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About Jay Norris

Jay operates a health insurance brokerage in Colorado, where he helps individuals and small groups obtain and maintain health insurance coverage.
Complimenting his work as a health insurance broker, Jay is also a data analyst working to create visualizations that are easily understood by consumers and other stakeholders in Colorado’s health insurance market.

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Recent posts by Jay Norris
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Colorado Selects Kaiser Permanente As Its Benchmark Health Insurance Plan

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Last December, HHS made it clear that they were giving states a lot of flexibility in determining what plan would serve as the benchmark for the state’s “essential benefits” for individual and small group health insurance policies that would be sold starting in 2014.

After months of consideration, Colorado has selected Kaiser Permanente’s small group plan as a benchmark.  This is the largest small group plan in the state, with almost fourteen thousand members, and was selected by a group of officials from the Colorado Division of Insurance, the Governor’s office, and the health benefits exchange.  The Division of Insurance will be taking comments until next Monday before making a final announcement, and you can contact them by email ([email protected]) if you’d like your comments to be considered.

The Kaiser plan covers services in the ten areas that are required by the PPACA (ambulatory patient services, emergency care, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription medications, rehabilitative services, lab work, preventive care/disease management, and pediatric care), which means that it will serve as a benchmark for services in those areas without the DOI having to add additional coverage minimums.  In addition, the Kaiser plan was generally considered to be a good balance between comprehensive coverage and affordable coverage.  It’s not the most comprehensive policy out there (the much maligned “Cadillac plans” offer more benefits), but it provides […]

Low Deductible Still Required To Waive CSU Student Health Insurance

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I’ve been getting a lot of questions from CSU graduate and international students. I just confirmed with the Colorado State University (CSU) Health Network that they’re not budging (much) on the requirement that graduate and international students have a $500 deductible if they want to waive the CSU Student Health Insurance. The person I talked to did mention they might allow a $1000 deductible if the student can prove sufficient financial resources to pay such a large bill.

Meanwhile, the CSU Student Health Insurance Plan has a policy year limit of $250,000 per accident/illness. It’s much better than a mini-med, but they still have a reputation for getting maxed out. I asked if they’ve ever had a student hit the limit (like has happened at other schools), and she said she could only think of one minor case when the student was able to wait until the next calendar year when the benefits started over.

The CSU Health Network is a really great organization though, if it weren’t for the low cap on benefits. They have top notch providers and are very friendly and helpful.  And on January 1, 2014, even university health insurance plans will be required to not have a cap on benefits because of the Affordable Care Act.

I Thought Insurance Companies Couldn’t Decline Due To Pre-Existing Health Conditions Anymore?

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One of the most common questions lately: I was declined for health insurance due to a pre-existing health condition. I thought insurance companies couldn’t look at our pre-existing health conditions anymore because of [the PPACA] ObamaCare?”

I’ve written a quick (yet detailed) answer to the question: “I thought they couldn’t decline people because of pre-existing health conditions” here.

Colorado Health Insurance CO-OP Receives Loan From HHS

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At the end of July, the first of Colorado’s health insurance CO-OP plans got a $69 million loan from HHS as part of a push by the ACA to develop consumer-owned-and-operated health insurance plans (“CO-OP” is short for Consumer Oriented and Operated Plans).   The CO-OP is sponsored by Rocky Mountain Farmers Union and the bulk of the loan from HHS will be put in reserve to fund claims expenses for initial enrollees. As premium dollars are collected, the loan will be paid back to HHS.

Colorado Senator Irene Aguilar introduced a bill last year to create a state-wide Colorado health insurance co-op, but the bill was tabled in May 2011 after passing its second reading in the Senate.

The new CO-OP being created with the loan money will be especially focused on rural areas of Colorado – which are generally underserved in terms of health insurance options.  In addition, residents in rural areas are often already familiar with the concept of co-ops for other services like utilities.  So a Colorado health insurance plan that is owned and operated by its members should be an especially good fit.

The CO-OP will begin marketing plans next fall with policy effective dates starting January 1, 2014, and is hoping to enroll 10,000 Colorado residents in its first year.  Unlike most commercial health insurance plans available in Colorado, the CO-OP will be able to direct profits back into the plan in the form of lower premiums and/or higher quality service rather than sending profits to shareholders.  And while most health insurance carriers that do business in Colorado are multi-state organizations, the CO-OP will be a local plan based here in Colorado (Rocky Mountain Health Plans is another example of a local, non-profit health insurance option for people in Colorado).

