Blue Shield Update

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C.A.R. and Blue Cross have reached an agreement for replacement coverage!! 

Please visit our OPEN ENROLLMENT page to view plans and rates available 6/1/07.  CLICK HERE!

This page is dedicated to keeping you informed about the progress being made in our efforts to renew the C.A.R. medical program with Blue Shield. We will also post important notices about our efforts to replace Blue Shield should that be necessary. This page will get very long before this matter is concluded. New postings will appear at the top of the page. The contacts links will always reside above the postings.

CLICK BELOW FOR IMPORTANT LINKS AND DOCUMENTS:
caution.jpg CLICK HERE BEFORE YOU CHANGE YOUR INSURANCE !

INDIVIDUAL/FAMILY HEALTH PLAN QUOTES: Benefits & Rates

IMPORTANT CONTACTS: Blue Shield, Department of Insurance, etc.

 Department of Insurance: Request for Assistance Form 

Department of Managed Health Care:

Find Your Local Legislators

Notice to Members 2/07
C.A.R. Press Release 2/12/2007
C.A.R. Interview on KNX Radio 2/13/2007

4/25/07.  C.A.R. announces that Blue Cross of California will offer its Employee Choice program to eligible C.A.R. members.  Applications will be sent to existing Blue Shield policyholders very soon along with rates, plan descriptions, procedures to enroll, etc.  We will also have the appllications available on the website within a few days.  Please bear with us as we work to make this transition as smooth as possible.

4/18/07.  Many people have read the quotes from Blue Shield in the articles about the results of the hearing.  Shield implies that RealCare has pursued its legal remedies without pursuing other coverage.  This is not true.  We have pursued and continue to pursue alternate coverage with numerous carriers.  We hope to have good news for our members within a week.  We wish we could be more positive, but despite the fact that we are making progress, no deal is done until it's done. 

The press has done a pretty fair job of reporting on this issue.  However, please be careful when you read a quote from Blue Shield.  It is natural for anyone to color the facts in his favor to try to influence public opinion.   

4/16/07. The hearing on our motion for a preliminary injunction did take place today.  Unfortunately, Judge Wiley was not able to grant the injunction based on the evidence presented to him.  C.A.R. and RealCare are pursuing all options to ensure that our members will have coverage effective June 1st, 2007.  We understand your apprehension about this situation and we will post an update as soon as we have more information.

4/9/07. Please note the hearing on the preliminary injunction is set for MONDAY, April 16th. Our earlier email gave the incorrect day.

4/5/2007. At 2:00 p.m. today, the court notified our attorneys that the hearing would be postponed until 4/16/2007. This was done on the judge's initiative, not due to the efforts of either party. The judge is in a trial that has prevented him from being able to read the pleadings. As our action is quite complicated, he thought it necessary to delay the hearing. This is very disappointing to C.A.R. and RealCare, but some things cannot be helped. Please hang in there as best you can. We continue to be optimistic that we will prevail without loss of coverage for any covered member.

3/17/2007. C.A.R.'s case against Blue Shield and RealCare's were deemed related by court order on 3/16/2007. This means the two cases will be heard by the same judge. Our actions for preliminary injunction will be heard on April 6.

3/6/2007. C.A.R.'s hearing for preliminary injunction was reassigned to Judge John Shepard Wiley, Jr. The hearing will be on April 6, 2007. RealCare's hearing for preliminary injunction is still set for March 22, 2007. We are attempting to have the cases deemed "related" so that all hearings, motions, etc. will be heard together. If this occurs, and we expect it will, our matter will be heard on April 6th as well.

2/23/2007. Blue Shield exercised its right to challenge the first judge that was selected to hear our motion for injunction. This will probably result in a delay of the hearing. Our attorneys say the hearing will most likely be heard after 3/14 but at least by 4/1.

2/9/2007 C.A.R. and RealCare filed separate motions for a prelinary injunction against Blue Shield. A hearing is set for the preliminary injunction for March 14 at 8:30 in Los Angeles. A preliminary injunction, if awarded, would maintain the status quo until a trial on the merits of the lawsuit could be heard. 

FAQs

Who initiated the cancellation?
The cancellation was initiated by Blue Shield’s management team. We received the notification by mail on December 2, 2006 that they intended to terminate the HMO program. The notification of termination of the PPO programs was mailed to us on December 6, 2006.

What is being cancelled? And what is NOT being cancelled?
Blue Shield intends to cancel all of the medical plans offered through C.A.R.. The dental, vision and life plans are being renewed as of 6/1/07. Kaiser is not being cancelled.

When is the cancellation effective?
5/31/07

What is being done to prevent cancellation?
RealCare and C.A.R. have attempted to talk with Blue Shield about their decision. So far, Blue Shield has refused to speak with us or to engage in any meaningful discussions. C.A.R. and RealCare are filing separate but coordinated lawsuits against Blue Shield. In addition to seeking damages, we are asking for an injunction to prevent them from cancelling the plan. Actions for injunctions can be heard very quickly. We are hoping to have our matter heard and decided within six to eight weeks.

What should I do if I am on Blue Shield?
While we expect to prevail with the litigation, there is always the possibility that we will not. In that case, members covered under Blue Shield will have several options as noted below. Please call RealCare at (800) 939-8088, ext. 208 to discuss your particular insurance situation.

Here are the options you have right now:

1. Wait until we know the outcome of the action for the injunction. This matter should be heard and resolved by March or early April. Should we not prevail with the injunction, we may have other PPO options with another carrier. We are optimistic that similar new group plan options with another insurance carrier can be in place before the date of cancellation.
2. Kaiser remains an option in the C.A.R. program. You can elect any Kaiser option now being offered.
3. You may investigate purchasing individual health plans. RealCare agents will assist you to determine if this is a possible alternative for you and/or family members.
4. If you cannot qualify medically for an individual plan, you may be eligible to enroll in a HIPAA guaranteed issue insurance policy. HIPAA is a federal law that requires health insurance carriers to issue a policy to certain qualified applicants. Termination from the C.A.R. plan meets one of the requirements.  If you live in a Kaiser Service Area you will not be eligible for HIPAA guaranteed issue coverage.
5. Members with at least one W2 employee may qualify on their own as a group and purchase guaranteed issue health insurance.

Why is the plan being cancelled?
Blue Shield claims that the contract between C.A.R. and Blue Shield is being terminated because the program does not meet the minimum participation requirements outlined in the underwriting guidelines. Those guidelines state that any employer that wishes to offer three or more plans alongside Kaiser, must enroll at least 75% of the employees (members) in a Blue Shield plan.

Those guidelines state that if an employer offers three or more Blue Shield plans alongside Kaiser, 75% of the enrollees must participate in one of the offered Blue Shield plans. Blue Shield considers C.A.R. to play the role of the employer and each member is an "employee" as those roles relate to its guidelines. When the plan was originally written in 1999 there were no Blue Shield participation requirements imposed on the C.A.R. program. Blue Shield has been advised in the past of the number of members enrolling in Blue Shield and Kaiser. The total number of members enrolling in Blue Shield has always been below 75%.Until now Blue Shield has never notified RealCare or C.A.R. that this was a concern. Coverage has always been offered on a guaranteed basis and renewed each year.

Why is Blue Shield canceling now?
We cannot answer for Blue Shield. However, we speculate that Blue Shield is not making enough money on the program for its purposes.

Isn’t Blue Shield a non-profit organization?
Yes, but they operate much the same as any other insurance company. They want to make as much money as they can.