Summary
Centene Corporation, through its subsidiary Health Net Life Insurance Company, has finalized its 2017 benefit plan design and rate adjustments for off-exchange PPO individual and family plans following discussions with the California Department of Insurance. The company anticipates these changes will significantly improve the product's performance in 2017. Key adjustments include increased out-of-network out-of-pocket maximums and deductibles, elimination of certain out-of-network coverages and travel network access, and revised reimbursement rates for out-of-network services. Additionally, restrictions are being placed on third-party premium payments, and a 9.9% premium rate increase is planned for these plans.
Key Highlights
- 1Centene's Health Net subsidiary has submitted final filings for 2017 off-exchange PPO individual and family plans in California.
- 2Changes are aimed at significantly improving the product's performance in 2017.
- 3Out-of-network maximum out-of-pocket levels are increasing to $25,000 (individual) / $50,000 (family).
- 4Out-of-network deductibles for Platinum and Gold plans will be introduced at $5,000 (individual) / $10,000 (family) starting in 2017.
- 5Non-emergent out-of-state coverage and travel network access are being eliminated.
- 6Reimbursement rates for out-of-network services are being reduced, with specific caps tied to Medicare rates and elimination of default rates.
- 7A 9.9% premium rate increase is planned for these PPO plans.
Frequently Asked Questions
The changes are being implemented to significantly improve the performance of Centene's off-exchange PPO individual and family plans in California for 2017, following ongoing dialogue with the California Department of Insurance.
Out-of-network maximum out-of-pocket costs will increase to $25,000 for individuals and $50,000 for families. Furthermore, Platinum and Gold plans will introduce out-of-network deductibles of $5,000 for individuals and $10,000 for families, which were not present in 2016.
Non-emergent out-of-state coverage and travel network access are being eliminated. Reimbursement rates for out-of-network providers and services are also being reduced, with specific limits based on Medicare rates. Coverage for home health and home infusion therapy for out-of-network services is also being eliminated.
Yes, Centene plans to implement a 9.9% premium rate increase for these off-exchange PPO individual and family plans.