$12.3 Million in Health Insurance Rebates for Individuals and Small Businesses

Highmark plan participants and groups to receive checks

Insurance Commissioner Trinidad Navarro announced today that Highmark Blue Cross Blue Shield Delaware will issue rebates totaling over $12.3 million to some Delawareans. Residents who purchase insurance on the Delaware Health Insurance Marketplace, those who purchase Highmark Delaware plans outside of the marketplace, and Highmark small group policyholders may receive rebates as a result of the Medical Loss Ratio (MLR) calculation.

MLR measures an insurer’s spending on medical expenses to confirm that at least 80 percent of premiums are being used for policyholders’ healthcare and prescription needs. It is an accountability measure included in the Affordable Care Act (ACA) that holds insurers to a strict standard and requires refunds if the threshold is not met. Insurers are not permitted to retain funds above this value for any reason, including to lower premiums for future years, as the policyholders effected may change. MLR is calculated on a three-year average – 2018, 2019, and 2020 were used in this assessment.

“Requiring insurers to meet the MLR ratio is one of the most critical tools the ACA gave us to protect consumers. These guardrails ensure residents and small businesses get the care they pay for, or get their money back – and they’re more important now than ever before,” explained Commissioner Navarro, who pointed to policyholders’ decreased and delayed use of healthcare throughout the pandemic as something likely to necessitate future rebates. “With decreased utilization of health services in 2020 and 2021 factoring into MLR for the next four years, and expected increases of utilization factoring into rates for 2022, this is yet another reminder that COVID will impact all aspects of healthcare, including insurance, for much of the foreseeable future.”

20,857 individual policyholders will receive rebates totaling over $8.4 million, with the average rebate being $405. This will be the second time in state history that rebates will be distributed to the participants of the individual market, with more than $12.6 million being sent to over 19,000 residents last year.

Highmark small groups, often small businesses, will receive nearly $3.9 million in cumulative return. 2,573 groups will receive an average rebate of $1,514, with 20 groups receiving rebates over $10,000. Employers can consider using these dollars to enhance benefits, reduce premiums for employees in future policy years, or provide refunds directly to group health plan participants.

Communications will be sent to policyholders in September and checks for both individual policyholders and small groups will be sent the week of September 15. Not every policyholder will receive a rebate. Those in the individual market with rebate questions can contact Highmark at 800-544-6679. Small group employers with rebate questions can contact their insurance producer, or Highmark at 800-241-5704.


Highmark Increases 2022 Affordable Care Act Marketplace Premiums

Expanded federal subsidies keep consumer costs low; SEP sees success

After two consecutive years of rate decreases, Highmark Blue Cross Blue Shield of Delaware, who offers the state’s Affordable Care Act (ACA) health plans, will increase base rates an average of 3% for the 2022 plan year. The announcement comes after extensive, in-depth independent actuarial reviews and a public comment period on the insurer’s initial proposal of a 4% increase. While insurers are increasing rates across the country, federal subsidies from the Biden-Harris Administration have cut consumer costs by 40% and will continue to be applied in the 2022 plan year. Residents are still expected to see savings despite the modest increase in the base rate.

The 2022 rate announcement comes after the end of the Biden-Harris Administration’s Special Enrollment Period (SEP), which gave residents the ability to enroll in 2021 ACA plans between February 15 and August 15. More than 5,377 Delawareans signed up for coverage during the SEP. Taking into account the 5% participation increase seen in last fall’s open enrollment, an estimated 30,000 Delawareans are now covered by 2021 plans. 23% of new and returning Delaware participants are enrolled in a plan costing $10 or less per month due to the American Rescue Plan.

“Stability in the individual health insurance market is so critical as we continue to battle COVID-19 and healthcare shortages. Rates remain more than 15% lower than they were just a few years ago, and with the American Rescue Plan, they’re more affordable than ever before,” said Insurance Commissioner Trinidad Navarro. “Coupled with the safety net of the SEP, the past year has been positive for insurance access.”

Delaware SEP enrollment February 15 through July 31 was more than double the same period last year, which saw higher-than-usual circumstantial enrollment due to COVID, and is nearly triple the typical enrollment for this time of year. Final numbers are expected in the coming weeks. The SEP’s success has led to proposals at the federal level for permanent open enrollment expansion as well as monthly enrollment opportunities.

Expansion of access and increased affordability remains a priority at the federal level, as American Rescue Plan funds increased tax credits and expanded subsidies farther into the middle class. Premium assistance will continue through 2022, and majority of Delaware marketplace enrollees will be eligible for these discounts that can reduce their monthly premiums.

