Blue Cross and Blue Shield of Illinois (BCBSIL) announced a first year renewal rate cap of 9%* for groups with 51-100 employees.

New groups with 51-100 insured employees sold with Jan. 1, 2012 – July 1, 2012 effective dates can take advantage of this offer if they meet the eligibility requirements below, which include completing individual medical applications.

Group Eligibility Criteria

• Groups must have 51-100 enrolled employees selecting products within the BluePrint product portfolio.
• The group will need to include our BlueChoice Select® and/or BlueAdvantage HMO network in the benefit offering to their employees. There will not be minimum enrollment requirements in these networks.
• The Illinois Small Group Standard Health Application including Section F (Health Statement) and Section G (Additional Information) must be completed by each participant applying for coverage.

*Please note that demographic adjustments between +/-3.0 percent will be included in the cap. However, if the demographic adjustment is outside this range, the non-demographic adjustments will be capped at 9.0 percent and the full demographic adjustment will not be included in the cap.

Tags: bcbsil small group rate cape, BlueCross BlueShield Illinois 2012 group health rate cap

(Crain’s) — After surging earlier in the year, profits of the parent of Blue Cross & Blue Shield of Illinois dropped sharply during the second quarter, to a still hefty $270 million, as benefits rose and membership shrank.

Chicago-based Health Care Service Corp’s net income fell nearly 23% during the second quarter compared with almost $350 million in the year-earlier period. The fourth-largest insurer in the U.S. has a tight grip on the health insurance market in Illinois, making its performance a matter of keen interest to employers, employees and people who buy individual insurance policies.

“They’re far and away No. 1,” said Joel Peyton, an analyst who studies the Illinois insurance market at Nashville, Tenn.-based research firm HealthLeaders-InterStudy. “I don’t see that changing anytime soon.”

Health insurance profits are expected to come under increased scrutiny because of a new law—part of the federal overhaul of health care—that requires the companies to pay a fixed percentage of revenues on medical care and activities that broadly improve health care, such as patient education.

Quarterly fluctuations in net income are not unusual for health insurance companies. Health Care Service’s second-quarter showing was offset by the insurer’s strong first quarter, when profits soared to nearly $437 million.

As a result, Health Care Service’s net income rose 13.2%, to $706.3 million, during the first half of 2011, compared with $623.9 million during the first half of 2010, according to a second-quarter statement the company filed with the National Assn. of Insurance Commissioners, which is a clearinghouse for insurance financial information.

For Health Care Service, rising benefit expenses are inherent in having a large claims base, and the company’s membership continually changes, a spokesman said.

He added that the drop in net income was partly caused by a lower rate of return on short-term investments, which he declined to provide.

The financial reports only cover Health Care Service’s insurance operation. Not included is its low-margin, fee-based work administering health plans for self-insured clients.

“It’s very difficult to look at our filing and get a full picture of the business,” the spokesman said.

Health Care Service is a mutual company, owned by its policy holders.

Insurance companies report their financial results on a cumulative, quarterly basis. Crain’s calculated Health Care Service’s second-quarter results by subtracting its first-quarter results from those for the first six months.

Profits plummeted in the second quarter even though revenue rose 4.5%, to $4.93 billion, compared with $4.72 billion for the year-earlier period. Benefit expenses, money spent on health care, climbed 3.6%, to a little more than $4 billion, in the second quarter, compared with $3.9 billion in second-quarter 2010.

Membership slipped 1.5%, to about 7.62 million, in the second quarter, compared with 7.73 million members in second-quarter 2010, when the company’s enrollment was boosted by Unicare Inc.’s exit from Illinois and Texas, states where Health Care Service is strong.

“Given the current economic and competitive environment, (Health Care Service) and the health insurance sector as a whole will continue to be challenged with organic membership growth over the next year,” according to a report by Moody’s Investors Service issued on July 12, before the company released its second-quarter results.

Health Care Service’s net profit margin tightened to 5.5% during the second quarter, compared with 7.4% for the year-earlier period.

The company wrote 54.1% of all small group plans and 71.9% of all large group plans issued in Illinois in 2010, according to a report earlier this year by the National Assn. of Insurance Commissioners, which is based in Washington, D.C.

During the second quarter, Health Care Service paid off $400 million in debt.

