Covered California: Pediatric Dental Coverage

In 168 days when open enrollment opens for the first time on Covered California (the state's health benefit exchange), California's children will get expanded opportunities for better dental health.  Covered California has contracted with six participating dental insurers to provide stand-alone coverage for children's dental services.  This means that these dental plans (with the exception of Health Net) are priced separately and do not require the additional purchase of a regular health insurance plan. The participating insurers are:

• Anthem Blue Cross of California
• Blue Shield of California
• Delta Dental of California
• Health Net
• LIBERTY Dental Plan of California
• Premier Access Dental and Vision

Depending on where the child lives, children will be eligible to be signed up for PPO, an in-network only PPO, and an HMO dental plan.

1. The Dental Preferred Provider Organization (DPPO) -- a wide variety of provider choice, including coverage for some out-of-network services.
2. The Dental Exclusive Provider Organization (DEPO) -- like DPPO, but without coverage for out-of-network services.
3. The Dental Health Maintenance Organization (DHMO) -- limits coverage to dental providers within one's network, and generally requires a referral for a specialist.

The plans offered will provide two types of payment options.  One option requires a higher premium, but lower out-of-pocket costs. The second option offers lower premium rates, but higher than average out-of-pocket costs. Therefore depending upon how much the family anticipates needing dental services for a child, they can choose the actuarial value plan that best fits their particular situation.

For a complete break-down of plan pricing by region, take a look at this report published by Covered California last month.

Friday Variety: Anthem Rate Hikes, Gene Patenting, & Arizona Medicaid Bill

Anthem Blue Cross To Raise Small Business Premiums
California Insurance Commissioner Dave Jones has intensified his campaign against rising health insurance rates by asking officials working with Covered California to bar Anthem Blue Cross from it's state health exchange. Jones stated that Anthem's intends to increase small business health insurance premiums (businesses with 50 or fewer workers) by 11%.  He called this rate hike "unreasonable" and accused the company of overstating its projected medical costs and improperly adding fees related to federal healthcare law.

Under state law, Jones can assess rate hikes and request to exclude them, but he lacks the authority to block Anthem's rate increase from taking effect this month (Terhune, Los Angeles Times, 6/13).

Anthem spokesman Daryl Lang says that Anthem's rate hikes are consistent with the economic reality of rising healthcare costs, and that its exclusion from the exchange would hinder competition.

Nonetheless, Anthem has actually imposed three rate hikes for small businesses over a seven-month period:

• 10.6% rate hike announced in January;
• 10.5% rate hike announced in March; and
• 7.6% rate hike scheduled to take place July 1 (Robertson, Sacramento Business Journal, 6/13)

(Read more: http://www.californiahealthline.org/articles/2013/6/14/jones-wants-anthem-excluded-from-small-business-exchange.aspx#ixzz2WCmqnuKy)

Meanwhile, Jones has praised UnitedHealth Group Inc. for cutting worker premiums for such small businesses.

Covered California will announce final health plans and rates for small businesses this August.

Supreme Court Rules Human Genes May Not Be Patented

The Supreme Court announced a unanimous ruling Thursday that naturally occurring human genes may not be patented. As a result, the costs of of getting gene tests are likely to drop as other companies can now compete with Utah-based Myriad Genetics, against whom the claims in this case were brought.

Synthetically produced genetic material, however, may still receive patent protection.

Arizona "Sweet Victory:" Medicaid Expansion Bill Passed

Thursday afternoon, the Arizona legislature approved a Medicaid expansion bill after a three-day special session.  This approval comes five months after Arizona Gov. Jan Brewer vowed to pass Medicaid expansion in her state. The bill, part of the state budget, must clear a final vote in each chamber before it goes to Brewer for her signature.