Covered CA Sending Out Corrected 1095-A Forms


Covered California, the California state health exchange, has sent out over 120,000 corrected tax forms and plans to have the remaining forms sent out by April 1.  According to the exchange, tax filers won't be required to amend 2014 tax filings to reflect the corrected data, but may file and amendment if they wish to.


LA Times Article

Dave
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Senators warn that Obamacare rule may be 'particularly harmful and disruptive'

The Washington Examiner is reporting that a handful of Democratic Senators have requested HHS delay the 2016 rule that would make groups of 51-100 employees part of the small group health market and take them out of the more flexible large group market.  

Currently small group is defined as 2-50 employees and in 2014, under a 'Grandmothering' provision, were allowed to maintain non-Obamacare coverage through 2017 (2016 in California).  

Grandmothering in California only applied to small groups 2-50 who had a plan renewal in the 4th quarter of the year.  All other groups were not allowed to exercise the Grandmother provision and were forced to move to ACA compliant coverage at their group renewal.

According to the article, only 9% of employers with 51-100 employees actually offer health insurance coverage.  Will be curious to see this play out.  They are asking for at least a two year delay on implementation.  

Washington Examiner Article

Dave
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Data breach at Premera Blue Cross in the Pacific Northwest

 
On March 17, 2015, Premera Blue Cross announced that it was the target of a cyber attack that affected as many as 11 million people.  This is a similar attack to the Anthem cyber attack.  The incident affected Premera Blue Cross, the Blue Plan in Washington, Premera Blue Cross Blue Shield of Alaska, and their affiliate brands Vivacity and Connexion Insurance Solutions, Inc.

Primarily affected members residing in Washington (state) and Alaska.  However, like the Anthem cyber attack, anyone on Anthem Blue Cross CA or Blue Shield of California plan who received services in a Premera area under the BlueCard PPO program may also be compromised.  

Dave
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Anthem Announces "New To Medicare" Plan F Discount


Anthem Blue Cross CA has announced the implementation of a "new to Medicare" discount on only Supplement Plan F.  The discount is $15 per month for the first year and is available to those who enroll in the supplement as "new to Medicare" on or after 3/1/15 effective dates.

The discount is available to those 65 and over who are new to Medicare and within six months of their Medicare Part B effective date.  

Blue Shield of CA continues to offer a similar discount however Blue Shield allows the discount on all Supplement Plans not just Plan F.  Another difference, Blue Shield's discount cannot be combined with certain other discounts (2 party household, etc.) whereas Anthem will allow the discount in combination with certain other discounts.  Both carriers also offer a further discount for those paying their premiums by EFT (check or savings deduction).  

For more information on the Anthem Blue Cross CA Medicare Supplement Plan F discount, please contact my office.

Dave
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Health Care and Sickle Cell Anemia

One very unique  health care disorder that affects primarily people whose families come from Africa, South or Central America (especially Panama), Caribbean islands, Mediterranean countries (such as Turkey, Greece, and Italy), India, and Saudi Arabia, according to the National Institutes for Health (NIH).

In the United States, it's estimated that sickle cell anemia affects 70,000�100,000 people, mainly African Americans. The disease occurs in about 1 out of every 500 African American births. Sickle cell anemia also affects Hispanic Americans. The disease occurs in more than 1 out of every 36,000 Hispanic American births. More than 2 million Americans have sickle cell trait. The condition occurs in about 1 in 12 African Americans.

According to the NIH, it is the most common form of sickle cell disease (SCD). SCD is a serious disorder in which the body makes sickle-shaped red blood cells. �Sickle-shaped� means that the red blood cells are shaped like a crescent.

Normal red blood cells are disc-shaped and look like doughnuts without holes in the center. They move easily through your blood vessels. Red blood cells contain an iron-rich protein called hemoglobin. This protein carries oxygen from the lungs to the rest of the body.

Sickle cells contain abnormal hemoglobin called sickle hemoglobin or hemoglobin S. Sickle hemoglobin causes the cells to develop a sickle, or crescent, shape. Sickle cells are stiff and sticky. They tend to block blood flow in the blood vessels of the limbs and organs. Blocked blood flow can cause pain and organ damage which can also raise the risk for infection. Much more detailed information can be found at this website: http://www.nhlbi.nih.gov/health/health-topics/topics/sca.

According to the Sickle Cell Disease Association of America (SCDAA), sickle cell conditions are inherited from parents in much the same way as blood type, hair color and texture, eye color and other physical traits. The types of hemoglobin a person makes in the red blood cells depend upon what hemoglobin genes the person inherits from his or her parents.