That loan was essentially replaced with $500 million in unsecured notes that the company issued earlier this year. Those notes, at an interest rate of 4.7% a year, come due on Jan. 15, 2021, according to Health Care Service’s second-quarter filing.

Tags: BCBS 2011 profits, BCBS profits, BCBSIL profit drop, Health Care Service Corp proftis 2011

Blue Cross and Blue Shield of Illinois (BCBSIL) announced the launch of 2 new child-only health insurance policies: Blue Pathway^SM and BlueChoice Pathway^SM. These new products provide coverage for children ages 1 through 18, who do not have other major coverage available to them for purchase.

The plans are designed to give children access to affordable health insurance in Illinois and is the only child-only policy available in the state. This product also complies with the requirements of the Affordable Care Act.

Blue Pathway and BlueChoice Pathway are “guaranteed issue” products. Children who are eligible for these plans will be approved for coverage, regardless of their health status. Applicants must still meet any non-health related eligibility criteria and must not have other major medical coverage available to them for purchase.

2011 Initial Open Enrollment Period

Beginning on July 15th through August 15th, 2011, individuals interested in the BluePathway plans can enroll on the BCBSIL website at www.bcbsil.com/coverage/individual/bluepathway.html.

Biannual Open Enrollment Periods

Beginning in 2012, enrollment in Blue Pathway will be open every January 1 to January 31, and July 1 to July 31.

Tags: bcbsil child health insurance, bcbsil child only plans, blue cross and blue shield of illinois bluepathways child health insurance, bluechoice pathway health plan, bluecross blueshield of illinois child only plans, bluepathways health plan, illinois blue pathway child health insurance, Illinois child only health plans

As previously announced in the Feb. 9, 2011 issue of News from the Blues, Public Act 96-1513, the Illinois Religious Freedom Protection and Civil Union Act, was signed into law on Jan. 31, 2011. Effective June 1, 2011, the law’s intent is to provide procedures for the certification and registration of a civil union in Illinois. Any person who enters into a civil union in Illinois consents to the jurisdiction of the courts of Illinois for the purpose of any action related to a civil union.

Also defined are prohibited civil unions and the process for dissolution as dictated by the Illinois Marriage and Dissolution of Marriage Act. Illinois residency is not an explicit requirement for an Illinois civil union. Illinois will offer “reciprocity” and recognize as a civil union any same-sex marriage, civil union, domestic partnership or substantially similar legal relationship, other than common law, entered into in other states. Additionally, the law does not link domestic partnership to civil union.

Since this is not an insurance law, Blue Cross and Blue Shield of Illinois (BCBSIL) has made the following business decisions:

• Spouses of civil unions will be eligible for coverage if the policy covers spouses in marriage for BCBSIL fully insured individual and group business, including HMOs, as well as self-funded state municipalities, school districts and counties, just as most insurance laws would typically apply to these entities.
• The law will extend to BCBSIL contracts issued and delivered in Illinois, regardless of where the member resides.
• Although the law provides religious organizations the freedom to choose not to officiate or solemnize a civil union based on their religious practices, as an employer, religious organizations are required to extend benefits as mandated by law. Therefore, if the religious organization is fully insured or offers fully insured products (such as HMO), the law will also apply to them.
• * All other self-funded ASO business will have the option to choose to provide coverage to a civil union spouse and dependents. The ASO Benefit Program Application (BPA) will be updated to accommodate this selection.

For insured business, coverage will be offered to a civil union spouse and dependents upon the qualifying life event of the BCBSIL member entering into a civil union on or after June 1, 2011. If the member does not elect to change their coverage within 31 days of entering into a civil union, the next opportunity will be upon the employer group’s open enrollment period. For group coverage, it is the employer group’s responsibility to determine eligibility, just as it is currently.

ASO municipalities, counties and school districts and ASO customers that choose to do so, should offer coverage to a civil union spouse and dependents upon their renewal as of June 1, 2011 and thereafter.

Existing BCBSIL members who have previously entered into a civil union as legalized by another state are able to add their civil union spouse and dependents upon the employer group’s next open enrollment.

Certificate language is under review in order to determine any applicable or necessary changes. With the exception of the ASO BPA, there will not be any changes to any other business forms or collateral materials (such as highlight sheets, product reference guides, enrollment guides, etc.). There are no changes to any of our health, dental or life products and/or benefit plans. Generally, civil unions will be treated the same as traditional marriages.

