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Blue Cross rate request includes deductible increases

December 5, 2011

A few weeks ago, Blue Cross Blue Shield of Rhode Island filed a request with the state’s health insurance commissioner to raise its rates by an average of 4.4% for direct pay clients (people that don’t get health insurance through their employers.)

But BCBSRI’s request includes more than a rate increase. The state’s largest health insurer also plans to raise deductibles and introduce new insurance options in 2012.

You can read the entire proposal here (you’ll find the best narrative on pages 10-19) but here are the basics-

  • If you currently buy HealthMate Coast-to-Coast Direct 500/1000, your deductible would increase from $500 to $1,000 if you’re an individual and increase from $1,000 to $2,000 if you’re paying for a family. The name also changes to VantageBlue Direct.
  • If you currently buy HealthMate Coast-to-Coast Direct 1000/2000 ($1,000 for an individual and $2,000 for a family) your deductible would change to $1,500 individual/$3,000 family with the new VantageBlue Direct name.
  • Same with HealthMate Coast-to-Coast Direct 2000/4000, which turns into HealthMate Coast to Coast 2500/5000.

Blue Cross lists other existing plans with new names, but the deductibles are the same. Whether benefits within those plans are different isn’t clear. Check the entire narrative to see the specifics for your plan and let me know if you notice any dramatic differences.

The proposal also includes an entirely new plan called BlueValue Direct 2500. This plan is only available for individuals, not families. Here’s a brief summary of what you’d get with the plan-

  • $2,500 deductible.
  • After deductible, Blue Cross pays 50% of the cost of health care services until you reach an out of pocket limit of $7,500.
  • For your first two visits to a primary care doctor or specialist you only have to pay a $30 co-pay, after that you pay out of pocket until you reach your deductible.
  • Your fist trip to an emergency room would only cost you $200. After that, it’s out of pocket till you reach your deductible.
  • You have a separate $500 deductible for pharmaceuticals, except cheap ones that are considered “tier 1.” After you satisfy that deductible, BCBSRI pays 50% for more expensive drugs, unless they’re considered “specialty” drugs, in which case your co-pay is $200.
  • You get one free dental cleaning and one free set of teeth x-rays a year.
  • Plus, $100 towards a gym membership.

Blue Cross is also planning a program that would reduce the deductible for direct pay customers every year they don’t end up spending the entire deductible.  Here’s an example chart-

But the deductible doesn’t stay that way if your spending changes. Let’s say on Calendar Year 4 you spend $2,503. For the next year you’d go back to the original deductible. The reduction lasts for four years or till the cost is 50% of the original, and then stays steady.

What about monthly costs? What would they look like under BCBSRI’s 4.4% rate increase? Here’s a sample. Here are the rates for folks who have costly health problems-

Here’s the chart for folks who are healthier (Preferred Pool II)-

Blue Cross Blue Shield of Rhode Island says it doesn’t want to comment on the benefit changes at this time. It plans to formally launch the new products/changes in mid January.

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