Nationally, insurers are requesting premium increases as policy use is expected to rise with more residents scheduling postponed elective procedures and visits. The rise of prescription costs continues to be a factor in premium planning.

All ACA plans offer essential health benefits, including coverage of pre-existing conditions, prescriptions, emergency services and hospitalization, mental and behavioral health coverage, outpatient care and telehealth, lab services, and more. ACA rates do not vary based on vaccination or COVID-19 status.

Highmark Blue Cross Blue Shield Delaware is the sole health insurer offering plans on Delaware’s Health Insurance Marketplace for 2022, offering 12 plans for individuals and families. Two dental insurers – Delta Dental of Delaware, Inc. and Dominion Dental Services, Inc. – offer stand-alone dental plans on the marketplace.

Open enrollment for the Marketplace takes place between November 1 and December 15 each year. However, residents may qualify to enroll or change plans based on special circumstances, such as a loss of qualifying health coverage, change of income, becoming a parent, and several other qualifying factors. Find out if you qualify for special enrollment.

The rate change does not apply to Medicare, Medicaid, or those with group or individual policies outside of the Marketplace.

More information on the rate review process


$21.5 Million in Health Insurance Rebates for Individuals and Small Businesses

Thousands of Highmark 2019 plan participants and groups to receive checks

After announcing a reduction of Delaware Health Insurance Marketplace rates for the upcoming enrollment year, Insurance Commissioner Trinidad Navarro has more good news for residents who purchase insurance on the Delaware Health Insurance Marketplace, those who purchase Highmark Blue Cross Blue Shield Delaware plans outside of the exchange in the individual market, and for Highmark small group policyholders, announcing more than $21.5 million in rebates for 2019 participants.

“Now, more than ever, we need to make sure that every resident and small business can afford the health insurance they need for their families and employees. These rebates, combined with the ACA health insurance rate reduction for the coming year, do just that,” said Commissioner Navarro. “This is just one of many ways we are working to reduce the cost-of-care our residents experience in the health care system.

For the first time in the history of Delaware’s individual health insurance market, more than $12.6 million will be returned to 19,273 policyholders, with the average rebate being $656. Highmark small groups, often small businesses, will receive more than $8.8 million in cumulative return. 2,779 groups will receive an average rebate of $3,198, with more than 175 groups receiving rebates over $10,000. Employers can consider using these dollars to enhance benefits, reduce premiums for employees in future policy years or provide refunds directly to group health plan participants.

Communications will be sent to policyholders in September and checks for both individual policyholders and small groups will be sent the week of September 21. Those in the individual market with rebate questions can contact Highmark at 800-544-6679. Small group employers with rebate questions can contact their insurance producer, or Highmark at 800-241-5704.

These rebates are required by the Delaware Department of Insurance according to Medical Loss Ratio (MLR) measurements set by the Affordable Care Act, which are meant to ensure that insurers are spending a majority of premiums on health claims and clinical services, not taking those dollars for profit or administrative expenses. The rebate system creates balance when data shows that this ratio was off in a previous year. Not every policy will receive a rebate. MLR review for the 2020 plan year will shine a light on changes in insurance usage due to COVID-19 and will be released in 2021.

On August 31, Commissioner Navarro announced the Delaware Health Insurance Marketplace would see an average decrease in rates of 1% for individual plans. Highmark small group plans will see an average premium decrease of 3%.


Action Ordered to Protect Highmark Medicare Supplement Consumers

Series of changes come after reports of Highmark premium notice errors

Dozens of complaints have been registered with the Delaware Department of Insurance after Highmark Blue Cross Blue Shield processed hundreds of customer birthdates incorrectly, leading to notices of higher July 1 premiums for many Medicare Supplement participants, including those in the company’s Medigap Blue Plan. Department staff have taken action to ensure that these errors are corrected, and impacted consumers will be notified. Additionally, the company has agreed to reduce their July 1 rate increase significantly.

“Medicare Supplement customers should continue to feel secure knowing that the Department of Insurance is working to ensure this problem is corrected quickly,” said Insurance Commissioner Trinidad Navarro. “As we worked to resolve this issue with Highmark, the company has also agreed to cut its average premium increase in half due to the reduction in claims activity throughout the coronavirus pandemic.”

Initially pursued prior to the advent of COVID-19, Highmark planned to increase Medicare Supplement premiums an average of 7.2%, the first increase on these plans in several years. The increase was justified for a normal plan year by independent actuaries, but the Department of Insurance and Highmark agree that due to the pandemic, these estimates no longer apply due to low utilization and fewer claims being paid by the company. Highmark has agreed to reduce the premium increase to an average of 3.5%. Consumers can expect to receive additional information in the mail.

