I wanted to provide you an update of the changes we anticipate in the individual health insurance market for the Jan. 1, 2016, open enrollment.

First - if you have a grandfathered health insurance policy (you have maintained your same plan since prior to March 23, 2010) - the below Changes Will Not Affect Your Policy. You may keep your grandfathered plan for 2016.
For anyone who made policy changes after March 2010, or purchased an ACA compatible plan in 2014 or 2015 the following applies:

In August, BCBS announced that they will NO LONGER OFFER ACCESS TO THE BLUE CHOICE PPO NETWORK in Texas for the individual health insurance policies (again - does not apply if you are grandfathered with an older plan issued before March 2010.) You should have received a notice from BCBS in September explaining the network changes.

BCBS will be terminating their current individual policies accessing the PPO network effective Dec. 31, 2015, and replacing the PPO plans with policies utilizing their HMO and HMO Plus networks.

- BCBS HMO Network (Blue Advantage)
Must choose a Primary Care Physician and will need to obtain a referral to visit any specialist.
No coverage outside of the network.

- BCBS HMO Plus (Blue Advantage)
Must choose a Primary Care Physician and will need to obtain a referral to visit a specialist.
There is coverage outside of the network - however you still must obtain a referral. Out-of-network claims will be subject to higher out-of-pocket costs. This plan is considered a POS (Point Of Service) plan.
The individual plan designs and rates for 2016 will be available November 1st, when the ACA individual open enrollment begins.  In order to receive a January 1, 2016 effective date - you must enroll in a new plan by December 15th. If you enroll after December 15th, you will not have coverage until February 1.  So it is VERY IMPORTANT THAT YOU ENROLL BY DEC. 15th. This is an ACA rule, and is true for all plans and carriers.

We are monitoring all the individual health insurance carriers offering coverage for the 2016 open enrollment, but will not have access to the rates or plan designs before November 1st.

AETNA - has a very small network and reduces access further for anyone on a subsidy (On Market/On Exchange)

CIGNA - Will be moving from the small Local Plus PPO network to a Baylor Scott & White network. We anticipate Baylor Scott & White direct to be a more affordable option.

HUMANA - They announced in late August that they will only be offering a high deductible $6,000 BRONZE HSA Plan. And, it will use their national PPO network. May be a viable option for anyone looking for catastrophic health insurance.

UnitedHealthcare One - UHC may be a viable option this year. They utilize their Choice PPO Network for their individual product. It is an EPO (Exclusive Provider Organization) - which limits care to IN-NETWORK only. The Choice network is only available to individuals that Do Not Receive a Subsidy in the federal Marketplace. If you receive a subsidy from the government thru - you have access to the smaller PPO network, called COMPASS. Again, we are waiting until Nov. 1 to review plans and rates for 2016.

BAYLOR SCOTT & WHITE - They are ramping up this year and should be competitively priced. They have their own HMO Network, which utilizes Baylor facilities and doctors. Their HMO plan is a point of service (POS) plan that does not require a gatekeeper (Primary Care Physician) referral, and you can use any doctor (including specialist) in their network.  They also have limited coverage if you go outside the network.  If you are comfortable with limiting your provider options to the Baylor facilities, this may be the most cost effective option.

Oscar Health will be new to Texas for 2016. They will also be using the Baylor Scott & White network, but only for residents in Dallas, Tarrant and Collin counties. We recommend accessing the Baylor Scott & White network direct with Baylor Scott & White until we have a little history with Oscar Health.

If you have a business entity, you may want to consider a small group health plan that will provide access to your current PPO network.  The ACA permits a couple to purchase group health insurance if the individuals are employees, partners or officers of a business.  This may be the best option for those who have a business entity.

We recommend that you start checking with your physicians to determine which networks they accept, and if you are considering an HMO, be sure that you can get the Primary Physician of your choice and that they are accepting new patients.  

The NEW REALITY is that there will be less choice in 2016 for individual health insurance policies. Individuals will have to choose a plan and choose to use the doctors covered in that plan.  In other words, you may not be able to keep your current doctor.  That is a big change from the last 15 years, where the large carriers offered large PPO networks.  You should be pro-active NOW and determine if your doctors are in any of these networks, so you can narrow down which plans and networks will work for you.  Remember, once you sign up you may only make a change at the next open enrollment, so if you choose the wrong plan, you may be locked-in until next year.

After November 1st, you may access the plans, rates and enroll from our website:

Our site provides links to:
  • All the major health insurance companies offering coverage in Texas
  • Quotit a multi-carrier "Off Exchange" quoting and enrollment site 
  • INSX a multi-carrier "On Exchange" subsidy eligible enrollment site
  • MediShare a Christian Healthcare Sharing Ministry
  • Healthiest You an affordable teledoc discount Rx coupon service for individuals and families
Please feel free to contact us after November 1st, when we will be better equipped to answer your questions.
I appreciate your using us as your Agent and your patience during this busy time of the year. Keep in mind your rates are not affected by using an agent.

Thank you, 
George Knox, CLU, ChFC
214.695.2904 (mobile) 214.443.1400 (office) |

Please Note: The information and materials herein are provided for general information purposes only and are not intended to constitute legal or other advice or opinions on any specific matters and are not intended to replace the advice of a qualified attorney, plan provider or other professional advisor. This information has been taken from sources which we believe to be reliable, but there is no guarantee as to its accuracy. In accordance with IRS Circular 230, this communication is not intended or written to be used, and cannot be used as or considered a 'covered opinion' or other written tax advice and should not be relied upon for any purpose other than its intended purpose.
The information provided herein is intended solely for the use of our clients and members. You may not display, reproduce, copy, modify, license, sell or disseminate in any manner any information included herein, without the express permission of the Publisher. Kindly read our Terms of Use and respect our Copyright.
2015 HR 360, Inc. - All rights reserved

Like us on Facebook   Follow us on Twitter