The Illinois Department of Insurance (IDOI) is expected to issue an insurance FAQ on the law in early spring 2011 and BCBSIL will make any appropriate adjustments based on the IDOI’s direction.

Tags: BCBS Illinois Civil Union Eligibility Guideslines, bcbsil civil union act, How the Illlinois Religious Protection and Civil Union Act affect health insurance, Illinois Civil Union Health Insurance Eligibility

As of June 1, 2010 Blue Cross and Blue Shield of Illinois (BCBSIL) is offering new Medicare Supplement Insurance Plans G and N. Members and those considering Plans G and N can enroll at anytime; there are no specific enrollment periods or deadlines. The changes to the configuration of Medicare Supplement plans are the result of the “Medicare Improvements for Patients and Providers Act of 2008” (MIPPA), which took effect on June 1.

All plans sold after June 1 have an enhanced hospice benefit, which includes coverage for some outpatient prescription medications and copayments and coinsurance for inpatient respite care, which were previously the responsibility of the insured.

These 2 plans are essentially replacing Plans D and E. Plan D is comparable to plan G but not quite as popular a plan. Plan E is a casualty of the Medicare Modernization Act of 2003 and can no longer be sold by any company. Folks who currently have Plan D or E from BCBS of IL are “grandfathered” in and can keep these plans because they are guaranteed renewable for life.
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Tags: BCBSIL Plan G, BCBSIL Plan N, Blue Cross and Blue Shield of Illinois New Medicare Supplement Plans, Blue Cross Blue Shield Illinois 2010 Medicare Plans 2010

BlueCare Dental provides members with access to the nation’s largest dental care network of access points, with more than 152,000 nationwide.* With so many access points, BlueCare Dental members have great flexibility to see a dentist and use their BlueCare Dental benefits when and where it is convenient for them.

BlueCare Dental providers are credentialed, and the network has the largest number of dental access points in many states, including Illinois. Across the state, members will find 5,711 access points.** In fact, contracting dentists are located in all 50 states. Also, the average provider discount in Illinois is 32.6 percent (based on the average in-force fees).

With Blue Access® for Members (BAM) at www.bcbsil.com, it’s easy for members to select a dentist because they can search for a provider online any time. BAM’s Provider Finder® tool is updated weekly with new network information.

Tags: BCBSIL Dental Network, Blue Cross Blue Shield Dental Network

The open enrollment period to add dependents to an existing Blue Cross® and Blue Shield® of Illinois (BCBSIL) individual policy is coming to an end on March 31, 2010. During this period there are no medical questions and the policy is guaranteed issue. The 12 month pre-existing condition waiting period is still applicable.

In order to qualify for the open enrollment period, the existing policy must have been in force prior to June 1, 2009. The open enrollment applies to all dependents under age 26 (and eligible military veterans under age 30), including children and/or spouses.

Tags: BCBS Individual Policy Open Enrollment for Dependents Deadline, BCBSIL Open Enrollment, Blue Cross and Blue Shield of Illinois Add Dependent to Age 26 Deadline, Blue Cross Blue Shield of Illinois dependent additon

The acquisition of Lake Forest Hospital by Northwestern Memorial Health System was formally announced on Jan. 29, 2010. For the time being, the Northwestern Memorial Healthcare System parent company will have two separate subsidiaries: Northwestern Memorial Hospital and Northwestern Lake Forest Hospital.

At this time, each hospital will maintain separate agreements with Blue Cross and Blue Shield of Illinois (BCBSIL) and there is no plan to renegotiate agreements with BCBSIL. Lake Forest Hospital will remain in the provider network for the remainder of its contract with BCBSIL.

Tags: Lake Forest Hospital BCBSIL PPO Network, Northwestern Acquires Lake Forest Hospital

Blue Cross and Blue Shield of Illinois (BCBSIL) is offering the Fitness Program as the newest value-added health and wellness option. The Fitness Program is an exclusive membership program that offers unlimited access to a nationwide network of fitness centers for a low monthly membership fee.

