The pace of change just keeps accelerating for the individual family health insurance market in California and we just got a phone conference with Blue Shield of California regarding their brand new suite of plans available July 1st, 2012. It's nice to see a reversion back to clean benefit designs after a decade on the market of piece-mealing benefits which leaves the end consumer confused as to what is covered. This was true for all the carriers. So let's jump into the new suite of plans and find out how it works for you.
First of all, any effective date July 1st or later will have the new plans available. The older plans (Vital Shield, Balance, Essential, etc) will be closed to new enrollees July 1st although existing members can stay on those plans. Some of the old plans will continue to be available but with the new Maternity mandate effective 7/1, these plans will be all but extinct due to a lack of competitiveness. Speaking of maternity, all the new plans will cover maternity as well as some other mandates coming on line such as Women's preventative services (the big one being 100% coverage of contraception) as well as Autism and Autism spectrum coverage. Preventative is already covered at 100% for all plans and these new plans are no exception. Let's now look at the core benefits.
Blue Shield of California has really worked to make to the benefits streamlined with changes occurring along four basic lines: deductible, brand RX deductible, coinsurance percentage, and out of pocket maximum. Otherwise, the plans all cover the same core benefits without carving certain types out (like durable equipment, etc). This is great news and makes it very easy to compare benefits now and a clear and cohesive fashion. California health insurance shopping was tough enough without having the myriad of differences built in which were imperceptible to the casual shopper or novice. The plan break down into 4 main product families: Shield Secure Plus, Shield Secure, Shield, Shield Wise, and Shield Savings in roughly decreasing benefits and premiums. The Shield Secure is the richest suite of plans with a choice of deductible ($2K, $4K, and $6K). The brand RX deductible is $500 (a distinguishing feature) for this plan and generics are available right away. The max out of pocket includes the deductible with all the new Shield plans so keep this in mind when running your quote since other carriers can reflect OOP or out of pocket maximums without the deductible component. You want to compare apples and apples. Office visits are prior to the deductible and there are no longer the limit on number of visits.
The only difference here is the brand RX
deductible which now is $3000. This is better
than the old "generic only" plans since it does
provide catastrophic brand RX coverage but also
allows a lower price point versus the Secure
The Shield Wise plans are structured differently and afford more savings on the premium. The deductibles are higher as are the out of pocket maximums. These plans also have the $3K brand RX deductible. The co-insurance goes up with each deductible but Shield was kind enough to make the transition easy for shoppers (and for brokers!). The $3500 deductible has a 35% coinsurance rate. $4500 has a 45% and $5500 has a 55% coinsurance rate. You have a limit of 2 office copays prior to the deductible per family member plus the preventative at 100% of course.
Finally, there's the Shield Saver which is a well-priced HSA compatible plan. These are fairly straight forward and should provide good catastrophic coverage plus the tax advantages that HSA accounts afford. The deductible is the out of pocket maximum which makes the plan's exposure very clean. You have a choice of $4K or $6K. RX and office visits are subject to the main deductible which is expected but preventative is still covered at 100%.
We'll explain this further in an entire article on embedded deductibles but the net take away is that it's in the consumer's interest for policies with more than multiple people. Make sure to quote comparable coverage in comparison keeping in mind that the Shield max's do include the deductible. Of course, we're happy to help you with any questions and the plan brochures are available by clicking on the plan name when running your personalized health quote through our California health quote engine.
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