Washington small businesses to get health insurance tax credits

Source: Washington State Insurance Commisioner

OLYMPIA, Wash. – The U.S. Treasury Department announced today that it will allow qualifying Washington businesses to get tax credits to help pay for up to 50 percent of their employees’ health insurance premium next year.

“This is great news for the small businesses in our state,” said Insurance Commissioner Mike Kreidler. “I know many of them care about their employees and have struggled to provide affordable coverage. Today’s announcement means many businesses will get some relief.”

Under the Affordable Care Act, certain small businesses that provided health insurance to their employees from 2010-2013 were eligible for premium tax credits of up to 35 percent. In 2014, the tax credit was to increase to 50 percent but only if the employer bought the health plan through the state’s Small Business Health Options Program (SHOP) or Exchange.

Washington state is one of two states without a statewide small business exchange or SHOP.  SHOP plans are currently only available in Clark and Cowlitz counties and the only insurer participating is Kaiser Foundation Health Plan of the Northwest (Kaiser).

Until today’s announcement from the federal government, the small business tax credit was only available to qualifying businesses in the two counties with an active SHOP program. It was up to the federal government to make an exception for Washington state.

Now, small businesses that meet the federal guidelines can receive a tax credit to help with the cost of providing health insurance to their employees – even if they purchase the plan outside of the Exchange.

To qualify for a tax credit, a small business must have fewer than 25 full-time employees, pay for at least 50 percent of their employee’s premium and pay an average wage of $50,000 or less.

Unfortunately, small business owners in Clark and Cowlitz counties who want a tax credit must purchase coverage through the SHOP program where only one insurer (Kaiser) is currently participating.

Thirteen health insurers currently participate in Washington state’s small employer market.

For more information, read this overview of the small business health insurance tax credit and how to apply.

Kreidler offers advice to consumers seeking health coverage by Jan 1

Source:  Washington State Insurance Commissioner

OLYMPIA, Wash. – With thousands of consumers still actively searching for health insurance and many who need coverage to begin Jan. 1, 2014, Insurance Commissioner Mike Kreidler is concerned that people may not understand all of their options for getting covered.  

“I’ve heard from consumers who have struggled recently to get signed up for new coverage through Wahealthplanfinder.org,” said Kreidler. “I share their concerns and understand their frustration – especially those who are losing their old plans and who really need coverage by Jan. 1.  Wahealthplanfinder is the only place to get a subsidy, but it’s not the only way to buy health insurance.”

The deadline for having health coverage – that starts Jan. 1 through the Wahealthplanfinder – is currently Dec. 23. Kreidler is encouraging the Exchange and the insurance carriers to work together to find a way to guarantee that anyone who applies by Dec. 23 will be covered on Jan. 1.

Kreidler also warned consumers that health plans for sale outside of the Exchange may need your application and payment sooner. Contact your insurer today if you have questions about what steps you need to take and when you must act.

Anyone looking for guidance before the end of the year should consider these options:

If you don’t think you’ll qualify for a subsidy:

  • Subsidies are generally available to individuals earning less than $45,960. The cut-off for a family of four is $94,200.

If your plan is cancelled and you don’t want to get auto-enrolled in a plan suggested by your insurer:

If your plan is cancelled and you are auto-enrolled in the plan suggested by your insurer:

  • You can keep the plan you’ve been auto-enrolled in or
  • You can continue to shop for a new plan with a different insurance company either inside or outside the Exchange until March 31, 2014. Keep in mind that if you’re auto-enrolled in a new plan, your insurer may not let you switch to one of its other plans.

Open enrollment for plans sold both inside and outside the Exchange ends March 31, 2014 but extends to April 30 for children under age 19. Medicaid open enrollment runs all year.

Kreidler stressed that people should not wait until Dec. 23 to contact their insurance company or an agent or broker if they want to guarantee they’re covered by the New Year.

“We’ve always known that implementing health reform would require many moving parts coming together and that it would take a number of agencies and the insurance industry working together,” said Kreidler. “My office is doing its part to ensure that all approved health plans live up to the new reforms and that people have better coverage. We’re counting on the Exchange to get and keep Wahealthplanfinder up and running.”

