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Applies to: Small Groups: (1-50 employees) / Deadline: December 16, 2019: From Nov.1 through Dec.15, 2019, small groups purchasing ACA/Metallic plans may opt to waive participation and contribution requirements.

The No Contribution/No Participation Option is available to new groups:

* Applying for coverage during the annual open enrollment period

* Sold during the open enrollment periods for Jan.1 and Jan.15, 2020, effective dates

Submission dates and deadlines:

If your new ACA/small group wants to elect the No Contribution/No Participation Option, please submit the small group enrollment with all required documentation via the ACA Small Group Enrollment tool between Nov. 1 and Dec.16, 2019.

* The group must sign the enrollment paperwork by Dec.15, 2019, and we must receive the enrollment by Dec.16, 2019.

* If we receive the enrollment after Dec.16, standard small group participation and contribution levels will apply.

 

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It withdrew from the market at the end of 2016, after two other insurers dropped out of the individual marketplace.

Health care startup Oscar Health sold insurance in Dallas-Fort Worth for 2016, only to lose money and drop out of the market a year later.

Now, the New York-based insurer is returning to North Texas to sell individual and family health plans on the exchange created by the Affordable Care Act.

In an interview, Oscar CEO Mario Schlosser said the company negotiated more cost-competitive contracts with local providers, so it can attract customers and keep the company on the path to profitability.

Oscar’s return to the Dallas area signals that it has the confidence to grow, even as lawmakers and presidential candidates debate changes that could shake up the health care market. It also indicates the startup is serious about competing in Texas, which has the highest uninsured rate in the country. The company has 260,000 members across the U.S., with about 1 in 4 living in Texas. It sells insurance in Austin, San Antonio and El Paso. It’ll tack on two extra Texas metro areas in 2020: Dallas-Fort Worth and Houston.

Oscar is expanding to 12 new markets and six states in 2020, its largest expansion since it was founded in 2012. It will be in 15 states and 26 markets, and will start selling Medicare Advantage in Houston and New York City.

It isn’t the only insurer in growth mode. Thirteen companies that compete in the individual marketplace are entering at least one new state in 2020 and none have announced they’re exiting a state, said Rachel Fehr, a research assistant who studies health reform and private insurance for the Kaiser Family Foundation. She said the companies have remained profitable despite policy changes — such as the repeal of a mandate that required most Americans to buy insurance or pay a fine.

“It’s definitely a stable market, despite uncertainty,” Fehr said.

In Dallas-Fort Worth, Oscar will offer about a dozen different insurance plans on the exchange for 2020. Oscar has signed contracts with Methodist Dallas and Medical City. It has deals with HCA Healthcare, the country’s largest hospital system and Medical City’s parent company, in other markets.

The last time Oscar was in the Dallas market, it partnered with Tenet Healthcare and Baylor Scott & White Healthcare System.

Oscar dropped out of the individual marketplace in the Dallas area at the end of 2016, after Aetna and Scott & White Health (a plan offered through the Dallas-based health care system) announced plans to withdraw from the marketplace. Oscar had between 7,000 and 8,000 members in the Dallas area in 2016.

Schlosser said the company had to make tough choices. At the time, he said, the company’s medical claims were about 20undefined of Oscar members’ visits to a new doctor, the company has been the source that has recommended that doctor, he said.

It has a feature that aims to get ahead of a common complaint, too. If customers are going to be billed more than $200 out-of-pocket for a claim, they get a message ahead of time that offers to answer questions.

Schlosser said Oscar and insurers on the exchange must pay attention to something that’s overlooked by many “sleepy incumbents”: customer service.

“If you hate your insurance company and you get it through your employer, you’re out of luck,” he said. “You can’t go to your employer and say, ‘Please, for the thousand people who are at this company with me, can you please change companies? I had a bad experience.’ That’s not going to happen. But in our market, you can vote with your feet.”

“In my view, that’s how all of health care should work and how all of health insurance companies should work,” he added.

BACK WITH A SPLASH

Oscar grew to $1.2 billion in annual revenue in 2018. Two years ago, it began offering Oscar for Business in select markets. The employer-based health coverage is available to companies with up to 100 employees in New York, New Jersey, Nashville and Los Angeles. It has 17,000 members covered through the plan.

Oscar will compete with other companies on Healthcare.gov in Dallas, Collin and Tarrant counties. Three companies — Blue Cross Blue Shield of Texas, Celtic Insurance and Molina Healthcare — participated in the exchange in Dallas and Collin counties in 2019. Two companies, Blue Cross and Celtic, competed on the exchange in Tarrant County in 2019. Open enrollment on Healthcare.gov begins Nov. 1.

