Health Reform News from BlueShieldCA

The Department of Health and Human Services (HHS) released the final Actuarial Value (AV) Calculator. This means that BlueShieldCA is closer to completing their individual and small group 2014 benefit designs.

“Under the Affordable Care Act, beginning in 2014 carriers participating in the individual and small groups markets will be required to provide coverage at a “metal level” of actuarial value: Bronze (60 percent AV), silver (70 percent AV), gold (80 percent AV) or platinum (90 percent AV). There is also a catastrophic plan for the individual market only.”

You might be wondering what AV means and why it’s important.  The simplest definition is that “Actuarial Value is a measure of the percentage of expected health care costs a specific health plan will cover for the “standard” population…For example, a plan with a 70 percent actuarial value would be expected to pay, on average, 70 percent of a standard population’s expected medical expenses for essential health benefits. The individuals covered by the plan would be expected to pay, on average, the remaining 30 percent of the expected expenses in the form of deductibles, co-payments, and coinsurance.”

“On February 13, Covered California (the California Health Benefits Exchange) presented two standard benefit designs for each of the metal levels and the catastrophic plan. One follows a PPO-like design and the other follows an HMO-like design. All carriers participating in Covered California must offer at least one plan at each metal level and a catastrophic plan to participate in Covered California.”

Although we have yet to receive emails from other providers, they are all probably completing similar efforts.  In addition to bookmarking the Coverd California site, and keeping up with their press releases, please do reach out to our office if we can offer any assistnce in reviewing your options as 2014 draws ever closer.  Are you a Bronze, Silver, Gold or Platinum?  Guess we’ll now be talking about these metals even in non-Olympic years….

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