New 2011 Open-Enrollment Periods for Children

Source: Washington State Insurance Commissioner

OLYMPIA, Wash. – The individual health insurance market will have two special open-enrollment periods for children this year. Parents who want to add their children to their individual health plans or buy child-only plans can do so from March 15-April 30, 2011 and from Sept. 15-Oct. 31, 2011.


Insurance Commissioner Mike Kreidler filed a regulation today, creating this year’s open-enrollment periods. The individual health insurance market is for people who do not have access to employer-sponsored health insurance. New consumer protections under the federal Affordable Care Act prevent health insurers from denying coverage to children with pre-existing health conditions.  However, special open-enrollment periods are allowed.

During open-enrollment times, children under age 19 cannot be denied health insurance because of a pre-existing condition. People looking for coverage for their children outside of the enrollment dates can apply either to the Washington State Health Insurance Pool (WSHIP), or if they qualify, to the new Pre-existing Condition Insurance Plan (PCIP-WA). To enroll in PCIP-WA, you must have been uninsured for at least six months and have a pre-existing medical condition.

Exceptions where parents can apply for individual coverage for their kids anytime include the birth or adoption of a child or if a child or the parent:

  • Is no longer eligible for a state program.
  • Loses coverage due to a divorce.
  • Loses employer-sponsored coverage.
  • Moves and their plan is not available where they live.

In 2014, when the full health reforms take effect, no one of any age can be denied insurance because of a pre-existing condition.


Anyone with questions about the individual health insurance market can call our Insurance Consumer Hotline at 1-800-562-6900.

LifeWise announces actions to waive certain out-of-pocket associated with H1N1 vaccine

Source: LifewiseWa.com

MOUNTLAKE TERRACE, WA – (October 1, 2009) – LifeWise Health Plan of Washington today announced actions to provide peace of mind to its members by waiving certain out-of-pocket costs that would otherwise be associated with the administration of the H1N1 vaccine.

“LifeWise has been planning and preparing for scenarios related to H1N1 flu since the issue arose this spring,” said Dr. Roki Chauhan, LifeWise’s Chief Medical Officer. “We are actively engaged with our associates, our members, and our network of healthcare providers to meet their respective needs on this issue.”


LifeWise of Washington is waiving certain out-of-pocket costs that would otherwise be incurred by members receiving the H1N1 vaccine. LifeWise will cover the cost of administration of the H1N1 vaccine for all members in fully insured groups, including those who have reached their preventive care benefit maximum or whose plan does not include an immunization benefit.

This action is part of our efforts since April, when H1N1 came to the attention of the health community, to be prepared to provide continuous service to its providers and members in the event of a major flu outbreak. The decision to waive certain out-of-pocket expenses related to the administration of the H1N1 vaccine until further notice is based on LifeWise’s recognition of the unique nature of this flu virus and the company’s desire to encourage appropriate member access to the vaccine.

“We want LifeWise members to have peace of mind knowing that receiving the H1N1 vaccine will not require payment of out of pocket costs for administration of the vaccination,” Chauhan added.

“We urge our members in at-risk groups as defined by the CDC to receive vaccinations recommended by that agency. In the meantime, we strongly encourage everyone to follow common sense steps to help minimize flu transmission,” Chauhan concluded.

The CDC currently recommends individuals in the following groups receive the H1N1 vaccine:

  • Pregnant women
  • People who live with or care for children younger than 6 months of age
  • Healthcare and emergency medical services personnel
  • Persons between the ages of 6 months through 24 years
  • People ages 25 through 64 years who have chronic health disorders or compromised immune systems.

LifeWise remains actively engaged in monitoring and preparing for all appropriate steps to support its associates, members, and network of healthcare providers during the upcoming flu season.

More information regarding the flu and the H1N1 virus, including links to relevant health organizations, is available at our “The Flu And You” page.

