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Massachusetts health care — wonky, with a healthy dose of reality

Weekly Small Group/Individual Insurance Availability Update

Weekly Small Group/Individual Insurance Availability Update

April 25, 2010

Here is the weekly update on insurance availability for individuals and small business:

  • The Health Connector is now selling insurance for Blue Cross/Blue Shield, CeltiCare, Health New England, and Neighborhood Health Plan. Tufts, Fallon Community Health Plan, and Harvard Pilgrim Health Plan rates should be posted within a few days.
  • Insurance is available directly through the following carriers: Aetna, Blue Cross/Blue Shield, Celticare, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England, Neighborhood Health Plan, Tufts, and United HealthCare – for the first time in weeks, you can buy coverage from all of these carriers.
  • The Division of Insurance had previously informed two carriers, Fallon and Harvard Pilgrim, that they are subject to fines, which could be significant for failing to certify rates appropriately. The carriers took the DOI to court on this issue and the Court held for the state. This means that Harvard Pilgrim and Fallon need to lower their charged rates for this month from the March 2010 amount to the April 2009 level.
  • The DOI’s administrative hearing process on their initial disapproval of April rates began this week. Attorney Richlin was back representing most (but not Harvard Pilgrim) of the carriers. The sessions were all about the procedure they would follow, which witnesses they would call, what the topic of the hearing was and other process matters. The hearings did bring a new player into the room- the Attorney General. The AG has the authority to intervene in these hearings and she is exercising that authority by asking for additional information and requesting that additional witnesses be called. We expect a new hearing schedule to be posted early next week as the parties work out next steps.
  • As noted in Bill Randell's blog post on CommonHealth, a number of carriers are suddenly requiring a 30-day advance purchase before insurance coverage starts. We understand Tufts started this practice, and is now joined by others, including Harvard Pilgrim, Fallon, and Blue Cross Blue Shield. We understand this does not apply currently to plans sold through the Connector.

Please use the comments if readers have corrections or updates to this information.

Now that it appears that the carriers are all offering coverage with appropriate rates from the same time period, the carriers and DOI will have to work out how to credit those individuals and small businesses who have overpaid due to the changing rates. We expect this process to begin in the coming weeks. It should be noted that while rates are now being quoted again for May and June, the rates are being contested so they could change one more time as a result of a decision by DOI or the state court in the summer. HCFA is pleased that all carriers are now selling insurance and that we can truly say that they are open for business.
-Georgia Maheras