The CO-OP expects to be available both through the Colorado Health Benefits Exchange (aka “the exchange”) and also via independent health insurance brokers and agents.  An innovative new health insurance product – especially one that strives to serve populations that are underserved by our current health insurance industry – is good news for Colorado, as it should foster more competition among the existing health insurance carriers in the market.  Congratulations to Rocky Mountain Farmers Union for the approval from HHS for the loan to get the CO-OP going!

5280 Magazine Needs Denver Area Self-Employed for Health Insurance Article

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Are you a Denver area resident who’s self-employed and had to navigate getting individual health insurance? Or do you fall somewhere in this description—“the self-employed, freelancers or ‘accidental entrepreneurs’ who started their own business or began doing freelance/contract work after being laid off from full-time positions during the economic turmoil of recent years”?

I’m writing a short article for 5280 magazine and would like to talk to about your experience. I would ask a few questions and potentially use a few short quotes. It should take about 10-15 minutes. I would be glad to speak at your convenience, but it will need to be during the week of July 30. You may contact me at [email protected] or 719-649-3634.

Walgreens, Anthem Blue Cross Express Scripts Agreement Reached

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Express Scripts and Walgreens have come to a multi-year agreement for Walgreens to participate as an in-network retail pharmacy. Anthem Blue Cross Blue Shield of Colorado members will be able to use their prescription drug benefits at Walgreens locations beginning Sept. 15, 2012.

Walgreens was in a situation where it needed to get this deal figured out. They were losing millions, not just in prescription drug sales, but the people who weren’t in the store filling their prescriptions also weren’t in the store to buy juice, toilet paper, grills, etc…

ACO Downsides

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Attorney Nina Kallen hosted this week’s Cavalcade of Risk, and it included a couple of interesting entries about the Facebook IPO. Given that we write about health insurance, I especially liked Dr. Jaan Sidorov’s article comparing Facebook and ACOs. His verdict? Well, you’ll have to read his article to get the details, but he’s not particularly impressed with either one. I tend to see ACOs in a relatively positive light, and I think they have a lot of potential for cost savings and creating more of a teamwork dynamic between providers and health insurance carriers. But Dr. Sidorov makes some good points about the potential downsides. As usual, good food for thought from the Disease Management Care Blog.

Anthem Introduces New Accident And Critical Illness Benefits In Colorado

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[…] For individuals and families who are healthy and rarely need their health insurance benefits, an accident may be their primary concern. Obviously we’re all susceptible to illness aswell, but accidents have a more “out of the blue” quality to them, and can happen to even the healthiest of people. We’ve never needed our health insurance due to illness, but we’ve had a few injuries over the years that have been pretty costly. Stitches and x-rays on our son’s finger alone came to $1,400. The charges can add up quickly when you’re in an emergency room, and if you have a high deductible health insurance policy, you’d be responsible for the entire bill for an incident like that. An accident supplement that will cover all or a portion of the deductible can help people feel more at ease with a high deductible (ie, less expensive) health insurance policy.

The accident supplement portion of Balance will coordinate with your health insurance, so it will pay you either your out-of-pocket amount or the Balance benefit maximum, which ever is lower. For example, if your out-of-pocket expenses for an accident – after health insurance has paid its portion – come to $1750 and you have the $2500 benefit Balance plan, you’ll get $1750 in supplemental coverage. But if your out-of-pocket expenses come to $4500, you’ll get the full $2500. The critical illness benefit is a lump-sum payment, but the amount paid depends on the specific diagnosis.

With the introduction of Balance, Anthem Blue Cross Blue Shield has added another solid plan to the options available for individuals and families in Colorado who are looking for an accident and critical illness supplement to go along with their health insurance policy.

Best Health Insurance Companies In Colorado

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We recently got a call from a client who mentioned that he had done a Google search for the “best health insurance companies in Colorado” and his concern was that Anthem Blue Cross Blue Shield was not on the top ten list that he said came up as the first search result.  We were a… Read more about Best Health Insurance Companies In Colorado

Kaiser Will Soon Be Available In Northern Colorado

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[…] The new Kaiser facilities will be in Fort Collins at Harmony and Ziegler, and in Loveland at I-25 and Hwy 34. For hospital services, Kaiser is partnering with Banner Health and members will be able to use McKee Medical Center in Loveland and North Colorado Medical Center in Greeley. The medical offices in Fort Collins and Loveland will offer a wide range of services (primary care, lab work, pharmacy, and x-rays, and mammograms will be available at the Loveland office), and are expected to begin providing care by the fall of 2012. A medical office is projected to open in Greeley by 2014. Between now and then however, northern Colorado Kaiser members will be able to see doctors at the Fort Collins and Loveland offices, as well as physicians on the Banner Health network.

Kaiser is planning to offer group coverage to employers in northern Colorado by October 1, 2012. Individual and family coverage should be available sometime next year.

