Clark County, WA Essential Benefit Changes on Individual Evolve Plans
April 8, 2011

In December 2010 we informed you of the new federal health care reform law requiring health insurers to remove annual dollar limits on covered services deemed essential by the U.S. Department of Health and Human Services (HHS).  At that time, we requested a waiver from the annual dollar-limit requirement for our Individual Regence Evolve plans in Washington, including Clark County, WA. 

Our waiver request included all of our existing dollar limits.   We recently modified our waiver request to include only the prescription drug benefit limitation.  This means our other dollar limits included in the initial waiver request have been removed.   However, for rehabilitation services we replaced the dollar limit with a day/visit limit.   These changes make our existing individual policies and waiver request more consistent with other carriers in Washington.

To align with our group plans, we’re treating all benefits on our individual plans—except dental and vision—as essential benefits.  As described above, we are not including pharmacy benefits subject to the pending waiver request either.

A small number of claims have been impacted by these changes, and Regence is working to reprocess them.  For members whose coverage became effective prior to October 1, 2010, we’re making these changes retroactive to January 1, 2011.  For members whose coverage became effective on or after October 1, 2010, we’re making these changes retroactive to their effective date.

We’ve implemented a $2 million annual maximum on essential benefits, which is aligned with federal minimum requirements that take effect October 2012.  Implementing the 2012 minimum now will improve (1) benefit continuity for our members and (2) administrative efficiency by avoiding the need to update plans annually to keep up with increasing federal minimum requirements.  As you know, annual dollar limits on essential benefits are prohibited altogether beginning in 2014.

We’ve updated our FAQ to reflect the benefit changes to our individual plans.

We hope the information provided here provides you with basic information about these changes and how they will be implemented for your clients.  Please do not hesitate to contact your Regence Sales Representative with any questions.

View the member notice which will be mailed shortly.

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