Examples:

--If one parent has Sickle Cell Anemia and the other is Normal, all of the children will have sickle cell trait.

--If one parent has Sickle Cell Anemia and the other has Sickle Cell Trait, there is a 50% chance (or 1 out of 2) of having a baby with either sickle cell disease or sickle cell trait with each pregnancy.

--When both parents have Sickle Cell Trait, they have a 25% chance (1 of 4) of having a baby with sickle cell disease with each pregnancy.

A simple blood test followed by a laboratory technique called Hemoglobin Electrophoresis will determine the type of hemoglobin you have. When you pass an electric charge through a solution of hemoglobin, distinct hemoglobins move different distances, depending on their composition.

The SCDAA reports that sickle cells are destroyed rapidly in the body of people with the disease causing anemia, jaundice and the formation of gallstones. The sickle cells also block the flow of blood through vessels resulting in lung tissue damage (acute chest syndrome), pain episodes (arms, legs, chest and abdomen), stroke and priapism (painful prolonged erection).
 
It also causes damage to most organs including the spleen, kidneys and liver. Damage to the spleen makes sickle cell disease patients, especially young children, easily overwhelmed by certain bacterial infections.

Health maintenance for patients with sickle cell disease starts with early diagnosis, preferably in the newborn period and includes penicillin prophylaxis, vaccination against pneumococcus bacteria and folic acid supplementation. Treatment of complications often includes antibiotics, pain management, intravenous fluids, blood transfusion and surgery all backed by psychosocial support. Like all patients with chronic disease patients are best managed in a comprehensive multi-disciplinary program of care.

Blood transfusions help benefit sickle cell disease patients by reducing recurrent pain crises, risk of stroke and other complications. Because red blood cells contain iron, and there is no natural way for the body to eliminate it, patients who receive repeated blood transfusions can accumulate iron in the body until it reaches toxic levels.

It is important to remove excess iron from the body, because it can gather in the heart, liver, and other organs and may lead to organ damage. Treatments are available to eliminate iron overload. Much more detailed material about this disease can be found at this website: http://www.sicklecelldisease.org/index.cfm?page=about-scd.

Scientists are constantly researching ways to help people with sickle cell anemia, according to this website:  http://kidshealth.org/teen/diseases_conditions/blood/sickle_cell_anemia.html.

Several new treatments, such as the drug hydroxyurea, have helped reduce painful crises and episodes of acute chest syndrome for adults and kids with sickle cell. Bone marrow transplant, a complex and risky procedure, is the only cure for sickle cell anemia. This disease is especially tough on children and adolescents.

Scientists are also studying gene therapy as a treatment for sickle cell anemia. One day, it's hoped that doctors may be able to stop the disease by changing or replacing the abnormal gene that causes it. With the right precautions, children and teens with sickle cell disease can do most of the stuff other kids do. To stay as healthy as possible, take these steps:

--Eat a balanced, healthy diet.

--Take medications, including folic acid supplements, as prescribed.

--Drink plenty of fluids to prevent dehydration.

--Avoid extreme cold or heat.

--Exercise regularly, but in moderation. Exercise is important for staying healthy, but overdoing it can trigger a crisis in some people, particularly if they become dehydrated, overheated, or exhausted.

--Get plenty of rest.

--Avoid alcohol, drugs, and smoking which can aggravate sickle cell disease and its symptoms. Some people with sickle cell disease are prone to lung problems, so smoking is particularly risky and must be avoided.

--Avoid places low in oxygen. (For example, it's not a good idea to go hiking at high altitudes or spend lots of time swimming under water.)

--Prevent serious infections by contacting your doctor as soon as illness symptoms start. Be sure to get any immunizations (such as pneumonia and flu vaccines) that the doctor recommends, and always call your doctor if you have a high fever (over 101�F, 38�C).

--Learn as much as you can about the disease and see your doctor regularly to help prevent complications.

For a tremendous human interest story about a family�s inspirational fight against sickle cell anemia, visit this website: http://sports.espn.go.com/espn/eticket/story?page=boozers

Sickle cell anemia is a disease that can be deadly and debilitating. If you or someone you know are suffering from symptoms, see your doctor. Follow the guidance provided by specialists and support groups. Work hard at staying healthy. Know that the disease can be managed.

Until next time.

CA Franchise Tax Board Revokes Blue Shield's Tax Exempt Status


The California Franchise Tax Board has revoked the State Tax Exempt Status of Blue Shield of California.  As a result, Blue Shield may be required to pay tens of millions annually as well as file tax returns retroactively back to 2013.  This move could undermine the 'not for profit' status of the carrier.  

