11/12/2009
New state laws impact benefits starting Jan. 1
Health carriers in Washington must often make changes to their policies and contracts in order to comply with legislation or rulings made by the state's Office of the Insurance Commissioner. As a result of recent mandates we are making several contract changes for 2010.
- Organ Transplant Lifetime Maximum—SB 5725 requires health plans to limit transplants to a separate lifetime maximum of not less than $350,000. The lifetime maximum on our plans will increase to $350,000. Covered services received within 90 days of the transplant will apply toward the lifetime maximum.
- Organ Transplant Waiting Periods—HB 1308 requires health plans to reduce organ transplant waiting periods by the amount of time a person had prior creditable coverage.
Effective Jan. 1, 2010, for some members there will be a minor rate change due to these new laws. A health plan is a community of people who help each other, whether it consists of a group of coworkers or individuals who never meet. This community helps pay medical care when a Regence member needs it. Although the per-member increase is minimal, it contributes collectively to cover the medical care of the community. We hope you understand why this small adjustment is necessary.
The rate adjustment depends upon the Individual health plan that each of your clients has. On average, the difference will range between $0 and $3 per family member per month. Members with coverage will receive a letter notifying them of the changes and outlining the additional language changes, along with a Summary of Change document that highlights the state mandates. Amendments to the contract will also be included.
Catastrophic plans will also experience changes next year to the minimum deductible and out-of-pocket expense policy. We will apply these new minimum deductible and out-of-pocket expenses for the calendar year deductible period of Jan. 1, 2010, through Dec. 31, 2010. The new minimum deductible for the Individual catastrophic plan is $1,820 (an increase from $1,750). Additionally, the family deductible changed from $5,250 to $5,460. There are no changes to out-of-pocket maximum expenses.
Catastrophic members will receive a letter notifying them of the changes and outlining the additional language changes, along with a Summary of Change document that highlights the state mandates. Amendments to the contract will also be included.
Rate changes will be effective Jan. 1, 2010. Next year's rate sheets are now available.
DentalOne members will be notified by mail of rate changes effective Jan. 1, 2010.
At this point in time, the outcome for Referendum Measure #71, Domestic Partnership, has not been confirmed by the Washington Secretary of State. However, we are proceeding ahead and have endorsed our contracts with Domestic Partnership coverage.
If you have questions or need more information, please talk to your Regence Sales contact or call Individual Marketing at 1 (888) REGENCE.
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