Column 33 New Shorter Waiting Periods for Groups

New shorter waiting periods for groups:

Small group employers are confused about the new mandatory 60 day waiting period in CA.  This is how Blue Shield of CA is handling it:

California will only allow a maximum waiting period of 60 days.  At the next renewal following 12/31/2013, the group will be defaulted to a 30 day waiting period.  The effective date of coverage for a newly eligible employee will be the 1st of the month after 30 days from the date of hire.  At your specific request you may choose one of the following alternatives:

First of the month after the date of hire or a 60 day waiting period with an effective date of exactly 60 days from the date of hire, which may provide an effective date other than the first of the month and a pro-rated premium will be charged.

Since so many groups opted for an early renewal in December of 2013, it's important to note that compliance would then be effective 12/1/2014.

Another reminder for groups: Don't forget to include the Exchange Notice in your new hire packets and the SBC's (Summary of Benefits & Coverage).  Check your plan's rehire provisions as well if you are rehiring after layoffs.

Small groups insured with Blue Shield are still battling billing issues: incorrect bills, taxes added etc.  Now your COBRA administrator likely wants a rate chart to upload new rates.  Since Blue Shield can't seem to get it together to make a rate chart including taxes for early renewal groups, brokers are scrambling to do so.  When there are multiple plans this creates a burden. In addition the rounding in their system may not agree with the spreadsheet rounding, so payroll deduction may be off.

Foster Children & the new law:

Kaiser Health News carried a report from the LA Daily news that states a little-known provision of federal health law.  The law now extends Medicaid coverage to former foster youths until they turn 26, regardless of where they live or how much they earn. The only requirements: They must have been in foster care when they turned 18 and have previously received Medicaid, the state-run insurance plan for the poor known as Medi-Cal in California.   

Nationwide, an estimated 180,000 former foster youths are eligible and another 25,000 will qualify each year, according to the child advocacy group First Focus, which worked to get the provision into the Affordable Care Act.  Youths are entitled to coverage even if they live in states that aren't expanding their Medicaid programs.

Since the children do not have parents who might insure them, this is a way to extend coverage to age 26.  One tricky part is that they must provide documentation of the time in foster care.  Also, if a youth aged out of foster care in another state, they may not qualify if they move.

     My husband is a high school teacher and I am continually amazed when I hear the stories of the lives of foster children who are often just turned out on their own at such a young age.  They are expected to find a job and a place to live, provide for all their own needs without the guidance from family members.   This is an important provision to provide health care for them.  While I understand that it's unlikely that these young people read this column, I hope our readers will keep an eye out for those that might benefit from this information. 

A very interesting article in the Annals of Internal Medicine reports on a study showing a new simple at home test can correctly identify about 94% of patients who do not have colon or rectal cancer.  On average the tests detected about 4 of 5 cancers with only round of testing. The report I read did not mention the cost of the test, but I suspect it will be less costly than the more invasive tests.  Since colorectal cancer is the second leading cause of death in the US, this could provide an opportunity for more screenings. With the emphasis on wellness and prevention, I expect we will hear more about this from our insurance plans.


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