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North Bay Business Journal

Monday, February 4, 2013, 6:25 am

Insurance: Partnership Health seeks further expansion

Also: Covered California plans to spend $43 million on outreach

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    Dan Verel, Business Journal Staff ReporterPartnership Health Plan of California, a Fairfield-based managed Medi-Cal plan, has petitioned the state for further expansion, hoping to include seven Northern California counties in addition to the six North Coast counties already in its network.

    Dave McCallum

    The nonprofit health plan recently announced it would expand into Lake County, which will become effective June 1, according to Dave McCallum, a spokesman for Partnership. The additional counties targeted for expansion include Del Norte, Siskiyou, Modoc, Lassen, Shasta, Trinity and Humboldt.

    If approved, the expansion would add approximately 98,000 new members to the health plan, on top of its current 200,000 members. The company expects to hear back from the state by mid-February on the planned expansion.

    Currently, the health plan contracts with Solano, Yolo, Napa, Marin, Sonoma and Mendocino county government agencies.

    Partnership’s reimbursement to physicians includes a fee-for-service payment, capitation and additional incentives for taking on Medi-Cal recipients, versus a predetermined, non-negotiable state reimbursement.

    ***

    Woodruff Sawyer & Co. of Novato is holding an seminar to discuss health care reform for employers, with subject matter including compliance with the Affordable Care Act, the California State Exchange and private exchanges, benefit design strategies, major employer issues for 2014, and other matters.

    Speakers include staff from Woodruff Sawyer’s Novato branch and Paul Fearer, a board member for California’s state exchange, Covered California.

    The seminar is Feb. 12, from 8 a.m. to noon, at the Sheraton in Petaluma. More information can be found at www.wsandco.com.

    Kristina Keck

    Meanwhile, Kristina Keck has joined Woodruff-Sawyer & Co. in the firm’s employee benefits practice as account executive, retirement plans. In her new role, Ms. Keck will serve as a lead consultant in the capacity of investment reporting and annual plan compliance, focusing on 401(k) planning in the North Bay where she resides and also in the San Francisco market

    Ms. Keck will also serve as the lead consultant with regards to employee enrollment and participant investment education services.

    She has 20 years of experience consulting in the retirement plan and pensions market. She began her career in that field at Northwestern Mutual Life. Prior to joining Woodruff-Sawyer, she worked as an accredited investment fiduciary, retirement plan consultant and investment advisor representative with ClearPoint Financial.

    In addition to her career in the financial services and retirement plans industry, she spent seven years as a force status controller with the United States Air Force, and continues her service today as a member of the Air National Guard.

    ***

    Covered California, the state’s insurance exchange set up under health care reform, plans to provide grants totaling $43 million for community groups to help spread the word of the exchange and how it will work.

    Roughly $40 million has been allocated for outreach regarding individual coverage, with the remaining $3 million going toward outreach for the small businesses, according to the California Healthcare Foundation.

    Community groups such as faith-based organizations, nonprofits and city and county governments are eligible to apply if they can show the exchange what their target audience for outreach will be, along with how to reach them.

    A webinar has been scheduled for Feb. 6 and applications are due March 4. More information can be found at www.hbex.ca.gov.

    ***

    Insurance experts have questioned whether the penalty levied on individuals and business for not obtaining health insurance as part of the Affordable Care Act would be enough of an incentive, but a recent report in the Journal of the American Medical Association found that would be.

    The penalty stems from the bill’s individual mandate, which requires those without employer-sponsored health plans to purchase health insurance or face a fine.

    Beginning in 2014, when most of the bill takes effect, the penalty will be$95, or 1 percent of household income, whichever is greater. But, come 2016, that fine will increase to $695 per resident or 2.5 percent of household income, whichever is greater. And in 2017, a cost-of-living adjustment will be included, and residents will be exempt from the penalty if the least expensive health plan costs more than 8 percent of total income.

    That should be sufficient in spurring individuals to purchase a health plan, according to the American Medical Association.

    In its analysis, the Association noted the effectiveness of a similar penalty in Massachusetts. The federal penalty will be stricter than the state’s $537 penalty, enacted in 2006. Once the fine was in place, the state’s health care system was able to expand the pool of patients, which helped offset the cost of one sick person with three healthy residents.

    Insurance experts have maintained that the mandate is necessary for the federal bill to work — without the expanded patient base, or pool, only the sickest and most expensive to treat patients would opt in, which in turn would be too costly to work.

    There is still concern, though, that younger, healthier individuals will prefer to pay the fine over purchasing a health plan, at least initially, according to the analysis.

    Businesses with more than 50 employees will have to pay a fine of $2,000 for every full-time worker who doesn’t receive benefits.

    Submit items for this column to Business Journal Staff Writer Dan Verel, dan.verel@busjrnl.com or 707-521-4257.

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