Helping Groups Transition To The Individual Market

With ACA changes for groups and employees, the Blues are continuing to look at how their current membership is impacted. They know that some members currently treated as groups will shift to individual market coverage post-reform.

To help agents keep members Blue, they are developing processes to simplify the transition from employer-sponsored insurance to an individual Blues’ product.

What We Know:
As a result of the ACA, some groups will no longer be eligible for group insurance and will only be eligible to purchase coverage in the individual market. These include sol proprietors, husband-wife groups without common law members and direct-billed association members.

What the Blues are doing in 2013:
The Blues are making this transition easy. They’re providing groups with the opportunity to select from a number of reform-compliant bronze, silver and gold-tier individual products that will be offered both on and off Marketplace beginning Oct. 1st 2013. These products are not the same as the customized group products some members may have been accustomed to. However, they do have the Essential Health Benefits required by the ACA. Key differences will be seen mainly in medical cost-sharing and the plan’s monthly premium.

They want to ensure the group has as much time as possible in advance of Jan. 1, 2014, to shop, select and enroll into the individual product that best meets their needs. If a group has not made a selection by Dec. 15, 2013, they’ll enroll them into an off Marketplace BCBSM or BCN gold-tier product (depending upon where the member currently has coverage). This will ensure that there is no lapse in coverage. The group will simply need to pay the premium bill to accept the change.

Blues selected a gold-tier level because for the majority of the membership in question, benefits aside, the medical cost share and monthly premium of these plans are likely the closet to what they currently have.

What this means to your customers:
The Blues recognize that this will be a change for some of your customers and in some cases their employees, who may not be familiar with the process of purchasing individual insurance on their own. Agents play a critical part in helping these individuals obtain coverage in this new environment.

When you’ll receive more information:
If a client intends to drop coverage or you have specific questions about the transition process and the support available to you, please email groupdropnotification@bcbsm.com or contact your managing agent. You can also call the Health Care Reform Agent Support Center at 1-866-582-5052.