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Highmark Expands Individual Member Health Insurance Options in Pennsylvania

Due to difficulty accessing the federal exchange website and enrollment process, Highmark members who were notified that their policies would end on Dec. 31, 2013 are faced with significant challenges in obtaining coverage through the new health insurance marketplaces by the enrollment deadline of Dec. 23, 2013 for Jan. 1, 2014 coverage.

Highmark is committed to helping these members continue to obtain affordable, quality health coverage and has expanded our individual insurance options for these members to ensure that they have no gaps in coverage.

Current Special Care members
Highmark covers approximately 19,400 members through the Special Care program offered through Pennsylvania's Blue Cross Blue Shield plans. Special Care is a low-cost, limited-benefit policy designed for individuals who do not qualify for Medical Assistance or Medicare and cannot afford to purchase private health care coverage. The Highmark Special Care program was scheduled to be discontinued as of Jan. 1, 2014 due to changes required under the Affordable Care Act.

To help support existing Highmark Special Care members until they can select a new Affordable Care Act-compliant plan to meet their needs, Highmark will enable current Special Care policies to provide members up to six additional months of coverage before those policies finally terminate. These members will be eligible to stay enrolled in their current coverage through June 30, 2014 rather than Dec. 31, 2013, which had previously been expected to provide enough time for policyholders to enroll in new coverage available by using the federal health insurance marketplace website. Special Care policyholders do not need to contact Highmark to request the continuation of their policy, but must continue to pay their billed premium amounts.

However, many Special Care members are expected to be eligible for cost savings available through the federal marketplace. They have the option to determine their cost savings eligibility and enroll in a new Affordable Care Act-compliant plan at any time during the initial open enrollment period that currently ends March 31, 2014. If members choose to stay in the Special Care plan for the entire six month period, they would still be eligible to purchase a new plan that starts July 1, 2014, provided they enroll during the applicable Affordable Care Act limited open enrollment period.

Existing Special Care members who remain in their current plan should understand that their continued Special Care coverage will not include new Affordable Care Act benefits, such as access to cost savings to reduce health care costs or the new benefits and protections that are available when they enroll in new 2014 plans.

Continuing the Special Care plan will result in significant operational and financial impacts for Highmark. In order to offset a small portion of the expected financial impact due to providing coverage to these members for an additional six months, Highmark will need approval of a rate increase request that will be filed with the Pennsylvania Insurance Department. Highmark will also work diligently with our members to help them to understand their options as they transition to an Affordable Care Act-compliant plan in 2014.

Members will soon receive a telephone call and letter explaining their options. Highmark's telesales support is open every day from 8 a.m. to 10 p.m. to help members during open enrollment.

Current guaranteed issue members
Highmark covers approximately 16,500 members through guaranteed issue individual plans, which provide health insurance coverage regardless of health status or condition. All Pennsylvania Blue Cross Blue Shield plans were required to offer guaranteed issue coverage which was not available from other health insurers. The Affordable Care Act mandates that the same guaranteed issue coverage, which has historically been provided by the Pennsylvania Blue Cross Blue Shield plans, now be provided by all health insurers in the individual market. Additionally, all new coverage starting in 2014 is required to include new essential health benefits and other consumer protections. New Affordable Care Act compliant health plans, in most cases, are priced lower than current Highmark guaranteed issue plans.

To ensure that members have the continuous coverage they need, Highmark will facilitate enrollment for current guaranteed issue members who have not taken action to enroll and pay for Affordable Care Act compliant coverage or who have not completed the transition to a new health plan either through the federal health insurance marketplace or directly through Highmark.

In the western Pa. counties of Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Washington, Westmoreland, Crawford, Erie, McKean, Mercer and Warren, members will be enrolled in Health Savings Blue PPO 2750, a Community Blue plan, which is the lowest-cost silver plan.

In the western Pa. counties of Bedford, Blair, Cambria, Centre, Clearfield, Huntingdon, Jefferson, Somerset, Cameron, Clarion, Elk, Forest, Potter and Venango, members will be enrolled in Shared Cost Blue PPO 2100, a Community Blue plan, which is the lowest-cost silver plan.

In the central Pa. counties of Centre, Columbia, Juniata, Mifflin, Montour, Northumberland, Snyder, Union and Schuylkill, members will be enrolled in Health Savings Blue PPO 1700, a Community Blue plan, which is the second lowest-cost silver plan.

In the central Pa. counties of Adams, Berks, Cumberland, Dauphin, Franklin, Fulton, Lancaster, Lebanon, Lehigh, Northampton, Perry and York, members will be enrolled in Health Savings Blue PPO 1700, a Community Blue plan, which is the second lowest-cost silver plan.

In order to accept one of these new health plans, a member will just be required to pay the new monthly premium bill that he or she receives in late December.

Members who receive facilitated enrollment will not receive federal cost savings. Such cost savings are only available in connection with coverage purchased directly through the federal marketplace.

Facilitating enrollment for this group of members so close to the Jan. 1, 2014 deadline involves significant operational challenges. Highmark will work diligently with the members to make the transition into new health care coverage as smooth as possible.

Members will soon receive a telephone call and letter explaining their options. Highmark's telesales support is open every day from 8 a.m. to 10 p.m. to help members during open enrollment.



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