CalCPA ProtectPlus

CaliforniaHealthline.org  -  Friday, April 30, 2010

On Thursday, WellPoint officials announced that the company’s subsidiary, Anthem Blue Cross of California, has withdrawn its request to raise premium rates for individual policyholders by as much as 39%, the Los Angeles Times reports.

The increase would have taken effect on Saturday and affected as many as 800,000 of Anthem’s customers. California Insurance Commissioner Steve Poizner (R) confirmed the company’s decision (Helfand, Los Angeles Times, 4/30).

Background

In February, Poizner WellPoint to delay the rate hike, which originally would have taken effect on March 1.

Anthem officials later said they would delay the rate hike until May 1, pending the findings of an investigation by external actuaries hired by Poizner, the Sacramento Bee reports.

Report Pending

Although the complete report is expected to be released as soon as Tuesday, Poizner released a summary of the findings on Thursday (Caina Calvan, Sacramento Bee, 4/30).

Poizner said the actuarial firm had found “multiple, significant errors” with Anthem’s proposal, including its calculations of medical claims trends (Wilde Mathews, Wall Street Journal, 4/30).

The report — conducted by the actuarial consulting firm Axene Health Partners — found that among other errors, Anthem overstated medical costs by raising the effect of aging. The actuaries found that modifying those numbers could lower the average rate hike by 10.2% (Los Angeles Times, 4/30).

Those errors “would have led to massive and unjustified rate increases,” Poizner said, adding that Anthem was notified about the errors “and they admitted to the mistakes” (Sacramento Bee, 4/30). (continue reading…)

Over the last few weeks the Group Insurance Trust has received a number of phone calls in response to headlines about significant premium increases recently proposed by Anthem Blue Cross. In fact, it turns out that Blue Cross is just one of many major insurers in California and throughout the nation who are contemplating big rate hikes. The good news, which Trust staff has repeated to these callers, is that ProtectPlus subscribers are not subject to the threatened rate increases that are so much in the news.

Since being licensed by the State of California as a Multiple Employer Welfare Arrangement (MEWA) in 1997, the Trust has acted as the insurer for the entire ProtectPlus medical, dental and vision plans, designing benefits to meet the needs of CalCPA members and setting its own rates.

The Trust’s executive director, Susan Young, notes, “The confusion may have arisen because the Trust contracts with Anthem Blue Cross for use of its Prudent Buyer Network and to adjudicate claims. The Trust has an administrative-services-only agreement for which it pays Anthem a negotiated fee per member, per month, for the services it provides.”  Young adds, “Although ProtectPlus members get the advantage of Anthem’s deep provider discounts, members should understand that it is the Trust that is responsible for setting ProtectPlus premium rates and benefits, which are based on our group’s claims experience. This is why the recent threatened increases by Anthem and others do not directly affect ProtectPlus members.”

For CalCPA members who are not yet taking advantage of the remarkable benefits found in the Trust program, this is an excellent time to see how their present plan stacks up against the ProtectPlus plans. Solo practitioners and members with small group plans who are facing big increases may well find that ProtectPlus offers them superior coverage at significantly lower rates. (continue reading…)