Portability of individual BC/BS plans

newmindfashion · 08-27-2007, 10:15 AM

This topic was on an older thread but couldn't find it. A couple of you had mentioned something about portability of BCBS individual plans.

Does the Blue Cross Blue Shield Association have a guaranteed issue program set up that automatically accepts customers moving from one BCBS state to another that may not be insurable on an individual basis in the new state?

I have a customer that had a minor malignant cancer diagnosis that is moving from one BCBS state with an HMO to another. This customer would not be able to get approved into the Blue Cross in their new state of residence. The new Blue Cross state is telling me no guaranteed issue program exists.

Is there anything else to this story regarding member states of the BCBS Association?

healthagent · 08-27-2007, 10:26 AM

In MD for indie Blue Cross HMO plans if you move out of the service area you need to submit a new app subject to underwriting.

somarco · 08-27-2007, 11:08 AM

Each BX plan is operated independent of the other regardless of parentage. When an individually insured policyholder leaves the service area they have 60 or 90 days to apply for new coverage. Doesn't matter if they are crossing state lines or not.

They cannot port coverage once they move outside of the service area by the issuing BX plan.

healthagent · 08-27-2007, 11:36 AM

Which is a huge flaw for Blue Cross. With GR, Assurant, World and others you're free to move in any state where they offer coverage and you simply pay the adjusted rate. No underwriting.

newmindfashion · 08-27-2007, 12:01 PM

My understanding is the same as you guys. However, one of our west coast brethern posted something about a guaranteed issue plan as part of being a BCBS Association member state.

FL for example, will accept other BCBS members on a non-underwritten basis if they move there as long as they apply for a plan that is not superior to their present coverage. Someone in BCBS of FL told me that.

al3 · 08-27-2007, 12:06 PM

Originally Posted by healthagent

Which is a huge flaw for Blue Cross. With GR, Assurant, World and others you're free to move in any state where they offer coverage and you simply pay the adjusted rate. No underwriting.

From my Aetna rep this morning....

....as long as the person moves to a state with an Aetna Individual Plan they can select the most comparable plan and pricing in that state with no health underwriting.

If they want to move to a richer plan, it would require health
Underwriting. I have attached a map of where we are and the states that are opening.

Deborah Springer
Account Executive
Aetna Northern CA Individual Markets

HTH

Al

healthagent · 08-27-2007, 12:42 PM

Interesting and that would have to be true since Aetna's benefits are different based on the state. Assurant and GR don't pull that kind of junk - Max Plan is the same benefits (barring additional mandated bene's) in every state and Copay Select is the same in every state.

For example, if you take an Aetna plan and move to MD there's now an immediate maternity benefit.

One more strike against Aetna.

Dave020 · 08-27-2007, 12:52 PM

I think with Blue it varies by state depending on what they offer in that state. Both CA Blues will take other state Blue new residents on a conversion plan (special) GI, all other plans require underwriting with one caveat...Blue Cross CA under Anthem has a deal with Nevada and Colorado to offer same or closest match coverage GI with those states. It may expand depending on what Indianapolis wants to do.

FL sounds about right, same or lesser coverage ok for GI, upgrade we want to look at you first.

Since there may be states where Blue does not offer conversion coverage, it may that those association members cannot provide a same or lesser benefit plan GI so they refrain from offering any GI coverage since all would be considered an upgrade.

The main problem is that BCBS Association simply refers you to the member in the state you desire and you have to contact them.

somarco · 08-27-2007, 01:03 PM

Nothing interesting about Aetna. If you want to change to a richer plan with any carrier you must go through underwriting.

Had a lady earlier this year move to FL. She was able to find a plan that was similar to her GA plan and no underwriting. Rates were higher, but no underwriting.

Sounds like a plus to me rather than a strike against Aetna.

BX and several other carriers offer conversion plans, assigned risk plans or risk pool if you are entering the state with creditable coverage and no carrier options. That is not the same thing as portability.

We have Anthem/Wellpoint in GA and there are no reciprocal agreements for portability.

Dave020 · 08-27-2007, 01:16 PM

Originally Posted by somarco

We have Anthem/Wellpoint in GA and there are no reciprocal agreements for portability.

I am hoping that Anthem/Wellpoint will continue to open up more states and eventually get them all in reciprocation. Currently only CA, NV and CO have the reciprocation agreement. How many states does Anthem/Wellpoint have currently?

newmindfashion · 08-27-2007, 01:25 PM

I know they have Connecticut, New Hampshire, Maine, Georgia, Southern Virginia, Kentucky, Ohio, Indiana, Missouri, Wisconsin along with the three that are in your reciprocation. That's 13 and I think I'm forgetting 1 other WellPoint state.

