Clark County Individual plan changes effective Jan. 1, 2012
November 22, 2011
A number of changes will be implemented for Individual plans starting Jan. 1, 2012:
- Self-administered chemotherapy benefit revision
- Rx deductible waived for diabetic insulin and supplies
- Rx annual limit removed
- Dental Option 1 closed to new business; new Dental Rewards Option available
Self-administered chemotherapy benefit
To meet the requirements of House Bill 1517, the Washington Self-administered Chemotherapy mandate, we’re modifying our Individual products to comply with this legislation:
- Non-HSA Individual: Zero dollar ($0) cost-share for members
- Jan. 1, 2012: Across the board (i.e., both new and renewing Individual members)
- Individual HSA/HSA 100: Revising the prescription medication benefit to include coverage for brand and non-formulary self-administered chemotherapy medications under prescription plan benefits. Combined medical/prescription deductible and out-of-pocket maximum apply and benefits covered at Category 1 coinsurance levels.
- Jan. 1, 2012: Across the board (i.e., both new and renewing Individual members)
Rx deductible waived for diabetic insulin and supplies
For new and existing Regence Evolve Plus policies, we'll waive the prescription medication deductible on brand-name medications for insulin and diabetic supplies.
This change, which arose out of discussion with the OIC, addresses a concern regarding benefit designs that may discriminate against those with conditions for which a generic drug is not available, especially diabetes.
Rx annual limit removed
We filed a waiver on our Washington Individual products (both medical and pharmacy) with the U.S. Department of Health and Human Services in October 2010. The Washington OIC was aware of the filing. We subsequently amended the waiver to address Rx only. We are now moving forward with amending our products to remove Rx limits on our existing products and are including Rx under our definition of Essential Benefits.
Specific dollar limits on Rx benefits will be removed from our Evolve Plus and HSA 100 plans. These plans formerly had the following annual dollar limits: $2,500 (Plus) and $2,000 (HSA 100).
To ensure that we are adequately covering costs associated with this benefit enhancement, we have filed for a rate adjustment with the state for our Evolve Plus and HSA 100 plans. To see the OIC’s most current information about our rate filing, visit its website www.insurance.wa.gov/health-rates.shtml. Current rates will remain in effect for January. As required by law, members will be notified 30 days in advance of any rate change.
How will members be notified of these changes?
Members will receive a letter, along with a Summary of Changes, detailing how their policy will be impacted by the changes outlined above. Sample member letters are provided below.
Sample Letters:
Dental Option 1 closed to new business; new Dental Rewards Option available
We’re closing our Dental Option 1 to new business and offering our new Dental Rewards Option. Members who already have Dental Option 1 with their Individual medical plan will remain on the plan. Only new members will need to choose Option 2 or the new Dental Rewards Option.
Dental Rewards distinguishes itself from Dental 1 by increasing the qualifying threshold from $500 to $750 in paid benefits in the first year. This gives members the opportunity to have an additional Rewards Benefit of $250 added to the maximum benefit the following calendar year(s) if they use less than $750 in paid benefits. The total annual maximum benefit can’t accrue to exceed an annual maximum benefit of $1,500.
As a reminder, Individual plan members, including dependents under the age of 19, may add, change or drop their dental coverage at any time during the year. Requests to add, change or drop dental will be effective the first of the month following the date the request is received. Credits will be given only for prior Regence dental coverage as long as there isn’t a break of more than 63 days.
As always, we appreciate your partnership and the time you invest in staying abreast of changes within our Individual product suite. If you have any questions, please talk to your Regence Sales contact or producer support at 1-888-888-3689.
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