Premera to stop offering individual health plans in some Eastern Washington counties

THURSDAY, MAY 12, 2016, 5:15 P.M.

By Rachel Alexander

One of Washington’s largest health insurance providers will drop most Providence, Swedish and CHI Franciscan providers from its network for individual health insurance plans starting in 2017.

The change will not affect the vast majority of Premera policyholders who are insured through employer-sponsored or Medicare plans.

Premera announced Thursday it would also stop selling individual plans under the Premera name and its subsidiary, Lifewise, in 12 Washington counties: Chelan, Douglas, Ferry, Kittitas, Lewis, Lincoln, Mason, Pend Oreille, San Juan, Skagit, Stevens and Yakima.

The change comes a week before the state Office of the Insurance Commissioner is expected to announce rate increase requests for 2017 health insurance premiums. Premera has requested a 19.6 percent rate hike, spokeswoman Melanie Coon said.

Providence spokeswoman Colleen Wadden noted no changes will occur until next year and people can change health plans during this fall’s open enrollment if they want to stay with their Providence physician or hospital.

“Our intent is to continue to participate in other Premera products for 2017, as we are negotiating the terms of our future relationship with Premera,” she said.

About 155,000 Washingtonians have individual Premera or Lifewise plans purchased through the state health insurance exchange or directly from the Premera website, Coon said. About 17,000 of those people are in the affected counties.

The network changes also affect a small number of employer-sponsored plans. Customers can see if they’re affected by looking at the network name on their health insurance cards. Plans in the Heritage Prime network, which is employer-sponsored, and the Heritage Signature Network, which is individual, will no longer have access to most providers in the Providence, Swedish and Franciscan systems.

A handful of hospitals and facilities from the dropped providers will remain in-network to provide adequate care in places with few options.

Facilities remaining in-network include St. Luke’s Rehabilitation Institute in Spokane, Providence St. Joseph’s Hospital in Chewelah, Providence Mt. Carmel Hospital in Colville and Providence St. Mary Medical Center in Walla Walla. Rockwood Health System will remain in-network.

Coon said the changes are in response to rising health care costs as more people have signed up for coverage through the Affordable Care Act. Premera saw a spike in claim costs in 2015, the second year many people had insurance through individual plans.

Coon said many of those customers had been deferring medical care for years and spent more on health care once they figured out how to use their new insurance plans. That drove up costs across the system, she said.

Costs have been especially high in many rural areas where there’s little competition, Coon said. Premera was faced with a choice between raising premiums further or exiting the market in some counties entirely.

“We can’t offer competitive rates if we’re everywhere in the state,” she said.

Without the changes, Coon estimated, Premera would have asked for a rate increase closer to 25 percent.



IRS Sets 2017 HSA Contribution Limits

The maximum contributions that can be made to health savings accounts in 2017 will increase $50 for individuals, but remain unchanged for families.

The Internal Revenue Service announced Thursday that the maximum contribution that can be made next year to an HSA linked to a high-deductible plan will be $3,400, up from $3,350, while the maximum contribution for those with family coverage will remain at $6,750.

However, maximum out-of-pocket expenses will remain the same in 2017 for both categories.

The maximum out-of-pocket employee expense, including deductibles, will remain at $6,550 for single coverage, and $13,100 for family coverage.

For 2017, a high-deductible health plan is defined as a one with an annual deductible of least $1,300 for self-only coverage and $2,600 for family coverage.

Increases in the HSA limits, which are detailed in Revenue Procedure 2016-28, are tied to changes in the cost of living.

IRS Deadline Extended- ACA Reporting Requirements for Large Employers

The Internal Revenue Service (IRS) granted employers an extension of the deadline to file a variety of reports required under the Affordable Care Act (ACA)? The new deadlines grant applicable large employers (ALEs), health insurers, and any employers who self-insure their employee medical insurance plans two additional months to compile their information and forward the applicable ACA forms to the IRS.

The deadline extension may also benefit other providers of minimum essential coverage, if they are among those required to provide workers with information and to file informational reports with the IRS in accordance with Code Section 6055.

For paper filers the Form 1095-C, originally due to the IRS on February 29, 2016, is now due on May 31, 2016. Again, this deadline applies only to those filing on paper, rather than electronically.

Attention Premera members! Change to Outpatient Rehabilitation

Effective July 1, 2016, Premera will partner with eviCore healthcare to provide a review and authorization and process for outpatient rehabilitation services for our fully insured individual and group plans.

This new approach to outpatient rehabilitation services is designed to help members get the most from their coverage by ensuring treatments are right for their condition, effective, and medically necessary.

Premera selected eviCore healthcare because of its experience in overseeing physical medicine services. These recognized experts will partner with Premera to manage use of member benefits so that:
• Members reduce or eliminate ineffective use of their benefits
• Employers can expect costs for rehabilitation services to be managed wisely

Limiting unnecessary services helps control costs for everyone.

Types of services
Outpatient rehabilitation services included in this program are:
• Occupational therapy
• Physical therapy
• Massage therapy
• Rehabilitation services provided by chiropractors (this does not include spinal manipulations.)

The program will not be used to manage speech therapy, neurological occupational or physical therapy, and cardiac or oncology rehabilitation.

The new process
Here’s how the authorization and review process for outpatient rehabilitation services will work for dates of service July 1, 2016, and after:
• The member goes directly to the provider who can provide outpatient rehabilitation services (not the referring physician). The first visit, which includes an evaluation and possibly treatment, is covered based on benefit eligibility.
• The provider, after seeing the member, develops an outpatient rehabilitation treatment plan and sends the plan to eviCore for review.
• eviCore evaluates the treatment plan, determines medical necessity and notifies the provider and Premera of the number of authorized visits.
• Providers who send treatment plans using eviCore healthcare’s online portal will, in many cases, obtain a response to their request in real-time.

Communication to groups and members
The new process for outpatient rehabilitation services impacts all Washington, Alaska and Oregon insured individual and employer group plans, including Optiflex groups.
• Groups: Will be contacting insured groups starting early in May.
• Members: Premera will be reaching out to those who recently received treatment and those who had more than 50 visits in the past year. Members also will be notified by eviCore in writing if a request for services is not approved. This notice will include the member’s appeal rights and instructions to file an appeal.

2017 Health Insurance Rates to be posted soon!

2017 health insurance rates were due to the Washington State Office of the Insurance Commissioner on May 6th, the rates will be released to the public 10 days later. These will be proposed rates open for comment until the OIC gives final approval. Learn more at