Posted April 14, 2014 – Blue Cross Blue Shield- Health Care Reform Blog

By: James LaCorte

Where does my health insurance premium really go? Health insurance customers often ask a simple question about the premium they pay every month:

Where does my premium dollar go? They’re usually not asking for a quick tutorial on how insurance works: Most people understand that everyone pays into a pool, and only those who need medical care take money out in the form of health care claims. What many of these folks really are asking is how much of that money actually pays for health care and how much goes toward running an insurance company — or toward profits.  Fair question.  Blue Cross and Blue Shield of North Carolina (BCBSNC) paid $5 billion in claims in 2013. Recently we announced that we spent almost 86 cents of every premium dollar paying for our customers’ health care – doctor visits, surgery, tests, medicine, eyeglasses, etc.

Our non-medical spending largely goes toward customer service and technology. We are also a full-taxed company. In 2013, we paid out more than $100 million in local, state and federal taxes.

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Open enrollment for health insurance has ended; however you may still qualify for a special enrollment period due to a qualifying event.  Some examples of these qualifying events include:

1. Marriage, having a baby, adopting a child or placing a child for adoption or foster care, moving outside your insurer’s coverage area, gaining citizenship, leaving incarceration.
2. Gaining status as member of an Indian tribe. Members of federally recognized Indian tribes can sign up for or change plans once per month throughout the year.
3. For people already enrolled in Marketplace coverage: Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions
4.  Losing other health coverage—due to losing job-based coverage, divorce, the end of an individual policy plan year in 2014, COBRA expiration, aging off a parent’s plan, losing eligibility for Medicaid or CHIP, and similar circumstances. Important: Voluntarily ending coverage doesn’t qualify you for a special enrollment period. Neither does losing coverage that doesn’t qualify as minimum essential coverage.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obama care. Call us for details.

Contact us today to discuss BLUE CROSS BLUE SHIELD OF NORTH CAROLINA plans.  You need to purchase your new health insurance policy before the Open Enrollment period ends on March 31, 2014. GET YOUR FREE RATE QUOTE AND APPLY TODAY.

We can guide you through all plans offered by BCBSNC, help you determine if you are eligible for a subsidy, guide you through the Marketplace to finalize your subsidy application.  Once the Marketplace process is finalized we will assist you with your enrollment/payment finalization through Blue Cross Blue Shield of North Carolina.  Don’t wait, time is running out.

During the Open Enrollment period, you can buy qualified private health insurance through the government Marketplace. After the Open Enrollment period, you can only sign up for Medicaid and the Children’s Health Insurance Program (CHIPS) through healthcare.gov. Unless, you qualify under Special Enrollment Period that require a change in your health insurance.  Some of these include getting married, moving, getting a new job that pays more, or losing your health insurance.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obama care. Call us for details.

Blue Advantage features a provider network that covers all 100 counties in the state at an affordable price.

91% of doctors and 99% of hospitals in the state are covered

Coverage in North Carolina, the United States and worldwide

More pharmacy and prescription drug options

Flexibility in how much you pay for doctor visits and prescription drugs

Preventive care covered at 100%

Blue Advantage is ideal for those who want choices: choices in which provider to see and choices for how much to pay for doctor visits and prescription drugs.

Benefit Choices

Blue Advantage offers a variety benefit choices to give you options for how much you pay for medical expenses: copayments, and deductible and coinsurance plans.

Copayment plans are what most people think of as traditional plans. They offer a fixed copayment for things like primary care office visits and prescriptions. While you’ll know what you’re going to pay with copayment plans, they come at a higher premium. These plans are ideal for someone who wants predictable costs and doesn’t mind paying more in premiums. (more…)

 March 31st is the final day for open enrollment!

Ok, you have shopped around the Marketplace and looked over the BLUE CROSS BLUE SHIELD OF NORTH CAROLINA plans. Or maybe you have been waiting for the smoke to clear before logging on to healthcare.gov to shop for your health insurance coverage. But, now the clock is ticking, and important ACA deadlines are looming. You need to purchase your new health insurance policy before the Open Enrollment period ends on March 31, 2014, if you plan to purchase through the exchange, or face a penalty. GET YOUR FREE RATE QUOTE AND APPLY TODAY.

During the Open Enrollment period, you can buy qualified private health insurance through the government Marketplace. After the Open Enrollment period, you can only sign up for Medicaid and the Children’s Health Insurance Program (CHIPS) through healthcare.gov. Unless, you qualify under Special Enrollment Period that require a change in your health insurance.  Some of these include getting married, moving, getting a new job that pays more, or losing your health insurance.

SO without qualifying for a Special Enrollment, the planned ACA deadlines for 2015 enrollment are much shorter than this year’s: November 15, 2014 through January 15, 2015. Buying health insurance after that date will be restricted to special circumstances unless you get coverage through your employer.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obama care. Call us for details.

Call today and go over questions about Open Enrollment vs Special Enrollment so you do not lose the opportunity to acquire coverage.  To enroll in a Blue Cross Blue Shield of North Carolina health plan, outside of the annual enrollment period, you must qualify under the Special Enrollment guidelines set out below.  Special circumstances for enrolling outside of the open enrollment period include:

Loss of minimum coverage (employer coverage, government plans, etc.)

