What is Considered Preventive Care?

                                If you have a new health insurance plan or insurance policy beginning January 1, 2014 or after the following preventive services must be covered without your having to pay a copayment or co-insurance or meet your deductible. This applies only when these services are delivered by a network provider.  When making an appointment with your provider for preventive services, it is always good practice to tell them that your visit will be for preventive services as outlined in your health plan.   15 Covered Preventive Services for Adults Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked Alcohol Misuse screening and counseling Aspirin use for men and women of certain ages Blood Pressure screening for all adults Cholesterol screening for adults of certain ages or at higher risk Colorectal Cancer screening for adults over 50 Depression screening for adults Type 2 Diabetes screening for adults with high blood pressure Diet counseling for adults at higher risk for chronic disease HIV screening for all adults at higher risk Immunization vaccines for adults–doses, recommended ages, and recommended populations vary: Hepatitis A Hepatitis B Herpes Zoster Human Papillomavirus Influenza (Flu Shot) Measles, Mumps, Rubella Meningococcal Pneumococcal Tetanus, Diphtheria, Pertussis Varicella Learn more about immunizations and see the latest vaccine schedules. Obesity screening and counseling for all adults Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk Tobacco Use screening for all adults and cessation interventions for tobacco users Syphilis screening for all adults at higher risk 22 Covered Preventive Services for Women, Including Pregnant Women Anemia screening on a routine basis for...

System changes are on the way for Blue Shield of CA Small Business clients

On March 1, Blue Shield of CA is moving Small Business clients with an April, May, and June 2014 renewal period onto our new membership and claims system. The system is now used by more than 70 other health plans across the country. What does this mean for Blue Shield of CA Small Business clients? Beginning on March 3, Small Business clients with medical, dental, vision, or life insurance* coverage with an April through June 2014 renewal period will see the following changes: A new March 2014 bill, including: A new account number for billing purposes. A new group number that replaces their current customer number. New subgroup number(s) that replace their existing billing unit. A new bill format now including medical and specialty products on a single bill. Your clients will no longer receive separate bills for any dental or vision coverage they obtain through Blue Shield. March 2014 bills for migrating groups will be delayed. We will mail them the last week of February and they should arrive the first week in March. Our standard 30-day grace period for payment will extend from the date we actually produce the March bill. New member ID cards for their medical plan and dental plan (if applicable). These ID cards include a new subscriber number and customer service number listed on the back. Newly enhanced Employer Connection Plus website: A newly enhanced Employer Connection Plus website to manage their account online for all their Blue Shield lines of coverage. Your clients who are currently using Employer Connection to access their account online will be able to access it using their existing...

Healthcare Reform – Commonly Used Terms Defined

  Most of us have been bombarded with information pertaining to the changes that have come with the newly enacted Affordable Care Act (ACA) or as it is commonly referred to, Obamacare.  For many of us, this information can be confusing.  In an effort to assist you better understand your health plan, we have provided definitions to a few of the more commonly used words associated with the new health plans. Adult Children – The Affordable Care Act requires plans and issuers that offer dependent coverage to make the coverage available until a child reaches the age of 26. Both married and unmarried children qualify for this coverage. This rule applies to all plans in the individual market and to new employer plans. It also applies to existing employer plans unless the adult child has another offer of employer-based coverage (such as through his or her job). Beginning in 2014, children up to age 26 can stay on their parent’s employer plan even if they have another offer of coverage through an employer. Essential Health Benefits – Essential health benefits are those that must be included in private health insurance sold in the exchange. The categories of essential health benefits are: a) Ambulatory patient services. b) Emergency services. c) Hospitalization. d) Maternity and newborn care. e) Mental health and substance use disorder services, including behavioral health treatment. f) Prescription drugs. g) Rehabilitative services and devices. h) Laboratory services. i) Preventive and wellness services and chronic disease management. j) Pediatric services, including oral and vision care. Full-Time Employee – The Affordable Care Act defines a “full-time employee” as working 30 or...

5 Things to Know About Deductibles in The Exchange

Having health insurance can lower your costs even when you have to pay out of pocket to meet your deductible. Insurance companies negotiate their rates with providers and you’ll pay that discounted rate. People without insurance pay, on average, twice as much for care. A health insurance deductible is different from other types of deductibles. Unlike auto, renters, or homeowners insurance, where you don’t get services until you pay your deductible, many health insurance plans provide some benefits before you meet the deductible. All medical plans cover preventive care. Screenings, immunizations, and other preventive services are covered without requiring you to pay your deductible. Many health insurance plans also cover other benefits like doctor visits and prescription drugs even if you haven’t met your deductible. In 2014, there usually is a $6,350 maximum for individual out-of-pocket costs for in-network services. The maximum for families is $12,700. Even if you choose a high deductible catastrophic plan, your out-of-pocket costs should not exceed this limit. Over 70% of Marketplace plans have deductibles under $3,000. When you choose a health insurance plan, it’s important to understand what your insurance company covers without requiring you to pay your deductible. Then you can decide whether you want a plan with lower monthly premiums and a higher deductible, or one with a higher monthly premium and a lower...

Health Insurers Extend Deadline for February Premiums

January 28 was the deadline to pay your Covered California February premiums however, some of California’s biggest insurers have extended their deadlines. Here are new dates for three major carriers: • Blue Shield: deadline is Friday, Feb. 14 for people who signed up for coverage starting Feb. 1. • HealthNet: For people who signed up for coverage beginning Feb. 1, you have until Feb 15 to make your first premium payment. You can pay by phone. • Kaiser: deadline is now Tuesday, Feb. 18 • Anthem Blue Cross: for ongoing members, the deadline is Jan. 31 (although there’s a one month grace period before cancellation). New members who signed up for coverage that starts on Feb. 1, have until Monday, Feb. 10 to make their premium payment. • L.A. Care: deadline for participants in “L.A. Care Covered,” its Covered California health plan, is now Feb....