Prescription Coverage Grows As Prevention Pays Off

Source: LifewiseWa.com

MOUNTLAKE TERRACE, WA – (September 17, 2009) – LifeWise Health Plan of Washington is announcing the following expansion of individual health-plan benefits to provide consumers with more choices and greater coverage:

  • A new comprehensive plan with lower out-of-pocket costs.
  • WiseChoices Prime will offer comprehensive coverage coupled with a reduced annual coinsurance maximum, reducing potential out-of-pocket costs for consumers by up to $2,000.
  • A market leading catastrophic plan that adds prescription drug coverage.
  • WiseEssentials Rx will provide consumers seeking catastrophic coverage the additional benefit of up to $3,000 in prescription drug coverage. No other catastrophic plan in Washington State combines multiple office visits, preventive tests at no cost, and now prescription drug coverage.
  • Access to a national network of healthcare providers to better serve members.
  • All LifeWise individual members will have access to a nationwide network as of January 1, 2010. Partnership with PHCS/Multiplan will provide members with access to more than 500,000 unique practitioners and 5,500 hospitals and ambulatory services across the country – in addition to the extensive LifeWise provider network in Washington, Oregon, and Alaska.

“This is a big step forward,” said Jeff Roe, President & CEO of Lifewise Health Plan of Washington. “Three years ago we made a commitment to providing first-dollar coverage of preventive care for our members. This was the right thing to do, and we have indications that commitment may also be contributing to an improved cost trend. We’re very happy to be offering expanded benefits while keeping rate increases below the rest of the market.”

The issue of trends in rising healthcare costs is important. Steady increases in the cost of medical care have resulted in double-digit rate increases across the individual market in recent years, from health plans across Washington State. LifeWise recently filed for a much lower increase of 7.4%, significantly below recent trends in the marketplace. While by no means an indicator that the problem is solved, this is a positive sign that steps to control costs – including by emphasizing the value of preventive care – can have an impact.

LifeWise is offering opportunities now to take advantages of these benefit improvements taking effect January 1, 2010. Customers purchasing LifeWise products during October, November, and December will be able to transition to equivalent new and improved product offerings without the need for additional underwriting as is otherwise standard in the individual marketplace. This will provide even more value to LifeWise customers.

Finally, LifeWise members will also soon be able to access enhanced online features, allowing them to manage their benefit dollars and health in one location. LifeWise expects to announce more about these online features in coming weeks.

Please call 1-800-592-6804 for more information on these expanded benefits and options for consumers.

Lifewise urges customers to take the same preventive measures they take during any flu season

Source: LifewiseWa.com

MOUNTLAKE TERRACE, WA – (May 1, 2009) – LifeWise Health Plan of Washington is actively monitoring developments around the swine flu and is working with our providers, employer groups, and members to address the situation as events warrant. In the meantime, we continue to be focused on providing our members peace of mind about their healthcare coverage, and we are also working with our own employees to take appropriate preventive steps to maintain a healthy and safe working environment so we can continue to address our customers’ concerns and needs.

We urge our customers to take the same preventive measures they take during any flu season, including:

  • Cover your nose and mouth when you cough or sneeze
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective
  • Avoid touching your eyes, nose or mouth since bacteria can live on surfaces you handle
  • Avoid close contact with sick people
  • If you become ill with flu symptoms, call your doctor for advice, and stay home from work, school or other public events
  • Try not to touch surfaces that may be contaminated
  • Get plenty of sleep
  • Manage your stress through exercise and plenty of rest
  • Drink plenty of fluids
  • Eat healthy, nutritious food

Additional Information

For the most up-to-date information, preventive care tips, frequently asked questions and more, please refer to the CDC or WHO Web sites.

  • Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/swineflu/
  • World Health Organization http://www.who.int/en/

A variety of other reliable resources are available to help answer questions about the Swine Flu:

  • U.S. Department of Health and Human Services http://www.pandemicflu.gov/
  • WA DOH: http://www.doh.wa.gov/swineflu/
  • Alaska DOH: http://www.hss.state.ak.us/
  • Oregon DOH: http://www.oregon.gov/DHS/index.shtml
  • Arizona DOH: http://www.azdhs.gov/
  • Health and Human Services: http://www.hhs.gov/
  • Government Pandemic planning site: http://www.pandemicflu.gov/

Health Care Bill Causes Rate Hikes

Source: WSJ.com

Health insurers say they plan to raise premiums for some Americans as a direct result of the health overhaul in coming weeks, complicating Democrats’ efforts to trumpet their signature achievement before the midterm elections.
Aetna Inc., some BlueCross BlueShield plans and other smaller carriers have asked for premium increases of between 1% and 9% to pay for extra benefits required under the law, according to filings with state regulators.
These and other insurers say Congress’s landmark refashioning of U.S. health coverage, which passed in March after a brutal fight, is causing them to pass on more costs to consumers than Democrats predicted.
The rate increases largely apply to policies for individuals and small businesses and don’t include people covered by a big employer or Medicare.
About 9% of Americans buy coverage through the individual market, according to the Census Bureau, and roughly one-fifth of people who get coverage through their employer work at companies with 50 or fewer employees, according to the Kaiser Family Foundation. People in both groups are likely to feel the effects of the proposed increases, even as they see new benefits under the law, such as the elimination of lifetime and certain annual coverage caps.
Many carriers also are seeking additional rate increases that they say they need to cover rising medical costs. As a result, some consumers could face total premium increases of more than 20%.
While the increases apply mostly to the new policies insurers write after Oct. 1, consumers could be subject to the higher rates if they modify their existing plans and cause them to lose grandfathered status.
The rate increases are a dose of troubling news for Democrats just weeks before an election in which they are at risk of losing their majority in the House and possibly the Senate.
In addition to pledging that the law would restrain increases in Americans’ insurance premiums, Democrats front-loaded the legislation with early provisions they hoped would boost public support. Those include letting children stay on their parents’ insurance policies until age 26, eliminating co-payments for preventive care and barring insurers from denying policies to children with pre-existing conditions, plus the elimination of the coverage caps.
Weeks before the election, insurance companies began telling state regulators it is those very provisions that are forcing them to increase their rates.
Aetna, one of the nation’s largest health insurers, said the extra benefits forced it to seek rate increases for new individual plans of 5.4% to 7.4% in California and 5.5% to 6.8% in Nevada after Sept. 23. Similar steps are planned across the country, according to Aetna.
Regence BlueCross BlueShield of Oregon said the cost of providing additional benefits under the health law will account on average for 3.4 percentage points of a 17.1% premium rise for a small-employer health plan. It asked regulators last month to approve the increase.
In Wisconsin and North Carolina, Celtic Insurance Co. says half of the 18% increase it is seeking comes from complying with health-law mandates.
The White House says insurers are using the law as an excuse to raise rates and predicts that state regulators will block some of the large increases.
“I would have real deep concerns that the kinds of rate increases that you’re quoting… are justified,” said Nancy-Ann DeParle, the White House’s top health official. She said that for insurers, raising rates was “already their modus operandi before the bill” passed. “We believe consumers will see through this,” she said.
Previously the administration had calculated that the batch of changes taking effect this fall would raise premiums no more than 1% to 2%, on average.
After Regence mailed a letter notifying plan administrators of its intention to raise group insurance rates in Washington state, the White House contacted company officials and accused them of inaccurately justifying the increase. Kerry Barnett, executive vice president for Regence BlueShield, said the insurer is changing the letter to more precisely explain the causes of the increase.
The industry contends its increases are justified. “Anytime you add a benefit, there are increased costs,” said Karen Ignagni, president of America’s Health Insurance Plans, the industry’s lobbying group.
Massachusetts, which enacted universal insurance coverage several years ago, also has seen steadily rising insurance premiums since then. Proponents of that plan attribute the hikes there to an overall increase in medical costs, while insurers cite it as a cautionary example of what can happen when new mandates to improve benefits aren’t coupled with a strong enough provision to force healthy people to buy coverage.
Republicans, who have sought voter support by opposing the health law, say premium increases could help in November’s congressional races. “People are finding out what’s in [the law], they don’t like it, and I think it’s going to play a big factor in this election,” said Iowa Sen. Charles Grassley, the top Republican on the Senate Finance Committee.
About half of all states have the power to deny rate increases. Ms. DeParle pointed out that the law awards states $250 million to bolster their scrutiny of insurance-rate proposals, saying that will eventually curb premiums for people.
“In Kansas, I don’t have a lot of authority to deny a rate increase, if it is justified,” said Kansas Insurance Commissioner Sandy Praeger. She recently approved a 4% increase by Mennonite Mutual Aid Association to pay for the new provisions in the health law.
The process of reviewing rate increases varies by state. For instance, Ms. Praeger said she can deny only rate increases that are unreasonable or discriminatory.
Some regulators say not all insurers have adequately justified their increases. “A lot of it is guesswork for companies,” said Tom Abel, supervisor at the Colorado Division of Insurance. “I was anticipating the carriers to be more uniform.”
Regence BlueCross BlueShield of Oregon, which estimates its increase covers 57,000 members, said its goal is to “anticipate the financial needs of our members as accurately as possible and to collect just enough premiums to cover costs,” said a spokeswoman. Other insurers offered similar explanations or declined to discuss their increases.
A small number of insurers have submitted plans to lower rates and cite the new mandates in the legislation as the reason. HMO Colorado, a Blue Cross Blue Shield plan owned by WellPoint Inc., submitted a letter to state regulators saying small group rates would fall 1.8% starting Oct. 1 because of changes from the law.
Democrats had hoped to sell the bill in the fall elections. But in recent weeks, some Democrats who voted for the bill have shied away from advertising that fact, while the handful of House Democrats who cast “no” votes see it as a potential boost to their re-election bids.
“I think it’s a question of short term versus long term,” said North Carolina Insurance Commissioner Wayne Goodwin, a Democrat up for re-election in 2012. “Thankfully we’re seeing people get more coverage and protections than they’ve ever had before. But until we see the medical-cost inflation affected, you’re likely to see rate increases as long as they are not excessive and in violation of the law.”