Blue Shield currently holds approximately $4.2 Billion in reserve, an amount deemed excessive by the state of California and well above the amount recommended by the Blue Cross Blue Shield Association (of which both Blue Shield CA and Anthem Blue Cross are licensees).  

From the LA Times



"The main motivation for any state that wants to see a conversion of a health plan is they would capture the assets," he said.  That idea could prove popular in Sacramento, experts say, where state lawmakers are searching for money to boost Medi-Cal reimbursements for doctors and hospitals and to expand coverage for millions of uninsured Californians who don't qualify for federal help under Obamacare.

Blue Shield was founded by the California Medical Assn. as part of a national movement by hospitals and doctors to form prepaid health plans.  The company is a "mutual benefit" nonprofit � "dedicated to charitable, religious or public purposes," according to California corporation law.


Dave
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OIC helps develop training for examining, analyzing insurers� climate change risk

As the state�s insurance regulator, one of the things the Office of the Insurance Commissioner does is examine and analyze insurers� finances to make sure they have enough money in cash and investments to pay consumers� insurance claims. Climate change is increasingly a risk to insurers� business, both from a claims standpoint and from an investment standpoint.
Some of OIC�s friendly financial examiners participate in a dry run of a new training for state regulators to evaluate insurers� climate change risk.


Commissioner Kreidler has led the climate change work group for the National Association of Insurance Commissioners (NAIC) since 2006. As part of that work, the OIC led a work group that developed the guidance for other state regulators to use when evaluating insurers� climate change risks and investments during financial examinations and analyses. Last week, the OIC�s financial examiners and analysts were given a dry run of the training to offer feedback before it is presented to other state regulators. In essence, insurers are expected to identify climate change-related risk to their business and evaluate how these factors may affect their claims and how they invest their money.

Washington is not new to working with insurers on climate change. Since 2010, our state has been one of a handful that requires insurance companies to answer an annual survey about how they are addressing their risk related to climate change.

You can read more about Commissioner Kreidler�s work with climate change and read the most recent report about how insurers are addressing climate change.

Blue Shield CA Extends Medicare Supplement Year Round SEP to 2016

Blue Shield of California has announced that they will be extending the year round SEP for Medicare Supplements until June 30, 2016.

This SEP (special election period) is sort of a year round  "Birthday Rule".  In California, Medicare Supplement subscribers may change their Supplement to any like or less Supplement on their birthday plus 30 days.  In this case, that privilege is  offered by Blue Shield at any time during the year.  

If you currently have a Medicare Supplement Plan with another carrier, now might be a good time to check and see if Blue Shield offers a more competitive rate.  Remember, Medicare Supplement Plans (A-N) are standardized supplements.  Every carrier's Plan F Supplement is identical, as are all lettered Supplement plans.  

Dave

Anthem Blue Cross offers Tax SEP Off-Exchange through 4/30

Anthem Blue Cross CA is the only carrier currently offering off-exchange enrollment SEP for the period 2/23-4/30/15 for those impacted by the 2014 tax penalty who are not currently insured in 2015.  Details below.  


New Off Exchange Applications (we are only accepting paper applications for this SEP):

  • Not be currently enrolled in a health care plan
  • Attest that they did not realize there was a tax penalty (complete this attestation form)
  • In addition, individuals applying for coverage during this SEP must write �I Did Not Know About the Tax Penalty� somewhere on the first page of the application, submit a completed and signed attestation form, and submit payment or select auto payment method. Applications submitted between the 1st and 15th of the month will have an effective date of the 1st of the following month. Applications submitted after the 15th, will have an effective date of the 1st of the month after next. 
  • Applications submitted without �I Did Not Know About the Tax Penalty� written on the first page or no Qualifying Event box checked will be returned. If the application is due to a �Normal� qualifying event - the Qualifying Event box must be checked because standard effective date rules would apply (see the Anthem application for details regarding effective date assignment for qualifying events).
Anthem Blue Cross applications are available for download on the links below.  Mail, scan and e-mail or fax to me for enrollment processing.  Be sure to select the appropriate application for your county of residence.

PPO Only - Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, Glenn, Humboldt, Imperial, Inyo, Kern, Lake, Lassen, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Plumas, San Benito, San Joaquin, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano, Sonoma, Stanislaus, Sutter, Tehama, Trinity, Tulare, Tuolumne, Ventura, and Yuba

EPO & HMO - Los Angeles, Orange and San Diego

PPO & HMOEl Dorado, Fresno, Kings, Madera, Placer, Riverside, Sacramento, San Bernardino, Santa Clara, and Yolo

EPO Only - San Francisco



Dave
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Tacoma woman trades guilty plea, diversion program for dismissed charges in insurance fraud

Isabel Osorto, 23, of Tacoma, pled guilty to insurance fraud and agreed to complete a diversion program in exchange for the charge being dismissed.

