Blues Marketplace Newsletter Banner
Volume 3, Issue 43 · November 3, 2010

BCBSM updating certificates and riders to comply with PPACA

To comply with the near-term changes required by the Patient Protection and Affordable Care Act, BCBSM is updating certificates and riders with an effective date of Jan. 1, 2011, including:

The information in this alert applies to:

  • BCBSM groups with a plan year that begins Jan. 1, 2011
  • BCBSM groups with a plan year that begins on a date other than Jan. 1, 2011
  • BCBSM self-insured groups that have confirmed with BCBSM that they will retain grandfathered status

NOTE: We provided information specific to BCN in a previous Blue Alert titled, Blue Care Network updating certificates and riders to comply with PPACA.

We created a job aid to assist you with:

  • Quoting for groups
  • Group Wide Changes
  • Changes to certificates and riders for groups

Here are some of the key items to note in regards to the job aid:

  • Only includes forms that need to be added or removed as a result of health care reform
  • Because there are no operational impacts with regard to the paperwork, doesn’t include any revised forms that will be retained, such as SOT-PE-3 and WP-180 for pre-ex
  • Doesn’t include any certificates or rider information regarding IBU, MESSA, SMBs, BCS or ASC-only products

Certificates and riders for groups with a plan year that begins on Jan. 1, 2011, will automatically be updated with the new provisions. Group-wide changes aren’t necessary.

Rating and benefit change process for BCBSM groups with a plan year that begins on a date before Jan. 1, 2011

Most BCBSM groups have a Jan. 1, 2011, plan year. However, for groups with a plan year beginning before Jan. 1, 2011, BCBSM must make interim changes by adding riders to comply with PPACA provisions.

The interim riders will be end dated as of Jan. 1, 2011, when the certificate changes to comply with PPACA go into effect. When subsequent group-wide changes are made after Jan. 1, 2011, the rider will be removed. This internal group-wide change to add these changes is being handled by Account Services; therefore, no action is required by the groups, sales reps or agents. For details on how to handle other group-wide changes, reference the job aid mentioned above.

Rating and benefit change process for BCBSM groups with a plan year that begins on a date after Jan. 1, 2011

NOTE: This information only applies to groups that already confirmed with BCBSM and provided appropriate documentation that they will be treated as a deferred plan and wait until their plan year date to make the changes. For these groups, BCBSM must make interim changes by adding riders to remove the PPACA provisions effective Jan. 1, 2011, based on the certificate updates until the groups’ plan year begins.

This internal group-wide change to defer these changes is being handled by Account Services; therefore, no action is required by the groups, sales representatives or agents. At the start of the groups plan year, the interim deferral rider will be removed and PPACA changes will go into effect. For details on how to handle other group-wide changes, reference the job aid mentioned above.

Rating and benefit change process for BCBSM groups with grandfathered status

NOTE: BCBSM is treating all groups as “new” health plans. This information only applies to groups that already confirmed with BCBSM that they will be treated as a grandfathered plan.

For these groups, BCBSM must make changes by adding riders to remove certain PPACA provisions, such as preventive benefits, effective Jan. 1, 2011. This internal group-wide change to apply grandfather status and remove benefit changes is being handled by Account Services; therefore, no action is required by the groups, sales representatives or agents. For details on how to handle other group-wide changes, reference the job aide mentioned above.

For more information, see this Blue Alert about grandfathering titled, ‘Grandfathering’ defined under health reform law.

Questions? Contact your sales health reform liaisons:

Key/Large/Multi-State Group – Beverly Stovall at 248-448-7215
Middle/Small Group – Diane Wolfenden at 248-448-6122
Auto/URMBT – Emma Bissonnette at 313-225-7608 or Lisa Redick at 313-225-9574
Individual members – Customer Service at 888-288-2738

The information in this alert is based on BCBSM's review of the national health care reform legislation and is not intended to impart legal advice. Interpretations of the reform legislation vary, and efforts will be made to present and update accurate information. This overview is intended as an educational tool only and does not replace a more rigorous review of the law's applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. Analysis is ongoing and additional guidance is also anticipated from the Department of Health and Human Services. Additionally, some reform regulations may differ for particular members enrolled in certain programs such as the Federal Employee Program, and those members are encouraged to consult with their benefit administrators for specific details.

Health reform
Talk back!
Blues Newsroom
Agent Secured Services