• Group Markets: As a new feature of Blue Care Connection®, the Fitness Program is now available to all group plan members (age 18 and older) who have Blue Care Connection. There is no additional cost to the employer or to the member’s premium for taking advantage of the Fitness Program.
• Individual Markets: The Fitness Program is available to all members (age 18 and older) with Individual Markets health care benefit plans, both Under 65 and Over 65.2 There is no additional premium cost to the member for the Fitness Program. (Under 65 Individual Members in the BCBSIL High Risk Pool may also participate in the program. Over 65 members with Part D coverage only are not eligible for this program.) Promotional postcards were mailed to individual members ages 18-55 and Over 55 at the end of 2009.

The Fitness Program offers:

• A one-time $29 enrollment fee and $29 monthly dues
• No long-term contracts with a flexible month-to-month membership
• Access to a nationwide network of popular fitness clubs, such as Bally’s Total Fitness, 24-Hour Fitness and participating YMCAs
• The option to work out close to home or work, near friends and family, or while traveling
• Easy online registration process through Blue Access® for Members
• Automatic direct billing through a major credit card or bank account
• Online fitness center location search, account management and customer service features
• Group Markets members and Individual Markets Under 65 members earn Blue PointsSM for joining the program and working out. [Note: Blue Points do not apply to Illinois Comprehensive Health Insurance Plan (ICHIP) members and Over 65 Medicare Supplement (Individual) members.]
• Tracking to earn Blue Points without self reporting. Fitness center visits are tracked via the membership card.

Enrolling is quick and easy. Members will be able to log in to their Blue Access® for Members account, click the My Health tab to find the Fitness Program button and use that link to search for participating locations and to complete their enrollment. Or, members can enroll by calling Customer Service at 888-762-BLUE (2583). The Fitness Program is available to members in addition to other fitness discounts available through the BlueExtras program.

Tags: BCBSIL Fitness Program, BCBSIL Wellness Discounts, BCBSIL Wellness Program, Blue Cross and Blue Shield of Illinois Gym Discounts, Blue Cross Blue Shield of Illinois

From the Chicago Tribune

Moody’s Investors Service has downgraded the debt and financial-strength ratings of the parent of Chicago-based Blue Cross and Blue Shield of Illinois.

Moody’s Investors Service this week said Health Care Service Corp., the nation’s fourth-largest health insurance company, has been hampered by higher than expected medical costs driven by increased unemployment and layoffs that reduced membership in its plans. Those issues have hampered earnings growth, Moody’s said.

“The pressures on medical trend and membership growth are expected to continue during 2010, which will make it difficult for (Health Care Service Corp.) to regain earnings traction,” said Moody’s Senior Vice President Steve Zaharuk. “We expect (Health Care Service) to produce after-tax margins in the 2 percent to 3 percent range over 2010, and to continue to manage earnings at that level going forward.”

The Moody’s report offers a glimpse into the finances of Health Care Service, which is a private mutual insurance company owned by policyholders and does not release quarterly financial reports to the public. In contrast, its publicly-traded and investor-owned rivals in the health insurance industry file and issue regular quarterly reports.

Health Care Service has 12.5 million health plan members. It operates Blue Cross and Blue Shield health plans in Illinois, Texas, Oklahoma and New Mexico.

Health Care Service ratings on its $400 million in debt dropped one notch to A2 from A1, the fifth-highest on Moody’s scale of 21 ratings. Meanwhile, the insurer’s financial strength rating dropped to A1 from Aa3, the fourth-highest on Moody’s scale.

Moody’s said an upgrade of the insurer’s rating is “unlikely” in the near term given the uncertainties of the economy and the coming impact of health care reform.

“(Health Care Service) remains one of the strongest health insurers financially and maintains the highest debt rating in the industry,” the company said in a statement. “Like other health insurers, we have been affected by the economic climate and increased utilization. Because of careful and prudent management, HCSC maintains a strong balance sheet and continues to meet all of its policyholder obligations.”

The ratings are still high and keep Health Care Service’s debt at investment grade. Net earnings for the first nine months of 2009 were $423 million on total revenues of $14.8 billion, Moody’s said.

Tags: Blue Cross and Blue Shield of Illinois Financial Rating, Blue Cross Blue Shield of Illinois 2010 Financial Performance, Moody's BCBSIL, Moody's Blue Cross Blue Shield of Illinois