As of 1/1/2020, as groups renew or enroll with Premera on their Community-rated plans (other than Peak Care), there will be a serious limitation with regards to total knee & hip replacement:
To date, there have been no official producer announcements about this from Premera. They included wording about this new requirement at the end of the table in each of their plan summaries (see page 5 of any of their summaries).
We did find an employer flyer for groups of 51+ with the information about which facilities will be considered Centers of Excellence; however, for groups of 51+ the member will have the option to utilize a Center of Excellence or another non-COE provider. With Community-rated groups, members will not have coverage at a non-COE provider unless they obtain a Hardship Exception.
We have updated the Plan Comparison Tool output for Premera small group plans (other than Peak Care) to include additional wording under the Hospital benefit description. See this sample of how this now looks.
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The Washington State Office of the Insurance Commissioner released approved 2019 rates for seven of our individual carriers. Four carriers continue to be in review. The most-watched renewal rating has been Kaiser of WA, which asked for the largest increase of all the carriers (30%). Thankfully, this number has been clipped a bit, down to a 19% increase. Overall, at least 2019 increases will be significantly lower than our 2018 increases were.
Check out our compilation of what’s happening in the WA small group health insurance market this year: what’s in, what’s out, common trends, enhancements, take-aways, and more.
With costs rising and access to health insurance tightening, micro groups are looking to fall in with the big kids. But, not all will qualify.
Here's a glimpse of the proposed 2018 health plan rates as submitted to the Washington OIC.
Here's how large groups, as well as association and trust plans are affected by the new Premera/Providence agreement.
Premera & Providence – Big Network Changes. Part 2: Small Groups, 1-50 – Plans offering the Larger Network
With the new agreement, only a few small group plans will be able to offer Providence as a PPO.
Beginning 1/1/17, the entire Providence network will only have PPO status on some Premera plans.
It's only barely summer, but get ready for winter changes.
Major 2017 changes to Premera's individual coverage could include eliminating coverage, exiting entire counties and excluding networks are in the works.
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I love numbers. I'm a math geek. I read benefits industry articles and periodicals for relaxation (but, honestly, I'm still a fun gal). I also like to share what I've learned and you'll find it all here.