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WDAY: The News Leader

Published November 08, 2013, 12:34 PM

Thousands in North Dakota face switch in health care coverages

FARGO – Thousands of customers in North Dakota must switch health coverage because their plans are being discontinued due to new requirements under the Affordable Care Act.

By: Patrick Springer, Forum News Service, INFORUM, Forum News Service

FARGO – Thousands of customers in North Dakota must switch health coverage because their plans are being discontinued due to new requirements under the Affordable Care Act.

The three major health insurers in North Dakota were required to report to state regulators their enrollment figures and cancellations under the health reform act, commonly known as Obamacare.

The state’s largest health insurer, Blue Cross Blue Shield of North Dakota, covers about 31,600 members – 17,000 in small groups and 14,600 individuals – whose insurance plans are being discontinued.

That combined figure represents 8 percent of the North Dakota Blues’ 400,000 membership total.

The Sanford Health Plan sent discontinuation notices to 450 members, all individuals, whose insurance plans did not meet the new coverage qualifications, which take effect Jan. 1.

That represents about 50 percent of the Sanford Plans individual policyholders in North Dakota, said Ruth Krystopolski, president of the Sanford Health Plan.

Most health insurance plans that existed when the law was passed in 2010 are eligible under a “grandfather” status, and therefore do not have to meet all of the requirements of the health care law, health insurers said.

But health insurance plans that made a major change and no longer comply with the Affordable Care Act, or plans purchased after March 23, 2010, are not eligible for the “grandfather clause” exemption.

The Sanford Health Plan did not begin selling policies in North Dakota until late 2010 or early 2011, so none of its coverage plans qualified for the “grandfather clause” exemption, Krystopolski said.

Also, certain requirements under the new law, such as limits on deductible, “out-of-pocket” payments, were not available to insurers until late last year, she said.

“We were working in the blind,” Krystopolski said, continuing to sell policies without knowing all of the new requirements.

“We sold what the market requested,” she added, noting that some customers preferred high-deductible plans with lower premiums.

Nationally, estimates of the percentage of policies that will be discontinued under the new coverage requirements have ranged from 40 percent to 67 percent, Krystopolski said.

In most cases, plans failed to meet the new requirements because they did not cover maternity care or because the deductibles were too high, she said.

Discontinuation figures were not immediately available for North Dakota’s remaining major health insurance provider, Medica.

Because of the major changes, Blue Cross Blue Shield has been trying to educate its members for the past two years, including notifying groups and individuals whose insurance plans do not meet the new coverage requirements.

The North Dakota Blues has and will continue sending out notification letters to affected members at least 90 days before their plans end, according to Andrea Dineen, a spokeswoman for the insurer.

Sanford mailed out its notification letters this week, and most members already should have received the notices, or will soon, Krystopolski said.

For more on the story read Saturday’s Forum.

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