IRS 2013 HSA Contribution Limits

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The IRS announced that the 2013 HSA contribution limit for an individual would increase by $150, from $3,100 to $3,250. The family contribution limit is increasing from $6,250 to $6,450 (+$200).

The maximum annual out-of-pocket increased as well. The individual out of pocket maximum is going from $6,050 to $6,250. The family out of pocket maximum is increasing from $12,100 to $12,500.

The minimum deductible on an HSA qualified plan also increases from $1,200 to $1,250 for individuals and increases from $2,400 to $2,500 for families.

What are the 2012 HSA Contribution Limits?

According to the Patient Protection and Affordable Care Act, OTC drugs may be reimbursed only if there is a prescription.

Non-medical withdrawals from an HSA are taxable income and subject to a tax penalty, which increased from 10% in 2010 to 20% in 2011 and remains the same for 2013.

Exception to the IRS tax penalty for non-medical withdrawals:
The tax penalty does not apply if the withdrawal is made after you:
1) Attain age 65;
2) Become totally and permanently disabled; or
3) Die.

More details and research about HSAs and HSA qualified plans.

Despite IT Problems, Report Gives Colorado High Marks On Exchange Progress

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[…] On the upside, the Urban Institute report gives Colorado props for making good overall progress on setting up the health benefits exchange. Despite the political hot seat that health care reform has been for the past few years, Colorado lawmakers managed to work together to create the framework for our health benefits exchange last year. We have a board of directors in place and the state is moving forward as fast as possible to get things in place for the exchange to be up and running in 2014. A lot is still unknown with regards to the future of the ACA, since the Supreme Court still has to issue their ruling in June regarding the legality of the individual mandate. But if the ACA remains in place and the health insurance exchanges become reality across the country, it’s safe to say that Colorado will be ahead of the curve in terms of getting the bugs ironed out.

The Urban Institute report notes that Colorado had a head start on a lot of the reform issues thanks to the 2008 Blue Ribbon Commission Report. Remember back when that was the big news in health care reform in Colorado? Before health care reform became such a divisive topic across the country, Colorado was working to come up with solutions to many of the problems with our health care system. Some of the recommendations of the Blue Ribbon Commission are very similar to the new guidelines in the ACA, and Colorado had been taking active steps for the past four years to implement the Blue Ribbon recommendations. If the ACA remains in place, it should be a bit easier for Colorado to make the necessary transitions over the next few years, thanks to the progress the state has already made on its own.

Health Wonk Bloggers Think The Supreme Court Will Rule In Favor Of The ACA

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[…] When I browsed around on most of the mainstream media regarding the Supreme Court and the ACA, I kept seeing predictions that the Court will ultimately find the individual mandate unconstitutional and either strike down that part of the law or return the whole ACA back to congress for a re-do (based on perceived negativity towards the law on the part of the Justices). But interestingly enough, all three blog posts in the HWR that dealt with this issue had the opposite opinion (and of course, at this point, all we can do is speculate and have opinions – nobody really knows how the Court will rule). They all take the position that the court is likely to rule in favor of the ACA and the individual mandate, or at least that the reports saying that the mandate is doomed are greatly exaggerated.

Sage’s article also notes that the Justices seem to be well aware of the problem of adverse selection (an issue that we’ve written about numerous times – guaranteed issue without a mandate either results in significant adverse selection or exorbitant health insurance premiums and few options for coverage). This is one of the major concerns that arises if we talk about doing away with the individual mandate, so it’s good that the Supreme Court is taking it into consideration (Sage notes that the lower courts didn’t seem to do so).

Now we just have to wait three months to see who’s right.

Colorado Child-Only Open Enrollment Details For January 2012

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The next open enrollment for child-only policies is almost here, so I thought it might be helpful to provide some specific details in terms of what policies are available and what parents should expect when submitting child-only applications next month.

The first open enrollment window in 2012 will be the month of January. Applications for child-only policies have to be submitted between January 1 and January 31. Application not submitted by the end of January will have to wait and re-submit in July, which is the second open-enrollment period of the year. For most carriers, each child in a family will have to have a separate application.

All eligible child-only applications submitted during the open enrollment period are guaranteed issue, so the child cannot be refused coverage. However, the applications are still medically underwritten and the rate can be increased by up to 200% based on the child’s medical history (so if the standard price is $100, the policy could actually be assigned a rate of $300, which is equal to a 200% rate increase).

Colorado Senate Bill 128 requires all Colorado health insurance carriers that offer coverage for adults to also offer child-only plans during the two annual open enrollment windows. But the bill does not require carriers to provide guaranteed issue coverage for children who are eligible for health insurance from another source (other than a high risk pool like CoverColorado or GettingUSCovered – see the bottom of page 4).

