Regence BlueCross BlueShield of Oregon Essential Benefit Changes

December 10, 2010

As you are aware, the new Federal Health Care Reform law requires health insurers to remove annual dollar limits on covered services deemed ‘essential’ by the U.S. Department of Health and Human Services (HHS).

Initial guidance issued by HHS did not specifically address benefit-specific dollar limits but further clarification that has been more recently released as well as state regulatory interpretation indicates that annual dollar limits on specific essential benefits are not permissible.  Therefore, we will be making changes to our products to remove benefit-specific dollar limits on ‘essential benefits’ except dental and vision services on all plans new and renewing after September 23, 2010.  Current Oregon Evolve members will see Reform changes take place beginning March 1 as their contracts renew.

The attached plan specific FAQs, provide additional detail as to why this change was made and the impact to Individual and (1) 2-99 groups. A benefit-specific grid is included in the FAQ.

For changes to 100+ group plans, please contact your Regence Sales Representatives.

While programming changes are being made as quickly as possible, we do not expect completion of the changes until next month.  

We hope the information provided here helps you with basic information about these changes and how they'll be implemented for your clients. Please reach out to your Regence Sales Representatives with questions.

« Back to Communications