The charge stems from a December 2012 collision in which Osorto hit another car. Later that day, she purchased insurance for her car and filed a $9,000 hit-and-run claim on her car three days later. The insurance company was tipped off that something was amiss when the driver of the car she hit contacted her insurance company about the damage to his car, which was supported by the citation she was issued by Washington State Patrol. She was charged with one count of insurance fraud in September 2014.

The terms of the diversion program include pleading guilty, full repayment of the restitution amount, payment of all administrative fees and full compliance with all program requirements. In this case, the restitution amount is zero because the insurance company did not pay Osorto�s $9,000 claim. The charge against Osorto will be dismissed once she completes the terms of the program. If she fails to complete the program, the charge against her will be reinstated.

The OIC�s Special Investigations Unit investigates insurance fraud and works with the Attorney General�s Office or local law enforcement�in this case, Pierce County � to prosecute criminal cases. Consumers can report suspected insurance fraud on the Insurance Commissioner�s website.

Will my insurance pay to replace a damaged convertible top?

The unprecedented sunshine we are experiencing in the Pacific Northwest may be enticing drivers to take their convertibles out for a spin. But do you know what your insurance policy will cover if something happens to your top or interior? 

Depending upon the age of your vehicle, your insurance company may not pay for the full replacement cost of the convertible top if it is torn from the vehicle or someone damages it. Some companies apply what they call �betterment� to the value of the car, taking into consideration the car�s age and condition. Another way of describing betterment is thinking about life span � car parts have different life spans and once they near the end of their life span, paying the full cost of replacing those parts would result in your car being in better shape than it was when it was damaged, thereby increasing its value.

The same idea applies to the interior of your vehicle. If someone damages the interior while your open convertible is parked somewhere, the insurance company may not pay the full cost of replacement or repair. It is also important to note that standard auto policies do not cover any personal property in the vehicle and any equipment that was not installed by the manufacturer. After-market items like sound systems, paint jobs and other special or upgraded equipment very well may not be covered by your policy.

Talk to your insurance agent about what your policy covers and does not cover.

Read more about auto insurance on our website. Questions? You can contact our consumer advocates online or at 1-800-562-6900.






Insurance Commissioner offers considerations about sharing economy

Forbes estimates up to one quarter of the population participates in some form of the sharing economy, whether it be ridesharing, renting out your home or sharing something you already have to make money.

We put together some information and tips for entrepreneurs and consumers alike to consider before they participate in the sharing economy. You can find that information here. 

Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Protecting insurance consumers all year round

This week is National Consumer Protection Week and the OIC is one of the many government agencies that helps protect consumers from financial harm.

So what does that mean for Washington consumers?

Consumer protection is part of the OIC�s mission, which is reflected in the way we do business. Our consumer advocates can help:
In 2014, our consumer advocates fielded 6,135 consumer complaints and helped recover more than $9.5 million in insurance billings, refunds and other claims-related issues for Washington citizens. Read more about the ways we helped consumers in 2014.

We share information of interest to insurance consumers on this blog and through our social media channels. Many of our blog posts are generated by questions our consumer advocates receive from Washington citizens.

More resources for consumers:

Consumer advocates Andy and Barb helping consumers on the phone.   

Health Care and Fear of Public Speaking

Phobias exist in the psyche of almost everyone. Those deep dark fears that make you cringe or break out into a sweat, or even into hysteria if severe, are often very difficult to overcome. Psychologists have studied these mental issues for many years, and have concluded that whatever phobia you have that creates extreme fear is legitimate in its perception.

According to the American Psychiatric Association (APA), fear is the normal response to a genuine danger. With phobias, the fear is either irrational or excessive. It is an abnormally fearful response to a danger that is imagined or is irrationally exaggerated.

People can develop phobic reactions to animals (e.g., spiders), activities (e.g., flying), or social situations (e.g., eating in public or simply being in a public environment). Phobias affect people of all ages, from all walks of life, and in every part of the world. Much more detail about phobias can be found at this website: http://www.psychiatry.org/phobias .