How The New Health Care Law Affects You

Source: Washington State Insurance Commissioner
UPDATED: 6/10/2010
Health reform was signed into law this past March and while most of the new benefits take effect in 2014, some significant changes start as early as this summer.  Most people who’ve contacted the state insurance commissioner want to know the same thing: How does the new law impact me?  Here, you’ll find the latest information on the new law for different age groups as well as a general timeline. Check back often, as we’re updating this page when new information becomes available.


Within 90 days:
■Washington state will contract with the federal government to create a new, temporary high risk pool for people who’ve been uninsured for at least six months and who have a pre-exisitng medical condition.
■Approximately $102 million will be available from the federal government to fund Washington state’s program until 2014, when the new reforms take effect. Many details about the benefits and costs have yet to be set, but the program should be up and running later this summer.
■The federal funds will pay at least 65 percent of the cost of enrollee health care services and the maximum enrollee annual out-of-pocket limit will not exceed $5950. Learn more about the new, temporary program and Washington’s current high risk pool, WSHIP.
■Employers can apply for federal funds to help cover their retirees’ health care costs.
 Many of the following new benefits take place at different times, depending on whether you have an individual plan or get your health insurance from your employer.


Beginning Sept. 23, 2010:
When your employer-sponsored health plan renews, your plan cannot:

■Charge out-of-pocket costs for preventive services.*
■Cap Lifetime benefits. (Caps of $1 million or $2 million are now common).
■Cancel or rescind a policy, except in the case of fraud or misrepresentation.
■Refuse to cover pre-existing conditions of enrollees under age 19.
■And young adults may be covered on their parents’ plan until the age of 26, unless they get a job that offers health insurance.

* If your employer enrolled in its plan before March 23, 2010, your plan is considered grandfathered and isn’t required to include these benefits.