Most Colorado carriers have selected one or two plan designs that will be available for child-only applications next month. To give you an idea of what is available in Colorado for child-only coverage, we’re providing information here regarding child-only options from six of the top individual health insurance carriers in the state. […]

Access To A Mini-Med Group Plan Does Not Prevent CoverColorado Enrollment

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[…] The person I spoke with at CoverColorado checked with a supervisor and then told me that mini-meds are an exception to CoverColorado’s rule banning eligibility for people who have access to group health insurance. In order to qualify, the applicant has to provide the usual proof of eligibility along with proof that their employer’s group health plan is a mini-med. This can be the declarations page from the policy or marketing materials for the plan (which now have to include language indicating that the plan has been granted a waiver by HHS and does not meet the minimum benefit requirements defined by the PPACA).

Hopefully this will clarify things for others in a similar situation. Normally, access to a group health insurance policy (even if it’s one you don’t like or your doctor isn’t on the network, etc.) makes a person ineligible for CoverColorado. But if that group plan happens to be a mini-med and you also meet the other eligibility criteria for CoverColorado, you can submit an application to CoverColorado.

Kaiser Permanente Announces Plans to Add Coverage in Fort Collins, Loveland and Greeley

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Yesterday, Kaiser Permanente filed for approval with the Colorado Division of Insurance to offer health care coverage in Northern Colorado beginning in late 2012. This expansion will include new Kaiser Permanente medical offices in Fort Collins, Loveland and Greeley, a contracted network of community providers and an exclusive hospital agreement with Banner Health hospitals and physicians. Technically, people in Loveland zip codes can already get coverage with Kaiser, but the closest facilities are in Longmont.

We don’t know yet if this expansion will include coverage for employer group as well as individual/family plans. For example, Kaiser has coverage in Colorado Springs, but only for employer groups. Individual/family coverage for Kaiser is limited to the south Denver metro area up through […]

Kaiser Permanente Colorado Gets Top NCOA Ranking

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Kaiser Permanente Colorado is the highest-rated private health insurance plan in Colorado and one of the top-ranked private health plans (#6) in the nation for clinical performance and effectiveness, as well as member satisfaction, according to new rankings by the independent, non-profit National Committee for Quality Assurance (NCQA).
Kaiser is one of the top 10 plans in the nation in 36 of the 40 health outcome measures, recognizing high quality clinical care

Walgreens Leaving Express Scripts Network

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If you’re insured through Anthem Blue Cross Blue Shield or another carrier using the Express Scripts network, Walgreens will be leaving the network on January 1, 2012. Express Scripts just posted on their website:
“At Express Scripts, we’re committed to keeping your prescription drugs affordable and accessible. That’s why we negotiate cost-competitive agreements […]”
Express Scripts is sorry that Walgreens did what they did and has expressed sincere regret about the situation:
“We regret any inconvenience that Walgreens’ actions have caused you. If you have any questions, please call us at 1.877.885.3409.”

Accepting Grand Rounds Submissions

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We’re honored to be hosting the next Medical Grand Rounds on October 4th, our fourth time to host! Grand Rounds is a weekly gathering of the best health and medical articles written by doctors, nurses, students, patients, and others in health care related professions.

IRS 2012 HSA Contribution Limits

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The IRS announced that the contribution limit for an individual would increase by $50 in 2012, from $3,050 to $3,100. The family contribution limit is increasing from $6,150 to $6,250 (+$100).

The maximum annual out-of-pocket increased as well. The individual out of pocket maximum is going from $5,950 to $6,050. The family out of pocket maximum is increasing from $11,900 to $12,100.

The minimum deductible on an HSA qualified plan remained the same, $1,200 for individuals and $2,400 for families.

For more details about HSAs and HSA qualified plans, visit our HSA page.

Filed Under: HSA

United HealthOne Finally Changes Initial Charge Protocol

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Good news for those applying to United HealthOne:
Beginning with applications received on March 24, 2011, the processing of credit card or EFT payment will not take place until the application is approved and issued.
It’s about time. It was tough to explain to clients “and yeah, they’re going to charge you before they’ve even made a decision.”

Aetna Withdrawing from Colorado Individual Health Insurance Market

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Aetna no longer offers health insurance plans for individuals, families and the self employed plans in Colorado.  Their explanation: After reviewing our portfolio of Individual health insurance plans in Colorado, we determined we can no longer meet the needs of our customers while remaining competitive in the individual health insurance market. While this decision was not… Read more about Aetna Withdrawing from Colorado Individual Health Insurance Market