Health Net Changing Plans/Networks in California (and other states)

For 2014 in California, Health Net was the only domestic carrier featuring a fairly robust PPO network on Individual plans under Obama Care.  As I expected, some serious changes are coming for 2015. (pending regulatory approvals). Health Net is referring to these as "significant changes".

Basically, on-exchange (via Covered CA) Health Net will be suspending all plans in Mariposa, Monterey and San Benito Counties.  Plans will change in northern and central CA to an EPO (exclusive provider organization) and a Health Service Plan (HSP) in southern California. These are referred to as "tailored networks".  These plans will be available both on and off exchange as required by the ACA.  

Current Health Net PPO will be offered off-exchange ONLY and only in the same rating regions where it is currently available.  Subscribers in Mariposa, Monterey and San Benito Counties will only have this choice, off-exchange with no subsidy, in order to maintain any coverage with Health Net.  

Lastly, Health Net Community Care HMO will continue to be available in the current select southern California regions.

Notifications to existing subscribers will begin being sent out on October 2, 2014.


Health Care and Rodents

When most people think of rodents, automatically mice and rats come to mind. However, nearly 40% of mammal species are rodents, and they are found on every continent except Antarctica. Rodents include mice, rats, squirrels, chipmunks and beavers, among others. A very detailed list can be found at this website: 

The approximately 4,000 rodent species are divided on the basis of their anatomy into three well-defined groups, or suborders, and more than 30 families. The Sciuromorpha, or squirrel-like rodents, include the various species of squirrel, chipmunk, marmot, woodchuck (or ground hog), prairie dog, gopher (or pocket gopher), pocket mouse, kangaroo rat, and beaver.

The Myomorpha, or mouselike rodents, include a great variety of mouse and rat species, as well as species of hamster, lemming, vole, muskrat, gerbil, dormouse, and jerboa, according to This is the largest rodent group. The Hystricomorpha, or porcupine-like rodents, include the porcupine, capybara, nutria (or coypu), agouti, cavy (including the domestic guinea pig), mara, and chinchilla, as well as many species whose common names include the term rat (e.g., the South American bush rat). More info can be found at this site:

According to the Orkin company, rodents� biology and habits can make them challenging to control, and they present a serious menace to your home. If you�re in need of rodent control services, here�s what you should know about these pests:


         Instincts: Rats are instinctively wary of things new to their environment, including rat control measures such as traps and bait, and colonize in attics, burrows, under concrete and porches, in wall voids and other hard-to-reach places.

         Disease: Rats can harbor and transmit a number of serious diseases. They can also introduce disease-carrying parasites such as fleas and ticks into your home.


         Access: They invade your home seeking food, water and warmth.

         Contamination: Each mouse can contaminate much more food than it eats.

Rodents are warm-blooded mammals that, like humans, can be found throughout the world. They have oversized front teeth for gnawing and check teeth, which are adapted for chewing. Rodents chew on a variety of items available to them and cause great damage in and around homes. Plus, they tend to be rapid breeders. Some species breed year-round, and populations are maintained through constant reproduction.

Because of the rodents� body plan, they are capable of squeezing through spaces that appear to be much too small for them. All such holes should be sealed to prevent entry and reentry of rodents. A pest control professional should be contacted for assistance. Rats and mice are both extremely destructive within agricultural communities. A number of species feed on seeds and grains. The feces and urine of some rodents may contaminate surfaces with which they come into contact. More details can be found at this site:

According to the Centers for Disease Control (CDC), worldwide, rats and mice spread over 35 diseases. These diseases can be spread to humans directly, through handling of rodents, through contact with rodent feces, urine, or saliva, or through rodent bites. Diseases carried by rodents can also be spread to humans indirectly, through ticks, mites or fleas that have fed on an infected rodent.

The primary strategy for preventing human exposure to rodent diseases is effective rodent control in and around the home. This is achieved by eliminating any food sources, sealing even the smallest entries into homes, and successfully trapping rodents in and around the home. Cleaning up after a rodent infestation can be labor intensive, and potentially harmful to your health. For a complete overview, visit this website for extremely detailed material:

In spite of some health hazards concerning rodents in general, some mice and rats, gerbils and hamsters, and a few other rodentia are available as household pets. If you�re interested in providing room and board for one, here is a good overview and comparison of what to expect:

Certain variations of mice and rats serve the medical research community. By testing these rodents through controlled laboratory testing, many medicines and valuable new clues to curing some diseases have been developed. Much more significant data about this topic can be found at this site:

However, some interesting studies using laboratory rodents have recently come to light. According to Nature, the international research journal of science, male, but not female, experimenters induce intense stress in rodents that can dampen pain responses, according to a paper published in Nature Methods. Such reactions affect the rodents� behavior and potentially confound the results of animal studies, the study suggests.

