Birth control and other services, such as pap smears and mammograms, are now free through private insurance plans, which has a local impact on BlueCross BlueShield of Tennessee and its customers.
Initially, there will be more cost to BCBST as a result of the recent provision of President Barack Obama’s Patient Protection and Affordable Care Act, but ultimately, long-term costs will be reduced, Kelly Allen, BCBST communications specialist, said.
“In the short term, we’ll see a cost impact on our operations as we’ll have to pay providers and pharmacy costs for this new mandated coverage,” she said. “However, we also estimate that if the result is more people taking advantage of preventive care, this will impact overall health outcomes for our members, which is our top priority. As members take advantage of better preventive services and early detection of health conditions, overall population health improves.”
When the general population’s overall health increases, insurance costs are expected to go down for BCBST.
The latest provision of the Affordable Care Act means that birth control and other preventive care benefits for women are copay-free for an estimated 47 million women, NBC News reported.
Who is covered locally through BCBST?
Locally, 96 percent of women with group benefit options through an employer will have this coverage through BCBST, Chris Ramsey, director of the office of health care reform at BCBST, said.
NBC also reported that there will be a delay for some women because the law applies to new policies, and women with existing coverage may have to wait for their policies to be renewed. And some insurers already provide this coverage.
For BCBST group members, it will take a year for all applicable benefit options to be available.
All individual policies that are “non-grandfathered,” meaning they were issued after Sept. 23, 2010, have been amended to include the women’s preventive requirements.
Grandfathered policies were issued before Sept. 23, 2010.
Between 45 and 49 percent of BCBST individual members are non-grandfathered and will have the provisions.
“The variance revolves around the number of guaranteed issue members who are grandfathered vs. non-grandfathered,” Ramsey said.
A guaranteed issue member is one who is not subject to pre-existing condition clauses or other limitations and is covered regardless of health status, leaders said.
Another provision of the plan that went into effect this week means that some Americans will start getting refunds from insurance companies that spent too much on administrative expenses as opposed to medical care.
The law requires insurers to spend at least 80 percent of premiums on medical care, not on salaries or other overhead costs, according to NBC News.
In 2011, BCBST spent 76.6 percent on health care, Allen said.
Aug. 1 was the deadline for insurers nationwide to pay rebates.
BCBST has already sent $8.6 million to individual policyholders, Allen said.
“We did not have to rebate small or large group employers,” she said. “Overall, the rebate is a small percentage of the individual policy premiums paid by our members—less than 3.4 percent. The amount represents the difference between the medical loss ratio threshold of 80 percent required in the law and the 76.6 percent medical loss ratio that BlueCross achieved in 2011 for this market segment. Although we work diligently to predict the usage of services by our members, it can be difficult to predict when setting premiums.”