriber who received Feller-Freed eligibility and subsequently moved to a CDI-registered PPO plan between September 2009 and September 23. 2010 also became eligible for the Serencsa-Lichtman Settlement benefit. Serencsa settlement beneficiaries are those who were enrolled in CDI-registered PPO plans with Anthem Blue Cross on or prior to September 23, 2010 and are still enrolled in the closed plan.

Simply put:

*I was on one of the four Share PPO plans in September 2009 = Feller-Freed
*I moved to an open CDI PPO Plan after the Share Plan closed but before 9/23/2010 = Serencsa

If I am eligible for both Serencsa and Feller-Freed, what are my options to change plans?
The key is to make sure that you use the most appropriate settlement option for plan changes and in the proper order. Under Serencsa, you can move to any open CDI-registered PPO plan currently sold to the public. These are generally denoted as "plus" plans (i.e., SmartSense Plus or Clear Protection Plus). Feller-Freed settlement beneficiaries have a different set of plan options which limit to specific plans (20 total) to which the Feller beneficiary may move. These plan change options are made without medical underwriting.

If you are eligible for both Serencsa and Feller-Freed it is best to exercise your plan change option under Serencsa BEFORE you exercise a change option under Feller-Freed. If you use Feller-Freed first, you lose your Serencsa settlement option. If you use your Serencsa first, you maintain your Feller-Freed option which can be used at any subsequent Feller-Freed Open Enrollment period to make a further plan change if desired, again with no medical underwriting.


I hope that this post helps to clarify a confusing situation for you. Being eligible for both Serencsa and Feller-Freed has implications in terms of which settlement option is best or may void the other settlement option right to change plans. As always, plan changes under either Serencsa or Feller-Freed will change status for those currently on Grandfathered plans to non-Grandfathered status.

Dave
www.an-insurance.com

Feller-Freed Open Enrollment Period 2012

Anthem Blue Cross has announced the 2012 Feller-Freed open enrollment period. For those eligible under the Feller-Freed settlement, the following applies.

Open enrollment will be from April 20,2012 to June 4, 2012. During this period, anyone eligible for a plan change under Feller-Freed may make the plan change election to a new plan.

Anthem Blue Cross subscribers will receive notification with election options in the next few days. This applies to any Feller-Freed settlement beneficiary who has a rate increase on their PPO Share plan. Those with no increase or a decrease are not eligible to change plans during this open enrollment.

Due to the announced closure by Anthem Blue Cross of certain plans originally part of the Feller-Freed settlement (Clear Protection Plus 5000 and Core Guard 7500/10000), other plans have been substituted by Blue Cross to arrive at the required number of available plan choices.

Choices include:

*Certain PPO Share plans (Closed) depending on original plan
*PPO Share 1000*, 3500, 5000, 5000* and 7500
*HMO and HMO Saver
*Individual Select HMO
*Core Guard Plus 750, 3500 and 5000 PPO plans
*Clear Protection Plus 3300 PPO
*Premier Plus 5000 and 6000 PPO
*SmartSense Plus 6000 std drug and 6000 with drug upgrade

As always, members affected by the Feller-Freed settlement should contact their agent of record regarding assistance with plan changes. If you do not know who your agent of record is, contact Anthem membership at 800-333-0912 and they will provide you with contact information for your agent.

Anthem Blue Cross members who are 'in house' accounts and purchased their PPO Share plan directly from Blue Cross without an agent may contact Anthem Blue Cross directly or may seek assistance from an independent agent. I require an AOR (agent of record) change letter before I will assist with any plan changes for 'in house' members.

Dave
www.an-insurance.com

* both the PPO Share 1000 and 5000 have dual registration with both the CDI and DMHC. Both registration change options may be available for these specific plans.

Feller-Freed 2012 Anthem Blue Cross Settlement

2012 Feller-Freed plan change election period has not been announced yet by Anthem Blue Cross. They anticipate more information by end of week and I will update blogs accordingly.

Also, I am waiting for an update on which plans will be available during the next Feller-Freed open enrollment (2012) as there have been some changes. Three of the Feller class plan change options will be closed on 5/1 and that would be the absolute soonest possible Feller election period although it probably will be later than May.

Anthem will likely not allow any Feller beneficiary to enroll in a closed plan coming from at closed plan so you can pretty much rule out the following plan choices from the settlement list (exhibit F of settlement agreement): CoreGuard Plus 10000, 7500 and Clear Protection Plus 5000. I am guessing Anthem will replace those options with three other plans but we have to wait and see.

As you may be aware, Serencsa settlement beneficiaries are working with a 5/1/12 cycle in conjunction with the 5/1 rate change. Feller-Freed works differently.

