New legislation amended this week, SB 133 by Senator Hernandez, will protect patients from losing their doctor during treatment, including when an insurer pulls out of a region, forcing the patient to switch health plans. Due to the uncertainty created by Congress and the Trump Administration, two insurers, Anthem Blue Cross and Cigna, are pulling out of the individual market in many of their coverage areas for 2018. This will leave over 300,000 health consumers in need of finding a new insurance provider next year, and possibly having to change providers. These insurers’ abdication of Covered California and the individual market means many patients are worried, through no fault of their own, if they can keep their doctor.
A Californian going through pregnancy, chemotherapy, or other condition shouldn’t have to switch providers and disrupt their care mid-treatment. Our state already has strong consumer protections to ensure patients who are in the middle of treatment for a serious condition are allowed to complete their care with their current doctors and hospitals, but these protections do not extend to those in the individual market. SB 133 will close that loophole.
Californians should not suffer because of federal actions causing instability in the health insurance market. The California Legislature must act now to protect these patients so they get the continuity of care they need.
On August 1st, 300,000 California consumers who get health coverage from Anthem Blue Cross found out they must switch health plans for 2018 because Anthem is pulling out of 16 of 19 regions in California’s individual market. These consumers purchased Anthem coverage both on-exchange through Covered California (153,000 people) and off-exchange (151,000 people). In addition, 5,000 consumers with coverage through Cigna must also switch to a new health plan because Cigna is also exiting the individual market. These consumers face serious disruptions in their care because their doctors may not be in their new health plan’s network.
Patients with the following health conditions can get continuity of care protections:
- Acute condition – care will be provided as long as the condition lasts;
- Serious chronic condition – care will be provided for not more than 12 months and until a period of treatment is completed and you can transfer care to another doctor;
- Pregnancy – care will be provided during pregnancy and three months after delivery (post-partum period);
- Terminal illness – care will be provided as long as the person lives;
- Child under 3 years old – care will be provided for up to 12 months; and
- Already Scheduled surgery or procedure – care will be provided as long as the surgery or procedure was scheduled to happen within 180 days of your doctor or hospital leaving your health plan.
SB 133, deemed “Jasmine’s Law” for Jasmine Winning, a two-year-old girl who suffers from Heterotaxy and a Hypoplastic Left Heart and whose family is currently covered by Cigna, will ensure people will not face disruptions in care and will have time to transition care if needed. SB 133 would also add clear protections for people awaiting a major transplant and will, for the first time, require that consumers are given notice of the availability of these consumer protections.
Health Access California is conducting a survey to hear from families who are impacted by Anthem or Cigna leaving the market in California. See the survey here: https://www.surveymonkey.com/r/AnthemCoverage
Learn more:VIEW THE FILE Individual Market