Texas is a significant business opportunity for health insurance companies, but it’s a challenging one. Nearly 18 percent — or 5 million — of Texans did not have health insurance in 2018, according to U.S. Census Bureau data. That’s higher than any other state and double the national average of about 9%.

While some states have encouraged signups with outreach campaigns and other approaches, Texas has taken the other tack. It is one of 14 states that have not accepted funding to expand Medicaid. It set strict rules and required additional training for navigators, people who help in the community with health plan sign-ups. And Texas Attorney General Ken Paxton is leading a challenge of the ACA in court.

That means companies like Oscar have had to field their own ground game to persuade Texans to sign up for health insurance — especially those who are young, healthy and feel they can go without it.

Oscar has a Texas office in Dallas with about a dozen employees who work in sales, growth and clinical review, said Kyle Estep, market director for Oscar’s central region. It opened in 2015.

Estep said the company, originally known for catering to hipsters and freelancers, has a diverse customer base that includes lower-income families, middle-age professionals and grandparents.

In recent weeks, Schlosser visited with insurance brokers in Dallas. And Dallas residents will soon see the Oscar brand on billboards and ads on streaming services, such as Netflix.

“We’re going to really try to make a splash in Dallas and reintroduce ourselves to the market in a very convincing way,” he said.

If you are among the Californians who buy your own health insurance, a surprise may await you as the enrollment period for 2020 coverage opens this week.

Starting Jan. 1, California will become the first state to offer subsidies to middle-income people who make too much money to qualify for the federal tax credits that help consumers buy health coverage through Covered California, the state’s Affordable Care Act insurance exchange.

Many people in the middle class have struggled to afford health insurance, often shouldering the entire cost of premiums that can surpass $1,000 a month.

“The law is going to do what it is intended to do, which is to help out those people who didn’t qualify for any assistance when in reality they should have gotten something,” says Jonathan Edewards, president of Citrust Insurance Agency in Pasadena, Calif. “And those people really got hammered.”

Covered California estimates that nearly 1 million Californians could benefit from the new state money.

Also starting next year, state residents will be on the hook for a tax penalty if they are uninsured for more than three months, unless they qualify for one of several exemptions.

The penalty will mirror the federal one that was nullified — effective this year —by the 2017 federal tax reform law. In many cases, it will amount to $695 for a single adult and about $2,000 for a family of four. But for a lot of people, the financial hit could be substantially larger.

In California the deadline to enroll in coverage through Covered California or the open market is Jan. 31, but if you want the coverage to begin Jan. 1, you must sign up by Dec. 15.

Some of the $429 million worth of state subsidies available in 2020 will go to low- and moderate-income people who earn between 200undefined of the federal poverty level, or roughly $25,000 to $50,000 for an individual and $51,500 to $103,000 for a family of four, based on 2019 figures. This group also qualifies for federal tax credits. The average household state subsidy in this category would be $15 a month, Covered California estimates.

The lion’s share will go to those whose incomes are between 400undefined of the poverty level — too high for federal aid but still low enough to make health care financially challenging. That’s between about $50,000 and $75,000 a year for an individual and $103,000 to $154,500 for a family of four. The average state assistance for this group will be about $170 a month, says Peter Lee, Covered California’s executive director.

Say, for example, you are a married couple in Sacramento, both 55 years old, with an annual income of $80,000. You would not have qualified for a federal tax credit this year and would have been responsible for the entire $1,654 monthly premium for a Blue Shield of California Silver 70 HMO, the second lowest level of coverage. In 2020, you would pay $995 per month after a $688 subsidy from the state — a savings of $659 a month, despite a 1.7% increase in the premium.

You could pocket those savings, or you could bump yourselves up to a higher level of coverage with lower deductibles and copays.

For a do-it-yourself estimate of what your financial assistance might be, go to the Covered California site (www.coveredca.com) and click on “Shop and Compare.” You will be asked to enter your ZIP code, the number and ages of people in your household, and your family income.

The tool will show you a list of health plans, how much you would pay per month for each and the subsidy amount, if any, labeled “monthly savings.” Hover on that, and you will see a breakdown of state vs. federal dollars.

But before you sign up, seek free help from an insurance agent or enrollment counselor, who can guide you through the complexities of the process. Find one in your area by visiting the Covered California website and clicking on the “Find Help” tab. You can also search for local insurance agents at the National Association of Health Underwriters website (www.nahu.org) under “Membership.”

A word of caution: Be careful estimating your income. If you end up making more than you guessed, you may have to pay back some or all of the financial aid.

That has been the case for the federal tax credits since the health insurance exchanges debuted in 2014.

“That’s caused a lot of stress. I have two people this year who owe about 20 grand,” says Larry Pon, a certified public accountant in Redwood City, Calif.

You may also have to pay back some or all of your state aid if your income exceeds your estimate, but the details of how much you will owe are being finalized.

