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Anthem settlement: open enrollment regardless of pre-existing
Old 12-24-2010, 01:43 AM   #1
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Anthem settlement: open enrollment regardless of pre-existing

I just got a notice in the mail that I am part of a settlement class due to my Anthem healthcare insurance. The settlement benefit is that I get to switch to any of the currently offered plans offered by Anthem, without needing a medical underwriting and without the possibility of being denied due to pre-existing conditions. This will be available to me whenever Anthem raises rates until the end of 2013. I've been in the the now-grandfathered HSA compatible PPO 3500 deductible plan for a few years now, and during that time had a hospital visit where a pre-existing condition was discovered. So this sounds like good news; I assume the newer plans will have more benefits since they were developed under the new stricter healthcare regulations.

Anyone else get this settlement notice? I'm wondering about strategy, whether to try to switch to a new plan ASAP, or wait as long as possible.

The settlement letter made what I think is a good point that my current plan will likely remain cheaper than new plans for a while, but that at some point it will probably become more costly than the newer plans because the grandfathered status means that younger healthier people won't be able to join, and only the older sicker folks will remain. That was apparently the basis of the lawsuit.

So my thinking as of now is to wait until 2013 to try and switch, so as to take advantage of a couple of years of lower rates, and to see what develops in terms of new plans. The only hitch is that Anthem could conceivably fail to raise rates in 2013, eliminating my ability to switch, but that just doesn't seem likely

I must admit that I thought the Obama healthcare reform eliminated denials on the basis of pre-existing conditions altogether, so it's not clear this is really even a benefit to me when (if) that kicks in in a few years. But I'd assume there's some loopholes in the Obamacare plan that would let them deny based on pre-existing.
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Old 12-24-2010, 08:32 AM   #2
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Quote:
Originally Posted by free4now View Post
I must admit that I thought the Obama healthcare reform eliminated denials on the basis of pre-existing conditions altogether, so it's not clear this is really even a benefit to me when (if) that kicks in in a few years. But I'd assume there's some loopholes in the Obamacare plan that would let them deny based on pre-existing.
(emphasis mine)

I thought so too, by 2014 anyway. I tried slogging through the entire bill myself and couldn't handle the legal-ese, but some summaries lead me to believe this.

My guess is that this settlement benefit only affects your ability to change plans between now and 2014. (?) Perhaps someone else has more light to shed on this.
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Old 12-24-2010, 09:20 AM   #3
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Yes, between now and 2014. The pre-existing condition rules do not go into effect until then.
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Old 12-24-2010, 09:59 AM   #4
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Whether you can switch plans or not is one thing....whether they will let you keep the same risk class is another thing. If you are at their best risk class now and they put you in the worst risk class for a switch to a different plan, it would probably be much more expensive to switch and might not make any sense. The devil is always in the details, as they say...
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Old 12-24-2010, 04:43 PM   #5
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W2R, I think you're probably right that this settlement essentially makes the Obamacare no pre-existing exclusions Christmas present come early, but doesn't add much else in the way of benefits.

dgoldenz, My understanding was that at least until recently all the healthcare plans available on the open market (e.g. ehealthinsurance.com) were only for the most healthy risk class. That the plans for riskier classes of people were the "special" plans available only through state regulatory programs and such. The settlement wording seems to imply that I'll be able to get into any plan that Anthem offers.


I suppose the million dollar question is which plans are the young healthy people going to flock to after 2014; those are probably the plans I want to be in to keep my rates low. Favoring high-deductible, high coinsurance plans might make sense, as healthier folks would probably not want to pay for more expensive plans.

I'm thinking maybe it's best to wait until mid-2013 and then get grandfathered into whatever plan looks best at that time, just in case Obamacare gets repealed by the republicans or other unforseeable happens. If Obamacare does go through, then I could probably switch later.
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Old 05-07-2012, 01:17 PM   #6
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I thought I'd reopen this old thread.

Anthem has notified me that I'm part of the serencsa settlement class that entitles me to a one time only switch to any of their plans before May 30, listed at:

http://anthem.com/ca/serencsa

And their letter says I will be able to switch if they raise rates again in 2013.

I took a quick look at the plans available, and none looks significantly more attractive than the HSA plan I'm currently in; they are all a bit more expensive for a bit less coverage overall.

So my current thinking is to stay with my current plan for now, but sometime in 2013 switch to another plan so I don't end up in a grandfathered plan full of only sick people.
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Old 05-07-2012, 01:27 PM   #7
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This insurance agent:

http://davefluker.blogspot.com/2012/...nd-feller.html

Seems to agree that trying to use this benefit to switch to a lower cost plan is not a good use of the benefits.
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Old 05-07-2012, 01:47 PM   #8
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This insurance agent:

Dave Fluker's California Health Insurance Blog: Anthem Blue Cross, Serencsa and Feller-Freed - My Position

Seems to agree that trying to use this benefit to switch to a lower cost plan is not a good use of the benefits.
Dave Fluker is one of Anthem's top agents in CA. Whatever he is recommending is good advice.
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Old 05-07-2012, 10:29 PM   #9
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And their letter says I will be able to switch if they raise rates again in 2013.
That little if would bother me. I don't know anything about this settlement but if you are saying that people can switch plans if they raise rates but can't if they don't then it seem to reason that many people might wait until near the end of the opportunity to switch. The insurer might realize and then not raise rates so as to keep people from switching... Again, I don't know anything about the specifics of the terms just going from what you said, but it would sure make me nervous to count on switching if they could keep me from doing that by not raising rates next year....
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Old 05-08-2012, 12:25 AM   #10
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Yeah, I considered the possibility that they wouldn't raise rates, but given that there's no rush to switch I think that's a good bet to take.
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