|The Michigan Blues anticipate that reform will bring about a more-level playing field where other insurers will no longer be able to cherry pick the young and healthy.
Michigan’s leading health insurer, Blue Cross Blue Shield of Michigan, created bcbsm.com/healthreform as a timely source of information to help Michigan residents understand how reform will affect them. The information there is relevant to all Michigan residents, not just Blues members.
Some reforms are already in place.
Some national health reforms took effect with plan years starting on or after Sept.23 of this year. Most people will be impacted by these changes on Jan. 1, 2011.The near-term changes include several provisions that protect people under age 19 from being penalized with higher premiums for ill health — or even excluded from coverage because of pre-existing medical conditions.
The changes, detailed on bcbsm.com/healthreform, include:
• An extension of eligibility for dependent coverage to age 26.
• Removal of exclusions for pre-existing conditions for people under age 19.
• Removal of waiting periods for people under age 19.
• Preventive services and immunizations with no cost-sharing.
• No lifetime coverage limits or restrictive annual limits.
• In health plans with benefits for hospital emergency services, equal coverage for in-network and out-of-network services and no requirement of prior authorization even if services are provided out of network.
• At least 30 calendar days’ notice to an individual before a health plan can rescind coverage; opportunity to contest the rescission; and no retroactive rescission of benefits except in cases of fraud or intentional misrepresentation.
There are additional reforms scheduled to occur in January 2014. These include:
• No pre-existing condition exclusions will apply to anyone.
• Rating will be based only on age, family size, geography and tobacco use.
• Charging for age is restricted so that the oldest policy holder is charged no more than three times the youngest policy holder.
• There will be no annual limits on essential benefits.
• A minimum level of benefits will be required.
Blue Cross Blue Shield plays a unique role as the state’s insurer of last resort and is Michigan’s only nonprofit health care corporation regulated by state law. That law requires Blue Cross to operate in a way that ensures access to quality health care services for all Michigan residents. National health reform will eventually require all insurers to operate more like Blue Cross in that all carriers will be required to accept everyone, regardless of health status, starting in 2014.
“Passage of legislation does not mark the end of the process to reform health care. It is just the beginning,” said Blues President and CEO Daniel J. Loepp after the reform legislation passed in March. As Americans are required to obtain coverage, there will be tremendous growth in the individual insurance market. There will be approximately 30 million to 35 million people entering the insurance market, added Loepp.
“Expansion of coverage also comes with challenges that will require innovative approaches and an unending pursuit of continuous improvement to stave off increased costs. The Michigan Blues have been pursuing these efforts for many years, and our continued efforts in a post-reform world will no doubt prove valuable.”
The Michigan Blues anticipate that reform will bring about a more-level playing field where other insurers will no longer be able to cherry pick the young and healthy. Meanwhile, Blue Cross is developing new products that put more focus and value on personal accountability by offering incentives for members to better manage and improve their health. For more information about Blue Cross Blue Shield of Michigan and its various health insurance products, visit bcbsm.com. More information on reform can be found on the Reform Alert page bcbsm.com/healthreform.
What if you are
need health care
Free clinics provide a safety net for the uninsured. Michigan’s free clinics are a lifeline of care to people across the state who are currently uninsured or underinsured. An uninsured population of more than 1 million, coupled with Michigan’s high unemployment rate, has broadened the number of those affected by the health care crisis.
In its unique role as safety-net provider, Blue Cross Blue Shield of Michigan has provided $5 million in grants since 2005 to help sustain these clinics and enhance the services they provide. Most of the clinics provide primary care, behavioral health care, case management, dental services, specialty and diagnostic care, and prescription drugs. Free clinics in the metro Detroit area funded in 2009 by Blue Cross Blue Shield of Michigan include:
Wyandotte Clinic for the
23050 West Rd., Ste. 260
1605 W. Davison Ave.
Joy-Southfield Health and
18917 Joy Rd.
Order of Malta
4860 15th St.
St. Frances Cabrini Clinic
1234 Porter St.
U of D Mercy
4001 W. McNichols