On the flip side, if you make less than expected, you can retroactively claim the credit, whether state or federal, when you file your taxes — but only if you enrolled in a health plan through Covered California.

So if you don’t seem to qualify for financial aid but think your income might drop, or you’re just not sure, strongly consider signing up with Covered California — even with no initial subsidy — instead of buying a plan through the open market.

“I am putting anybody on Covered California if there is any potential for their income to fall,” says Tom Freker, a Huntington Beach, Calif.-based insurance agent.

Maribeth Shannon and her husband, residents of Napa, Calif., plan to switch to Covered California in 2020. They are paying $1,671 out of pocket each month for a Kaiser Permanente bronze HMO that they purchased outside the exchange, and they just learned it will rise to $1,834 in 2020. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanante.)

Shannon, 63, is retired. Her husband, also 63, is self-employed, and his income fluctuates. She thinks that by working less, he can reduce it enough next year to qualify for a state subsidy. He’s been wanting to cut back anyway, “and this has really given us the motivation to speed up his retirement plan,” she says.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

READY, SET, QUOTE!
2020 ACA Small Group (1-50) new business plans are now available for quoting.
The plan designs and rates for new groups can be found in Blue Access for Producers on the eSales Tools home page for Jan. 1, 2020, effective dates. If you have any questions, please contact your sales executive or general agent.

Review Helpful Changes to Small Group Paperwork Due Date and HMO Disclosure Form.If you need a few extra days to submit December renewals or want to reduce the number of required forms, we have you covered. Find out how we’re making the Q4 rush easier.

Group:

New This Fall: Producer Ancillary Bonus Program

Learn about the new, expanded producer bonus program for Blue Cross and Blue Shield of Texas (BCBSTX) ancillary products. These include life, disability, dental, vision, critical illness and accident insurance. Our new program PDF will provide you the ability to earn:

* Up to a 5undefined for persistence on existing case

Big picture:

The updated incentive program for 2020 business was designed with producer feedback to improve the dental program. It will align with and complement the Medical Package Pricing that rolled out for medical and ancillary in September. For questions, contact your BCBSTX representative.

Q4 Is Here; Get Your Mid-market Quotes Faster

Want to know how to get your 2020 quotes back quickly? See our mid-market quoting tips.

Contact our Enrollment Support Team at 1-866-590-9771 or support@enrollinsurance.com for more BCBS information.

Blue Advantage HMOSM Provides State-wide Access to Doctors, Specialists: Small Groups (1-50): 2020 renewals are almost here, and Blue Advantage HMO is front and center as a cost-saving solution. Don’t let concerns about network adequacy stop your clients from taking advantage of savings opportunities.

We Can Help Dispel Myths About HMOs

We listened to your feedback on HMO network adequacy concerns. Next week, we’ll send another targeted message to groups with January 2020 renewal dates to talk about the thousands of Blue Advantage HMO PCPs and specialists located across the state.

We want to help you dispel myths about HMOs and encourage employers to talk with you about how a dual option in 2020 can be the cost-saving advantage they need.

Our message is simple; Blue Advantage HMO is statewide:

– Covering all 254 counties

– 8,442 participating PCPs

– 39,938 specialists

Materials to Help You Sell

The fliers and video below can help employers understand how Blue Advantage HMO covers each Texas region, and they show the similarities between modern HMO and PPO benefits.

Myth Buster Video: Doctors and Hospitals Don’t Take HMOs

Blue Advantage HMO Regional Fliers

– Austin

– DFW

– East Texas

– Houston

– San Antonio

– South Texas/Valley

– West Texas

Want to Talk?

Please call the Texas Small Group Account Management Team at 877-239-5582 with questions. We know you don’t want to miss out on cost-saving opportunities for your clients.

Source Link: http://www.bcbstxcommunications.com/newsletters/nftb/2019/1002/stories/NLT_PROD_NFTB_TX_100219_BLUE_ADVANTAGE.html

Oscar Health will roll out its biggest expansion of health insurance yet, expanding to 12 new markets and six new states to sell coverage for individuals and families in 2020.

Calling the expansion its “biggest market expansion ever,” Oscar’s effort comes as health insurance companies across the country make more money and better manage the care of sick patients signing up for individual Obamacare coverage sold under the Affordable Care Act.

“This is the third consecutive year Oscar has significantly expanded its footprint, and this expansion brings Oscar’s total geographic footprint to 15 states and 26 markets,” Oscar said Thursday. The company said its “2020 insurance plan portfolio” is still being reviewed by regulators so executives didn’t release pricing or provider network partners on Thursday.

The announcement comes after Oscar announced another quarterly underwriting profit and signed an agreement with a new reinsurance partner, Berkshire Hathaway’s National Indemnity reinsurance subsidiary. Such reinsurance partnerships typically mean a health plan like Oscar will have more capital to expand and invest in new technology.