Dave020 · 08-27-2007, 01:27 PM

They also have Empire in New York

newmindfashion · 08-27-2007, 01:33 PM

That's the one I was missing.

TXINSURANCE · 08-27-2007, 02:22 PM

This is a state to state and BLUE issue...

I had a client get BURNED by this BADLY..

Client has BCBS of some other state... On COBRA...

Moves to Texas...

BCBS of other state mails her CONVERSION offer or something? No u/w for $1800/mo

Client declines offer and applies for RISK POOL

RISK POOL declines application because client WAS eligible for another offering and declined it (regardless of price).

There are a lot of little situations like that from time to time... Most are timing issues. I vaguely remember the story - my details might be off a tad.

Dave020 · 08-27-2007, 02:45 PM

Originally Posted by TXINSURANCE

This is a state to state and BLUE issue...

I had a client get BURNED by this BADLY..

Client has BCBS of some other state... On COBRA...

Moves to Texas...

BCBS of other state mails her CONVERSION offer or something? No u/w for $1800/mo

Client declines offer and applies for RISK POOL

RISK POOL declines application because client WAS eligible for another offering and declined it (regardless of price).

There are a lot of little situations like that from time to time... Most are timing issues. I vaguely remember the story - my details might be off a tad.

TX has a good point here - Blue to Blue. I think that was John's original question. I have been told that All Blue Association members MUST provide a GI coverage option to any Blue members moving to that state. Usually in the form of a conversion plan. I have dug through the Association site and can't find anything in writing that deals with that. According to CA Blues, all Blue must allow Blue to Blue in some form.

On the second point, that situation is a no-win for the client. CA is different, risk pool has a caveat that you must be declined or highly rated with offer of premium in excess of the MRMIP premium to qualify. In her case, since the conversion was $1800 a month and no way she could pay that much for MRMIP, they would have accepted her into the CA risk pool.

TXINSURANCE · 08-27-2007, 02:57 PM

It is my understanding as well that ALL BLUES must offer state to state GI however they do not say at what price.

My client was told "due to your medical conditions of blah blah blah your rate would be... $1800/mo" It was even in a letter she read me mailed to her.

She made the mistake of being honest and telling our risk pool she was offered coverage, they then declined her pool membership.

I agree with CA (on this issue ONLY...lol...)

If your offering is MORE than the pool the pool should be an option.

somarco · 08-27-2007, 04:21 PM

There are two policies available to uninsurables here in GA.

Rape, and Pillage.

Both are indemnity plans (no network). Rates are at least 3x the price for a traditoinal underwritten indemnity plan.

One is a conversion from a Blue group plan. The other is what you get when you go through the DOI and they assign you to Blue.

You can't even say it is great coverage for the price. Just slightly better than having nothing at all.

newmindfashion · 08-27-2007, 05:34 PM

Dave020,
You said "I have been told that All Blue Association members MUST provide a GI coverage option to any Blue members moving to that state. Usually in the form of a conversion plan."

I guess that is the central issue. Where does one find the details if this is true? The Blues in question are saying that there is no such GI conversion. If they are wrong, I'd like to find that out.

The problem is that if the BCBS Association refers back the carriers, I'll get the same info as I'm getting now.

somarco · 08-27-2007, 06:28 PM

I would be curious in seeing this as well. Here is the site for the association. I don't see anything there that speaks to the portability issues.

The problem is the way the original Blues were set up. Each was independent & structured as a non-profit organization. Eventually there were about 70 different plans. Some states (NY, VA, GA) had multiple, competing plans.

The association was formed so each Blue could participate in administering national accounts.

They have several divisions locally, each operating independent of the other. The local BX has individual, Medicare, (soon to have) Medicare HMO, HMO, small group, large group, association plans. They also own Greater Georgia Life to administer their group term life, dental & disability plans.

I have never known of a situation where someone moving from another state is offered a guaranteed conversion that did not go through the DOI. They move here from other states. Call Blue. BX sends out an application that is underwritten. When they are declined sometimes it is too late to apply thru the DOI so they are left out to dry.

I personally think that is the way BX wants it.

bluemarlin08 · 08-27-2007, 06:42 PM

Because of these very issues, I ask in my questionaire if they are planning to leave the state and reside in another state, if so I don't recommend BC/BS. Recently went through this issue with a doctor who has been a client that is reaching 65, wife 54, and they will be moving in a couple of years to their ranch in Washington.