QualChoice's limited plans off exchange

Insurance Department says provider network too small

At the request of the state Department of Insurance, QualChoice Health Insurance will not offer its limited-network plans on Arkansas' health insurance exchange next year, the company and department officials said Wednesday.

About 1,000 people are enrolled in the "high-value network" plans, which are offered in the central and northwestern coverage regions delineated by the Insurance Department.

Premiums for those plans are 10 percent lower than those for identical plans with broader networks of doctors, hospitals and other providers. Patients can go to providers outside the networks but must pay higher fees.

"Because the state runs the exchange, it was their decision that they only wanted full-network products" for 2015, QualChoice Chief Executive Officer Mike Stock said.

People who are enrolled in the limited-network plans will be able to stay in the same plans next year but will have access to the company's broader network of providers, he said.

Consumers who don't want to apply for federal subsidies through the exchange will still be able to enroll in the limited-network plans directly through the company, he added.

Insurance Commissioner Jay Bradford confirmed that he asked the company not to offer the limited-network plans on the exchange next year.

People who sign up for such plans may not understand the limitations, he said.

"I felt like it was shackling the consumer to a degree, and I didn't feel comfortable with that," Bradford said. "I want the consumer to have as much flexibility to choose their physician as they possibly can."

Zane Chrisman, an attorney specialist with the department, said the plans were allowed this year because they met state and federal requirements. Department officials expected the networks to grow to include more providers, but they didn't expand as much as officials had hoped, she said.

Last fall, the Arkansas Medical Society asked the department to investigate whether the networks violate the state's "any willing provider" law, which requires insurance companies to include in their networks any doctor, hospital or other provider who agrees to the company's conditions.

In finding that the networks comply with the law, Bradford sided with Stock, who said the company will contract with any "integrated network" of providers, as long as the network agrees to the company's conditions.

David Wroten, the Medical Society's executive vice president, said Wednesday that he had heard complaints from some doctors whose patients enrolled in the plans without realizing their doctors were not in the network.

"The limited network really didn't cover the whole region, but it had to be offered to everybody in that region," Wroten said.

As more providers join the limited networks, or if the coverage areas become smaller, such networks might become a better option, he said.

QualChoice is among four companies that offered plans on the exchange this year and have reapplied to offer plans next year.

The deadline for companies to submit plans to the department for the exchange for 2015 was June 15.

The Insurance Department will review the plans and make recommendations on their approval to the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services.

The rates will be announced after the federal agency approves the plans, which is expected to happen by Nov. 3, Insurance Department spokesman Heather Haywood said.

Set up in every state under the 2010 federal health-care overhaul law, exchanges allow people to shop for coverage and apply for subsidies to help them pay for it.

Under Arkansas' so-called private option, most people who qualify for coverage under the state's expanded Medicaid program can sign up for a plan on the exchange and have the premium paid by Medicaid.

The expansion extended eligibility to adults with incomes of up to 138 percent of the poverty level: $16,105 for an individual, for instance, or $32,913 for a family of four.

Those who don't qualify for Medicaid may be eligible for federal tax credits to help them buy coverage. The tax credits are available to those with incomes of less than 400 percent of the poverty level: for example, $45,960 for an individual or $94,200 for a family of four.

As of June 1, more than 192,000 Arkansans were enrolled in the plans, including more than 152,000 who qualified for Medicaid-funded coverage.

While those who qualify for Medicaid can enroll at any time, others are mostly limited to signing up during annual enrollment periods. People also can enroll outside of the enrollment period after certain events, such as losing job-based coverage.

The initial enrollment period was from Oct. 1 through March 31, although those who started enrollment before March 31 were given additional time to complete the process.

The enrollment period for coverage starting next year will be Nov. 15-Feb. 15.

QualChoice offered plans this year through a subsidiary, QCA Health Plan. Next year, Stock said, the company has applied also to offer plans through another subsidiary, QualChoice Life and Health Insurance Co.

The offerings from QualChoice Life and Health Insurance will include gold-level plans, designed to cover 80 percent of a typical patient's medical expenses, and silver-level plans to cover 70 percent of a patient's expenses, Stock said.

"With more companies on the exchange and more products offered, it just gives consumers more choice and increases the likelihood that they'll find one of our products they like," Stock said.

QualChoice has applied to offer plans through both the subsidiaries in all seven coverage regions of the state, Stock said. This year, QualChoice is offering plans in five of the regions.

Bradford said St. Louis-based Centene Corp., as expected, also applied to offer plans in each region. This year, the company offered plans in three of the regions.

Arkansas Blue Cross and Blue Shield and its national affiliate, the Blue Cross and Blue Shield Association, offered plans in all the regions this year and applied to offer plans in the same regions next year, Bradford said.

As of late June, about 152,000 people were enrolled in the companies' plans, including 115,000 in Medicaid-funded plans, Arkansas Blue Cross spokesman Max Greenwood said. The companies are not discontinuing any plans, and Arkansas Blue Cross has applied to add one plan, she said.

Bradford said he had hoped the state would attract another company for next year. One company with nationwide offerings had expressed interest but ultimately decided not to apply, he said.

He said he still expects additional companies to apply in future years, after more data are available on the medical expenses of those who are signing up.

"Three years from now, everybody's going to be looking at hard numbers, actual claim experience," he said. "There won't be judgment in there as much."

Metro on 07/03/2014

Upcoming Events