Oscar currently sells individual Obamacare coverage in 14 markets in 9 states: New York, New Jersey, California, Tennessee, Ohio, Texas, Florida, Michigan and Arizona. Oscar now has 260,000 health plan enrollees across the country.

On Thursday, Oscar said it will expand in Florida to Miami, Tampa, Ocala and Daytona. In addition, Oscar said it will sell plans for the first time in Philadelphia; Denver; Richmond, Va.; Atlanta and the Kansas City market that includes both Kansas and Missouri. And in Texas, where Oscar has offered coverage for several years, company executives said they will “enter Houston and expand the plan options we offer in Dallas-Fort Worth.” The company is also expanding to “serve several counties in Western Michigan,” Oscar said.

“Oscar’s expansion proves that our commitment to making health care easy — by developing seamless technology and providing personalized support — is working,” Oscar CEO and Co-founder Mario Schlosser said. Schlosser founded Oscar with Joshua Kushner, brother of Donald Trump’s son-in-law Jared.

Oscar, which made its name as a startup focused on providing Obamacare coverage, earlier this month reported second-quarter “underwriting profit of $128 million.” Earlier this year, Oscar announced plans to enter the business of selling private Medicare Advantage plans for seniors.

Source Link: https://www.forbes.com/sites/brucejapsen/2019/08/22/oscar-health-to-launch-biggest-obamacare-expansion-yet/

We also created a Guide to Oscar Medicare Certification for your convenience. If you have any issues or questions about getting certified, please contact our Enrollment Support Team at 1-866-590-9771 or support@enrollinsurance.com

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ST. LOUIS, Aug. 13, 2019 /PRNewswire/ — Centene Corporation (NYSE: CNC) today announced that it is expanding its offerings in the 2020 Health Insurance Marketplace, or exchange.

The company is expanding its footprint in ten markets: Arizona, Florida, Georgia, Kansas, North Carolina, Ohio, South Carolina, Tennessee, Texas, and Washington.

Last year marked another year of Centene’s successful operations on the exchanges. At June 30, 2019, we served approximately 1.9 million exchange members across 20 states. The key demographics of these members including age, gender, financial assistance and metal tier are consistent with Centene’s experience over the past three years. Over ninety percent are eligible for subsidies.

“Centene takes pride in being the country’s largest provider of health insurance marketplace plans,” said Michael F. Neidorff, Chairman, President and CEO for Centene. “The need for affordable, high-quality healthcare has never been more urgent, and we will continue to demonstrate disciplined execution, agility and capacity to successfully navigate industry changes to the benefit of our members, customers and shareholders.”

Centene has started the process for seeking all necessary regulatory approvals in targeted states for 2020.

About Centene Corporation

Centene Corporation, a Fortune 100 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children’s Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long-Term Services and Supports (LTSS), in addition to other state-sponsored programs, Medicare (including the Medicare prescription drug benefit commonly known as “Part D”), dual eligible programs and programs with the U.S. Department of Defense. Centene also provides healthcare services to groups and individuals delivered through commercial health plans. Centene operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, commercial programs, home-based primary care services, life and health management, vision benefits management, pharmacy benefits management, specialty pharmacy and telehealth services.

Centene uses its investor relations website to publish important information about the Company, including information that may be deemed material to investors. Financial and other information about Centene is routinely posted and is accessible on Centene’s investor relations website, http://www.centene.com/investors

SOURCE

Centene Corporation

Related Link

http://www.centene.com

We launched Oscar’s individual and family plans six years ago with one goal in mind: to make health care easy. Last week, we announced that we intend to bring the same ease, affordability, and personalized care this fall to Medicare Advantage consumers across New York and Texas.

We want to give Medicare Advantage consumers the same opportunity our members in the individual and small group markets have: to choose an insurer who will be their advocate and put them first. That’s why we’ve partnered with renowned hospital systems such as Montefiore Health System, Orange Regional Medical Center, Northwell Health, and Crystal Run Healthcare in the Bronx and Lower Hudson Valley. In Houston, we’ve partnered with Houston Methodist, HCA, IntegraNet Health, VillageMD, and Privia. We’ve also made sure all of our plans are $0 premium, offer $0 tier 1 prescriptions drugs, and do not require referrals to see specialists.

*We invite you to join our Medicare Advantage launch. Getting certified to sell is easy! All you have to do is:

1. Create your Oscar Broker account or log in at business.hioscar.com

2. Click on “Medicare book” in the top right hand corner

3. Start your Medicare certification by clicking the “Get certified” button

We also created a Guide to Oscar Medicare Certification for your convenience. If you have any issues or questions about getting certified, please contact our Enrollment Support Team at 1-866-590-9771 or support@enrollinsurance.com

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