According to the research, this surprising gender disparity was discovered while investigating whether the presence of experimenters affects rodent pain studies. For years, anecdotal reports have suggested that rodents show a diminished pain response when a handler remains in the room. More information about this study can be found at this site:

Finally, according to the State of Florida Health Department, wild rodents can cause home damage, contaminate food, and cause illness in people and pets. Rodent infestations are more likely to occur when events such as flooding displace them. To avoid rodent infestation remove potential rodent food and water sources, and store food for people and pets in sealed containers. Clear debris and other material where rodents can hide.

Safely clean up rodent droppings, urine and nesting areas, always wearing gloves and spraying material with disinfectant until thoroughly soaked before attempting to remove or clean. More details can be found at this website: .

Rodents serve a purpose in creation, but they can also be problematic in many cases. Make sure that your home or worksite is protected and monitored, and cleaned. Rat bite fever is not the same as Saturday Night Fever, so your dance routine is definitely not the same.

Until next time.

Stanford Health Care terminates its contract with Anthem Blue Cross

(Note: In late 2014 Anthem renegotiated the contract with Stanford and they are back in the Pathway network).

Effective September 8, 2014, Stanford Health Care (formerly Stanford University Medical Center) has terminated its contract with Anthem Blue Cross.  Below is the information from Anthem.........

Anthem Blue Cross and Stanford Health Care (formerly known as Stanford University Medical Center) have been engaged in Commercial contract negotiations for several months to reach agreement on reasonable reimbursement rates and contractual terms that are beneficial to both organizations. Unfortunately, Anthem Blue Cross and Stanford Health Care were unable to reach agreement and Stanford terminated the contract effective September 8, 2014.  From that date forward, Stanford Health Care will no longer participate in our provider network.  The hospital is located in the City of Palo Alto in Santa Clara County.
Letters are being mailed today, September 8, 2014, to subscribers that personally accessed or had a covered family member access Stanford Health Care within the last 12 months and to any members with an authorization for care at the hospital.  We are also mailing letters to related clients, brokers and agents and to PPO physicians and HMO medical groups with admitting privileges at Stanford Health Care.
 If you are covered by Anthem Blue Cross and utilize services from Stanford Health Care, you will need to locate new providers outside of that medical group unless and until a new contract can be reached.  


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New QLE (Qualifying Life Event) & Special Enrollment Period Info on my Site

I've added a new page to my site as we move into the autumn and towards the 2015 Open Enrollment Period.

There are quite a few Special Eligibility criteria currently available for people outside of the open enrollment period and I wanted to summarize them in a concise list.  #11 alone has 7 different scenarios for enrollment eligibility outside of open enrollment.

If you are viewing this blog on my web site ( then just select either the ACA or Health Insurance tab and there will be a link on either of those pages.  If you are on the blogspot page click on the link below.  

Dave's QLE List

Remember, 2015 open enrollment begins November 15th, 2014 and runs through February 15th, 2015.  


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Health Care and Lipstick

Women and teens cannot get enough of it. Married men fear it on their shirt collars. Store shelves are stocked with it by the case. Celebrities hawk it on commercials non-stop on television, magazine ads, and billboards; and billions of dollars per year are spent on acquiring it. The ancient Egyptians were the first recorded people to use it, and people have been enhancing their lips with it for thousands of years.

Lipstick by definition is a cosmetic used to color lips, usually crayon-shaped and packaged in a tubular container. No individual inventor can be credited as the first to invent lipstick as it is an ancient invention; however, the history of the use of lipstick and credit individual inventors for creating certain formulas and methods of packaging, according to this website: .

The actual term "lipstick" wasn't first used until 1880. However, people were coloring their lips long before that date. Upper class Mesopotamians applied crushed semi-precious jewels to their lips. Egyptians made a red dye for their lips from a combination of fucus-algin, iodine, and bromine mannite. Cleopatra was said to have used a mixture of crushed carmine beetles and ants to color her lips red.

Historians note that the first cosmetic lipstick manufactured commercially (rather than homemade products) occurred around 1884. Parisian perfumers had begun to sell lip cosmetics to their customers. By the late 1890s, the Sears Roebuck catalog started to advertise and sell both lip and cheek rouge. Early lip cosmetics were not packaged in their familiar tubes that we see used today. Lip cosmetics were then wrapped in silk paper, placed in paper tubes, used tinted papers, or sold in small pots.

