Friday, September 16, 2011

Premera's rate increase disapproved

We've disapproved a request from Premera Blue Cross to increase its individual health plans by 3.1 percent. The company used a medical trend of 7.24 percent to calculate its increase. Medical trend is the change in claims costs over a specific period of time (usually one year) and is often based on both the company's past claims costs and what they expect to spend on claims in the future.

After a careful review of the company's supporting documentation, we don't believe it made its case - specifically, we believe the annual medical trend is likely to be 5.17 percent or less.

The rate was scheduled to take effect on Jan. 1, 2012 and would've impacted 4,039 people.

See if your health plan has filed rate change.

Parents: If you need individual coverage for your children, open enrollment is NOW

Open enrollment for individual health plans started Sept. 15 and runs through Oct. 31. (Individual health plans are those bought by individuals, as opposed to health plans offered by employers or groups.)

We can't say this enough: If you need health insurance for your child, make sure you enroll early. If you miss this open enrollment period, you'll have to wait until March 15, 2012, unless you meet certain qualifications. And if you wait until even the beginning of October, your coverage may not kick in until Nov. 1.

Federal health reform prevents health insurers from denying coverage to children because of a pre-existing health condition. However, just like employer-sponsored health plans, insurers can create open enrollment periods. During these open-enrollment times, children under age 19 do not have to complete a health questionnaire and cannot be denied health insurance.

We should note that there are some exceptions. You can apply for coverage for your child anytime, for example, after the birth or adoption of a child, or when the parent:

  • Is no longer eligible for a state program such as Medicaid.

  • Loses coverage due to a divorce.

  • Loses employer-sponsored coverage (including COBRA coverage).

  • Moves and their plan is not available where they live.