To recap, settlement beneficiaries for Feller-Freed are those current Anthem subscribers who were enrolled on one of four PPO Share plans in September 2009 when those plans were closed (Share 500, Share 1000, Share 1500, Share 2500). The settlement (Feller-Freed) allows eligible Feller-Freed beneficiaries an annual option to move to a selected group of open (currently sold) health plans with Anthem Blue Cross with no medical underwriting. In addition, Feller-Freed provides those still on closed Share PPO plans with a 2% discount on future rate increases until 2014.

As soon as I get solid information regarding 2012 Feller-Freed rules and plans, I will let you all know.

Take Care and God Bless!

Dave
www.an-insurance.com

Anthem Blue Cross, Serencsa and Feller-Freed - My Position

As I have mentioned in past blogs, sometimes I feel I need to address certain issues with regard to health insurance due to activity by phone and e-mail. I want to address my position with regard to both Serencsa and Feller-Freed options for Anthem Blue Cross subscribers. This is mainly directed at those Anthem Blue Cross subscribers who are not my current clients and are seeking assistance in changing to lower-cost coverage while being eligible for either Serencsa, Feller-Freed, or both..

Both Serencsa and Feller-Freed provide opportunities for plan changes within Anthem to lower cost coverage (if that is desired) WITHOUT any medical underwriting. Additionally, both Serencsa and Feller-Freed options are on the table until at least January 1, 2014 which means there will be multiple options to make the one-time plan change due to rate increases between now and 2014.

It appears that there are quite a few Anthem Blue Cross subscribers who do not understand their options under Serencsa and Feller-Freed and seem quite willing to give up those options for reasons that make little sense.

To be clear, both Serencsa and Feller-Freed provide plan change options and the ability to move to lower-cost coverage in a variety of 'open' Anthem Blue Cross health plans (plans currently sold to the public) with no medical questions asked. Since there are lower-cost health plans available to move to, it makes very little sense to look at changing insurance carriers in an attempt to lower rates and put oneself through medical underwriting and a new 2-year contestability period. I have a hard time finding a significant reason, in the current California individual & family health market, where it would make more sense to change insurance carriers than to exercise Serencsa or Feller-Freed rights with Anthem Blue Cross.

Once a person elects that change to another insurer, the protection and change options under Serencsa and Feller-Freed are lost forever. They can never be recovered.

I fully expect that at some point someone (or maybe a whole bunch of someones) is going to make that kind of change and later realize what they gave up (probably the first time the other carrier cranks up premiums with a rate increase and offers no guaranteed-issue change option), and that is when the fireworks are going to start.

I am not willing nor interested in assisting any Anthem Blue Cross subscriber who has un-exercised Serencsa or Feller-Freed protection in trying to buy health insurance from another insurance carrier just to try get a lower premium. I feel that this creates a legal exposure and at some point agents making these kinds of changes may face legal and E&O repercussions.

Sorry, but I don't do business that way. I will not take away a class-action entitlement benefit just to make a buck.

Good luck and God bless.

Dave
www.an-insurance.com

Health Net and Cigna Settle with CDI over Autism

California Insurance Commissioner Dave Jones announced today that he has reached a settlement with Health Net and Cigna regarding coverage of Applied Behavioral Analysis Therapy (ABA) for autism.

This makes three carriers who have reached settlement with the CA Dept of Insurance with regard to appropriately covering ABA and autism in California.

Last month CDI reached a settlement with Blue Shield of California to provide ABA coverage for autism. See my Jan 31 blog post: (http://an-insurance.blogspot.com/2012/01/blue-shield-ca-agrees-to-settlement.html)

Of interest is Dave Jones' comment regarding Anthem Blue Cross of California (which was not forced to settle any issues with regard to autism and ABA coverage). Per Dave Jones:

"And we are pleased to reconfirm and acknowledge Anthem Blue Cross of California for providing this treatment as the Department of Insurance has directed since November 2009."

Link to the full announcement from CDI: http://www.insurance.ca.gov/0400-news/0100-press-releases/2012/release017-12.cfm

If there any further settlements with regard to ABA therapy and autism, I will let you know in a future blog.

Dave
www.an-insurance.com

Blue Shield CA Agrees to Settlement over Autism Coverage

California Insurance Commissioner Dave Jones announced today that he as reached a settlement agreement with Blue Shield of California Life & Health regarding the carrier's non-compliance with California's Mental Health Parity law.

Blue Shield of California agreed to end the dispute with the California Dept of Insurance and to cover ABA therapy (Applied Behavioral Analysis) as a life-saving medical benefit for autistic children in California.

Blue Shield of California Life & Health has agreed to cease the following practices:

*Denying ABA therapy as an uncovered service
*Challenging the medical necessity of ABA therapy
*Forcing parents into an unnecessary Independent Medical Review to secure treatment

Blue Shield has agreed to establish a dedicated customer service unit to respond to inquiries from families seeking approval for necessary ABA therapy and to pay for services at higher in-network benefit levels.

Read the CA DOI Press Release

This is very good news for Blue Shield Life & Health subscribers who have autistic children.


Dave
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