According to CNN, every day millions of women apply lipstick without a second thought. What many don't know is that lipsticks may contain lead, the notorious metal that can cause learning, language and behavioral problems. Lead is a neurotoxin and can be dangerous even at small doses. So what's lead doing in lipsticks? Not all lipsticks contain lead, but a number of studies in recent years show that the metal is more prevalent than previously thought.

Medical experts say there is no safe level of lead in your blood. The FDA says it doesn't consider the lead levels it found in lipsticks to be a safety issue. No lipstick lists lead as an ingredient. The amounts are small, but the presence of lead in lipstick, which is ingested and absorbed through the skin, raises concerns about the safety of a cosmetic product that is wildly popular among women.

Urged on by both consumers and the cosmetics industry, the U.S. Food and Drug Administration conducted its own testing in 2010. The FDA's results were even more astonishing: The agency detected lead in all 400 lipsticks tested, ranging from 0.9 to 3.06 ppm -- four times higher than the levels observed in the study done by Campaign for Safe Cosmetics in 2007. 

And lead isn't the only toxic metal you may be applying to your lips.  Recently, University of California researchers tested eight lipsticks and 24 lip glosses and detected nine toxic heavy metals, including chromium, cadmium, manganese, aluminum and lead. It's true that a single lipstick application will not lead to harm. And the good news is that not all lipsticks contain detectable levels of lead or other heavy metals. (And by the way, cost doesn't seem to be a factor; a cheap or expensive lipstick isn't the determinant of how much lead is present.)

The problem is when women who wear lipstick apply it 2 to 14 times a day, according to the study by the University. The result is that they are ingesting and absorbing through their lips as much as 87 milligrams of product a day, the study says. Women are not only applying their lipsticks several times a day, but they also are doing this in the span of a whole lifetime, which means that exposure to lead and other heavy metals adds up and can potentially affect their overall long term health. More details on this subject can be found at this website: 

There remains a wide range of metal concentrations across colors and brands, according to the New York Times, and cosmetic companies are able to control metal content when they choose.

Some metals are undoubtedly absorbed through mucosal tissues in the mouth. And people do swallow lipstick, one reason that it�s so often reapplied. Given the continued debate about how much is absorbed, everyone � including the cosmetics industry � is pushing the F.D.A. to study the issue further.

In the meantime, health care practitioners recommend that consumers take a common-sense approach to cosmetics. For starters, don�t let young children play with lipstick. You should treat it like something dangerous, because if they eat it, a comparatively large level of metals are going into a small body. And be cautious about how often you reapply that shimmering color. Given the uncertainties, two or three times a day is all that beauty can reasonably demand. More information can be found at this site:

Cosmetics safety should be assessed not only by the presence of hazardous contents, but also by comparing estimated exposures with health-based standards. In addition to lead, metals such as aluminum, cadmium, chromium, and manganese require further investigation, according to the National Institutes for Health. A detailed overview of a scientific study can be found at this website: 

Now that you're thinking about lipstick in a new way, let's look at the basics. In short, lipstick is a compressed tube of waxes, oils, additives and pigments that color and moisturize the lips. Most lipstick-wearers don't give much thought to anything other than the color, how it feels on their lips and how much it costs. Lipstick can be had for anywhere from $1 to $100, depending on the brand. One lipstick made by Guerlain costs more than $60,000, but that's probably because of its diamond-encrusted, 18-karat gold tube, according to

Although there are many different types of lipsticks and a vast array of colors, there are some basic ingredients. And that list of ingredients above is just a paltry few of the many substances that might be in the tube of lipstick in your purse. For many women, wearing lipstick for the first time is a rite of passage, and even if they wear no other makeup, they feel naked without it. Lipstick essentially began the modern cosmetics industry. Much more info on lipstick can be found at this website:

Lipstick in general is considered to be safe, but check the ingredients with the manufacturer of the brand you want to buy. Although the health effects of lipstick have not shown to be harmful yet, there is a growing body of evidence that it could cause long term issues. If you suspect that you may have health related issues due to using lipstick, see your doctor. All health issues should be addressed by a physician or professional medical practitioner.

Until next time.

New Medicare cards are coming starting in April

The Centers for Medicare & Medicaid Services (CMS) will start mailing redesigned Medicare cards to beneficiaries in Washington state aft...