Phobias are emotional and physical reactions to feared objects or situations according to the APA. Symptoms of a phobia include the following:

         Feelings of panic, dread, horror, or terror.
         Recognition that the fear goes beyond normal boundaries and the actual threat of danger.
         Reactions that are automatic and uncontrollable, practically taking over the person�s thoughts.
         Rapid heartbeat, shortness of breath, trembling, and an overwhelming desire to flee the situation�all the physical reactions associated with extreme fear.
         Extreme measures taken to avoid the feared object or situation.

One very common phobia is the fear of public speaking, which can disrupt careers and lead to countless sleepless nights. Glossophobia, or speech anxiety, is the fear of public speaking or of speaking in general. The word glossophobia comes from the Greek word �glossa�, meaning tongue, and �phobos�, fear or dread. Many people only have this fear, while others may also have social phobia or social anxiety disorder.

Symptoms of glossophobia can be grouped under three primary categories: physical, verbal, and non-verbal. Physical symptoms, the most overt one, include increased blood pressure and heart beats, increased sweating tendency, stiffening of neck and upper back muscles and dry mouth. Some organizations, such as Toastmasters International, and training courses in public speaking may help to reduce the fear to manageable levels. Self-help materials that address public speaking are among the best selling self-help topics. More information about glossophobia can be found  at this site: http://www.glossophobia.com/ .

Dr. David Carbonell, also known as the Anxiety Coach, says that you can solve the problem of public speaking anxiety. Fear of public speaking is the most common of all phobias. It's a form of performance anxiety in which a person becomes very concerned that he or she will look visibly anxious, maybe even have a panic attack while speaking.

Over time, people try to protect themselves by either avoiding public speaking or by struggling against speech anxiety. In this way, people get tricked into making the fear of public speaking more chronic and disruptive. Much more material about this subject can be found at this website: http://www.anxietycoach.com/fear-of-public-speaking.html .

Susan Adams, staff writer at Forbes Magazine, wrote that Jerry Seinfeld once joked that for most people, the fear of public speaking ranks higher than the fear of death: �This means to the average person, if you have to go to a funeral, you�re better off in the casket than doing the eulogy.�

Additionally, she goes on to report that for Jane Praeger, a New York City media and presentation coach, helping people overcome those fears is a critical part of her coaching. Praeger coaches corporate, non-profit and academic clients to make presentations on camera and in front of groups. She teaches in Columbia University�s graduate program in strategic communications, runs group trainings; and she also does a lot of work one-on-one, with people who are paralyzed by their fear of public speaking.

Praeger also is the founder and president of Ovid, Inc., a 20-year old strategic communications firm that specializes in speech, presentation, and media training. More about her company and her services can be found at this site: http://www.ovidinc.com/ .

Jane Praeger stands by the standard advice: know your material and the audience, practice your speech, check out the room in advance, do relaxation exercises like deep breathing, don�t apologize for being nervous. However, Praeger says the most important lesson she�s learned as a coach is that most people have no idea where their public speaking phobia comes from. And, once she does some detective work with her clients, she can uncover the source, get her client to see it, and usually make the fear evaporate.

In almost every case, the fear has nothing to do with the speaker�s ability to talk clearly and fluidly or even to feel comfortable in front of a group. It�s usually connected to some other fear or past wound--a parent�s disapproval, worry that colleagues will think you aren�t polished enough, or concern that you don�t have encyclopedic knowledge about your topic.

Sometimes, according to Jane Praeger, the fear stems from the fact that you don�t like your job, but haven�t yet grappled with that issue. Much more information on this topic can be found online at this site: http://www.forbes.com/sites/susanadams/2012/03/07/why-public-speaking-scares-you-and-how-to-overcome-your-fears/ .

Now for the good news. Most people can reduce their anxiety of public speaking and increase their confidence by avoiding a few poor habits, while incorporating some helpful tips, according to Psychology Today. The following are five tips to reducing public speaking nervousness:

1.    Don�t Expect Perfection from Yourself
2.    Avoid Equating Public Speaking to Your Self-Worth
3.    Avoid Being Nervous About Your Nervousness
4.    Avoid Trying to Memorize Every Word
5.    Avoid Reading Word for Word

For more details on overcoming fear of public speaking, visit this website: https://www.psychologytoday.com/blog/communication-success/201311/5-tips-reduce-the-fear-public-speaking .

Public speaking is definitely a way to generate fear, especially if you�re not prepared. However, by following a few simple techniques, you can learn to overcome it. If you are asked to make presentations in front of audiences, and you get the �heebie jeebies�, do what professionals do. And, remember, everyone, including professional speakers, get nervous. The difference is that they are able to control the nervousness, and the nervousness does not control them. Practice makes perfect.

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...