Author Archives: Reeve Conover

Blue Cross SC Rate increase on grandfathered plans!

2016 Rate Notifications for Under 65 Grandfathered Plans
BlueCross BlueShield of South Carolina is applying a 19 percent rate increase for Under 65, grandfathered plans ONLY (plans and freestanding drug benefits that became effective before March 23, 2010).
Under 65, non-grandfathered plans (plans that became effective between March 24, 2010 and December 15, 2013) WILL NOT receive a rate increase.

The effect of high deductible health plans on your finances

The high deductible plans so prevalent since the advent of ObamaCare are having a dramatic impact on Americans.  The concept that you have to have health insurance, that has a deductible so high you cannot really use it, has been written about alot.

Less than half of all households above the poverty level have enough assets to cover an out-of-pocket maximum of $3,000 to $6,000, considered a moderate level, according to a March analysis by the Kaiser Family Foundation.

Does a high deductible health plan cause people to bypass medically needed care?  Read this article from the Charlotte Observer and learn more.

NYU leaves United Compass Network


We have been advised that NYU is no longer in our UHC Compass Individual exchange network as of 1/1/16 as United Healthcare was unable to agree on an updated contract. Letters have gone out to exchange members to advise them of the change.

For members currently involved in an ongoing course of treatment or pregnancy in their second or third trimester, they may be able to continue to receive covered services through Continuity of Care benefits.

Oxford now enforcing drug card rules

As you may be aware, in 2014 Oxford small group NY and Conn went to a mandatory generic Rx card, which they called the “Ancillary charge program”.  If you wanted a name brand drug and there was a generic available you were supposed to pay the difference (the ancillary charge) in cost between the name brand and the generic, even if the doctor write DAW (dispense as written).  This was never properly adjudicated by Optum Rx, so members in some instances have been getting name brand drugs for the 3rd Tier copay instead of paying the difference in price between the name brand and the generic.

They have caught the error and are correcting it  now as of Jan 1st, 2016 to adjudicate scripts as they had set it up originally to do.  So now it’s more important than ever to make sure members discuss Rx options with their provider  so they are best prepared for this.  Oxford reports that “Impacted members received {a} letter in December of 2015 – outlining the drug(s) they are currently taking, that will be enforced as part of the program.



What is my job as your broker?

My role as your broker has changed my thirty years in the industry, and never more than in the last 5 years.  Some of this is related to the Affordable Care Act, of course, but some of it isn’t.  It used to be all about price;  that has changed alot – when everyone has the same price and the same product, how does your broker differentiate themselves?  And the single hardest thing to do these days is keep up with all the changes.

So who should your broker be, and how should they behave? 

  1.  You must have a broker that you feel comfortable turning to with question and concerns, give you an education, and show you your options.
  2.  When their is a problem (usually with medical insurance), the broker should be there to help you navigate through the craziness of the insurance world.
  3.  A broker should keep you informed and updated.  While they cannot do things that are your responsibility, you should be aware that you have that obligation.
  4. Your broker must be abreast of all the changes in the regulations, making you aware of them and providing guidance on how to comply.
  5. Your broker should be starting to work on your renewals well in advance, so that you don’t have to make last minute, pressured decisions.
  6. Your broker should be bringing you all the products available to you, not just their favorites.  You may have a different opinion.
  7. They should work with your employees and staff easily and willingly to provide support, education and guidance.

What can’t they do:

  1.  Handle your billing problems.  Generally insurance carriers will not let us interact on billing problems, and we don’t have access to your financial records.
  2.  Take on unusual tasks without additional compensation. Broker compensation has been cut by more than 50% over the last 5 years, so this is no longer an option.

Warning Signs that you have the wrong broker:

  1.  Your calls or emails aren’t returned for several days, or not at all.
  2. Everything is always being done under time pressure.
  3. They are not familiar with the new regulations and rules as they apply to your company.

Your relationship with your broker is critical.  Many people shop for the “cheapest” product not understanding that, for the most part, everyone has the same product and pricing.  Instead, you should be interviewing Brokers like you would a high-end employee.  Find the best fit for you, and hire them to do their job.

February 2019
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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA. - SIPC - Brokercheck