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Exchange To Lay Out Benefit Designs

This week, Covered California’s board will take up the subject of insurance benefit design in 2015.

The discussion Thursday of health plan offerings in 2015 comes just a couple of weeks after the end of the exchange’s first open enrollment period and just two days after the April 15 deadline to complete enrollment forms.

The exchange signed up roughly 1.2 million Californians by the end of March. That number could rise due to the two-week extension to finish incomplete applications and it could decline when the total of those who actually paid their premiums is announced.

A second open enrollment period is slated to begin Nov. 15 and rates need to be established soon so consumers can review rates in advance of that period.

The process for setting rates is a long one, so insurers are expected to submit rate proposals to the exchange in late May. Before insurers can run the actuarial data to determine rates, though, they need the 2015 benefit design criteria from exchange officials.

According to Anthony Wright, executive director of Health Access California, the proposed benefit design changes are pretty mild.

“They’ve made it pretty clear what their direction has been, that this should be a year of stability,” Wright said. “So that means that it does allow some benefit designs to continue that have been confusing to consumers.”

Wright said major changes in benefit design already have been made, such as inclusion of pediatric dental care.

“We appreciate the changes that have been made, and we’re not looking for major changes,” he said. “They’ve promised a more thorough review next year and we look forward to that. There still are some things we raised, such as coinsurance, which is confusing for consumers.”

According to a stakeholder webinar held last week but not yet posted on the web, there likely will be the following changes made to Covered California Silver-level plans (200% to 250% of federal poverty level):

  • A proposed 10% increase in imaging cost-sharing from 20% to 30%;
  • A $450 hike in the deductible, for a total deductible of $1,950; and
  • Co-pay deductible would rise by $100 — from a total of $1,500 up to $1,600.

If everything moves along as planned, insurance rates could be determined as early as the end of the summer.

Exchange officials said the meeting materials for 2015 benefit design should be posted by tomorrow.

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