Beginning Jan. 1, 2011:
If you have an individual plan, your plan cannot:

■Charge out-of-pocket costs for preventive services.*
■Cap lifetime benefits. (Caps of $1 million or $2 million are now common).*
■Cancel or rescind a policy, except in the case of fraud.
■Refuse to cover a child’s pre-existing condition.*
■And young adults may be covered on their parents’ plan until the age of 26.

* If you enrolled in your individual plan before March 23, 2010, your plan is considered grandfathered and isn’t required to include these benefits.


This year:
■Medicare enrollees with prescription drug coverage (Part D) will receive a one-time check of $250 to help pay for their medications in the coverage gap (“doughnut hole”).
■Small businesses will not be required to continue coverage for their employees up until 2013, but they’ll receive tax incentives if they do. If they pay for at least 50 percent of their employees’ premiums, they can receive a tax credit equivalent to 35 percent of their contribution.
■Washington state will begin applying for federal grants to implement the new health reform law.

In 2011:
■Drug manufacturers must provide a 50 percent discount to Part D (Medicare’s prescription drug benefit) for brand name drugs.
■ A new voluntary long-term care program, called the CLASS Act, begins. It provides a modest cash benefit to help disabled people stay in their homes, or cover nursing home costs. Benefits can begin five years after people start paying the premium. More details, including premium amounts and the amount of case benefits that’ll be available will be announced later this year.

In 2014:
■Health plans cannot exclude coverage for pre-existing conditions.
■Health plans must accept every employer and every individual that applies for coverage, although they may create special enrollment periods.
■Health plans cannot require individuals to take a health questionnaire or deny them coverage because of their health condition.
■Individuals and families can receive subsidies, based on their income, to help buy coverage from their state’s health insurance exchange. Also, income-based caps on out-of-pocket medical expenses take effect.
■People under age 30 can purchase a comprehensive coverage plan or a catastrophic plan designed just for their age group.
■Small businesses can purchase insurance for themselves and their employees through the health insurance exchange. Their tax credit will increase to 50 percent of premiums and last for two years. The tax credits are available to employers with fewer than 25 workers and average wages below $40,000 a year.
■From 2014-2019, Washington state will receive $13.78 billion to help pay for health insurance coverage for the uninsured, either through subsidies for low and middle income families or through the state’s Medicaid program for the very poor.

In 2020:
■The coverage gap or “doughnut hole” in Medicare’s prescription drug program closes.

Regence responds to Senate Finance Committee vote on key health care legislation

Source: Regence.com

PORTLAND, Ore. — The following is a statement from Mark Ganz, president and chief executive officer of Regence BlueCross BlueShield, regarding the Senate Finance Committee vote today on the America’s Healthy Future Act:
“Regence continues to be cautiously optimistic that an economically sustainable health care reform package will be adopted this year. Today’s vote is an important step toward ensuring long-term health care security and stability for all Americans. However, there is still more work to be done. 
“Our company’s deep commitment to improving the health care system is unwavering. In the coming weeks, we will continue our ongoing advocacy for these key reform elements: all Americans must have affordable coverage and access to quality care; insurers must drop pre-existing barriers to coverage, medical care must become more efficient; and the entire system must be simpler and more transparent. 
“Regence will work tirelessly to achieve the critical pillars of reform that will ensure broader economic sustainability for our members and the nation as a whole.”

Regence Video Asks “What if Everything Worked Like Health Care?”

“45 Seconds to Share” illustrates health care system foibles

PORTLAND, Ore. — What if you could not find the price for anything at the grocery store, even the most basic items? What if the check-out clerk offered to mail you a bill, but could not tell you what your total amount would be?
Although that sounds ridiculous, that is exactly how our nation’s health care system often operates.
As the country’s health care reform debate charges forward, the unsustainable rise in health care costs remains a significant issue. Understanding the cost of medical care – from a doctor’s visit to a flu shot to knee surgery – is the key to controlling those costs. To illustrate the absurdity of not knowing what a procedure or office visit costs, unlike other sectors of our economy, Regence launched a video called “45 Seconds to Share,” part of the company’s WhatsTheRealCost.org campaign.