Adding a dependent through birth

Adoption or marriage

Gaining citizenshipEnrollment/non-enrollment errors by the federal Marketplace or the US Department of Health and Human Services

Qualified health plan violates the material provision of its contract with the individual

Newly eligible for a subsidy or a change in the amount of subsidy you are eligible for

Moving to a new state

American Indian/Alaska Native status (may change once a month)Other exceptional circumstances

In 2014, the Affordable Care Act mandates that all taxpayers purchase health insurance or pay a penalty on their tax returns. The penalty will increase every year until 2016.  Get your Free Rate Quote and apply for your coverage today through Blue Cross Blue Shield of North Carolina and avoid these penalties.

Enrolling in a Blue Cross Blue Shield of North Carolina plan is simple and easy. You can enroll online 24/7.

When you get your free, no-obligation rate quote, we will help you estimate any advance premium tax credit (subsidy) or cost-sharing reduction you may be eligible for through the government.  Your quote will outline the estimated subsidy so you can see the reduced rate.

Use the tools and tips on the rate quote results page to compare prices and plan details. Your quote will also provide links to more information about our plans and assistance picking the right plan.  Once you pick a plan, you are ready to enroll.

It all starts with a free rate quote.  Note: You only have a limited time to enroll.The annual enrollment period is from 10/1/2013 to 3/31/2014. You can choose to have your coverage start between 1/1/2014 and 5/1/2014.  Unless special circumstances apply, you will not have the opportunity to enroll again until  the next Open Enrollment starting November 2014 for coverage that starts 1/1/2015. That means you cannot wait for a medical need to enroll.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obama care. Call us for details.

Enrolling in a Blue Cross Blue Shield of North Carolina plan is simple and easy. You can enroll online 24/7.

When you get your free, no-obligation rate quote, we will help you estimate any advance premium tax credit (subsidy) or cost-sharing reduction you may be eligible for through the government.  Your quote will outline the estimated subsidy so you can see the reduced rate.

Next Step: Register through your free rate quote, click the link in your quote to start your healthcare.gov application process.  We will help you select a plan and guide you through the entire process.  Once your subsidy application is completed, we will guide you through the payment process and provide you the payment coupon so you can mail your payment to Blue Cross Blue Shield of North Carolina to guarantee your coverage starts on the effective date you requested.

NOT APPLYING FOR A SUBSIDY.  Apply today and start coverage immediately.  YOU DO NOT HAVE TO GO TO THE MARKETPLACE and we can walk you through these very simple and easy steps.

You only have a limited time to enroll. The annual enrollment period ends 3/31/2014.   As of today, you will have the option for an April 1st or May 1st effective date.  Unless special circumstances apply, you will not have the opportunity to enroll again until  the next Open Enrollment starting Nov 2014 for coverage that starts 1/1/2015. That means you cannot wait for a medical need to enroll.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obama care. Call us for details.

For In-Network Providers: North Carolina providers or specialists in the BCBSNC network will request prior review for you. You may want to check with your health care provider to make sure that prior review was obtained before you have the service or procedure in question.

For Out-of-Network Providers:  You are responsible for ensuring that out-of-network doctors have requested prior review and certification from BCBSNC before the service is performed. The physician or her office should request the review from BCBSNC. This also applies to BlueCard providers (out of state providers who contract with another Blue Cross Blue Shield plan) outside of North Carolina. Your Benefit Booklet has more information about prior review and certification that is specific to your policy. (more…)

CHAPEL HILL, N.C. Brad Wilson, president and CEO of Blue Cross and Blue Shield of North Carolina (BCBSNC), has issued the following statement about family coverage for married same-sex couples and domestic partners. “In order to ensure that our technology was ready for the Affordable Care Act, our company chose to postpone a number of product updates until 2015. One of these was to begin making family coverage available to same-sex married couples and domestic partners (same-sex or opposite-sex) in our ACA-approved plans.We should have more thoughtfully considered this decision, with full appreciation of the impact it would have on same-sex married couples and domestic partners. We’re sorry we failed to do so. Our employees have worked with the Centers for Medicare and Medicaid Services and the Department of Insurance over the past week to update our plans in order to make family coverage available sooner. Starting Monday, same-sex married couples and anyone in a domestic partnership may purchase new family coverage on or off the Exchange for an effective date of March 1.  Domestic partners and same-sex married couples who enrolled separately on ACA plans can convert them into family plans retroactive to their original effective date.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obama care. Call us for details.

Catastrophic Plans provide minimum coverage at a lower price.  They are High deductible plans; they provide Essential Health Benefits covered after deductible is met; Preventive care is covered at 100%;  Primary care in-network office visits covered with a $35 copayment for the first 3 visits and you can save as much as 22% over the least expensive bronze plan.   Click Here to generate your rate quote to compare these plans.

These plans have high deductibles that you must meet before BCBSNC pays for Essential Health Benefits. They may be a good option if you do not expect to have many medical expenses.

To qualify for these plans, you must meet one of the following criteria to be eligible for a catastrophic plan.  You must be under 30 years of age when the plan year begins or qualify for a hardship exemption through the federal government.

If you choose a catastrophic plan, you cannot use an advance premium tax credit (federal subsidy). If you do not qualify for or decide to forego a subsidy, you may save money with these plans.

The Essential Health Benefits that are covered include Ambulatory service;Emergency service;Hospitalization; Maternity and newborn care; Mental health and substance abuse services (including behavioral health);Prescription drugs;Rehabilitative and habilitative services and devices; Laboratory services;Preventive/wellness services and chronic disease management;Pediatric services, including dental and vision.

Catastrophic plans are not required to meet the metallic levels that other plans must meet. However, because BCBSNC is committed to quality coverage, the catastrophic plans do meet bronze level requirements.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obama care. Call us for details.