The Department of Insurance Market Conduct investigators are monitoring the resolution of this issue, will work with the company to explore the causes of the error as well as any other instances that it may have occurred, and will review measures taken to prevent billing issues in the future.

Medicare Supplement plan premiums are, in part, based on the age of the participant. While the department has not approved a rate increase for Highmark’s plan in several years, participants may have had premium adjustments due to their birthday. These age-based increases are generally very low, are included in the consumer’s policy, and are not reviewed by the department. An error in the birthdate of a consumer can result in an increase, as occurred within the Highmark plan. Plan participants are urged to review the date of birth that is recorded with their insurer.

Contact the Delaware Department of Insurance Consumer Services team to report insurance issues by visiting insurance.delaware.gov, emailing consumer@delaware.gov, or calling (302) 674-7300.


Medicaid MCOs Embrace YMCA’s Diabetes Prevention Program

NEW CASTLE (Aug. 1, 2019) – As a way to improve the health of Delawareans who are covered by Medicaid, while potentially reducing overall health care spending, the Department of Health and Social Services’ two Medicaid managed care organizations are making the YMCA’s Diabetes Prevention Program available to their members who meet eligibility criteria.

The program is available at no cost to adult members of DHSS’ Division of Medicaid and Medical Assistance two managed care organizations (MCOs) – Highmark Health Options and AmeriHealth Caritas Delaware – who meet the program’s eligibility criteria. To participate, MCO members must be 18 or older, overweight with a body mass index (BMI) over 25 and be diagnosed with prediabetes or have a previous diagnosis of prediabetes. YMCA of Delaware membership is not required.

“Unfortunately, obesity and diabetes are twin epidemics in our state,” said DHSS Secretary Dr. Kara Odom Walker, a practicing family physician. “I thank Highmark and AmeriHealth Caritas for making the YMCA Diabetes Prevention Program available at no cost to Medicaid MCO clients who meet the eligibility criteria. This is an important step forward in reducing the impact of obesity and diabetes, while helping us to build a healthier Delaware.”

Across the state, about two-thirds of Delaware adults are at an unhealthy weight, either overweight or obese. In 2017, 11.3 percent of Delaware residents age 18 and older reported they had been diagnosed with diabetes and an additional 12.2 percent reported being told they have pre-diabetes.

“Highmark Health Options is proud to partner with DHSS and the YMCA Diabetes Prevention Program as we work together to reduce obesity and chronic disease,” said Todd Graham, President and CEO for Highmark Health Options. “We look forward to this partnership that will lead to a healthier lifestyle for our members while supporting the My Healthy Weight pledge.”

“We are very pleased to be a part of the YMCA’s Diabetes Prevention Program, alongside the Department of Health and Social Services, Highmark Health Options, and our valued community partner, the YMCA of Delaware, to help reduce the life-threatening chronic conditions caused by diabetes,” said Emmilyn Lawson, CEO of AmeriHealth Caritas Delaware. “Through this complimentary community-based program, we hope to nurture healthy citizens and healthier communities by increasing access to the support and services that Delawareans need to achieve their wellness goals.”

The YMCA’s Diabetes Prevention Program is a yearlong, evidence-based health behavior change program consisting of 25 one-hour group sessions. A trained lifestyle coach helps participants learn skills and strategies to eat healthier, increase physical activity, lose weight, overcome stress, stay motivated and more. The goals of the program are to reduce participants’ body weight by 7 percent and increase physical activity by 150 minutes per week.

“We have offered the YMCA’s Diabetes Prevention Program about 10 years, we’ve seen tremendous results, and will now be able to reach even more people in need,” said Tricia Jefferson, RD, LDN, Director of Program Development and Partnerships for the YMCA of Delaware. “Partnering with both Managed Care Organizations to serve our Medicaid-eligible participants will not only help us further prevent diabetes in a population that is at great risk, but it will help shape the future of how prevention programs are delivered and paid for across the nation.”

“We are grateful to Highmark, AmeriHealth Caritas, and the YMCA for their partnership in offering an evidence-based program to address obesity and related chronic disease for eligible Medicaid enrollees,” said Steve Groff, Director of DHSS’ Division of Medicaid and Medical Assistance. “DHSS was one of nine founding members of My Healthy Weight, a national collective initiative offering obesity prevention and treatment. The Diabetes Prevention Program will fulfill our pledge to provide access to community-based programs.”

To learn more about your eligibility for the YMCA’s Diabetes Prevention Program, contact your managed care organization.

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The Department of Health and Social Services is committed to improving the quality of life of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.