Why does Blue Cross of California offer an individual conversion
policy (policies where someone moving to
California from another state where they have a Blue cross policy, or
a Blue Cross/Blue Shield policy and are automaticall offered a policy
in California without having to go through the underwriting process).
Are they required to by law Is it in their bylaws? What laws require
them to do this. What are the rules and regulations governing this?
Where can I get more detailed information?

Hello lew1234-ga,

This is a complicated question and there may be variables about your
situation that I don?t know that might affect my answer. Please be
sure to ask for clarification if what I?ve provided leaves out some
aspect of your question.

Individual health insurance conversion policies are covered by Federal
and State laws and regulations. Coverage by Blue Cross/Blue Shield is
governed by the provisions of the national and regional plan
offerings.

Blue Cross and Blue Shield are part of an association of independent
health plans that have some agreements about interplan transfers and
coverage policies. The first part of your question seems to ask about
how such policy transfers are governed between states. My research
seems to indicate that each Blue Cross/Blue Shield plan has its own
rules about transferring from one plan to another. The information
I?ve found shows that some of these transfers do not have to go
through the underwriting process.

The next issue to address is the question of ?individual conversion
plans? and what laws and regulations apply to them. I believe this
part of your question is concerned with the Health Insurance
Portability and Accountability Act of 1996 (HIPAA) which provides for
portability and continuity of health insurance. This is a complex
Federal law that was further modified by many states, including
California. I?ve collected a variety of resources on how these laws
apply to Individual Conversion Plans. I?ve included links government
websites as well as some consumer information to help you explore this
topic in depth.

I trust that the information I?ve furnished will give you all the
details you?re looking for. Please don?t hesitate to ask for
clarification if any of this is confusing.

Wishing you well with your project.

~ czh ~


===================================================
BLUE CROSS AND BLUE SHIELD -- CORPORATE INFORMATION
===================================================

http://finance.yahoo.com/q?s=ath
Anthem Inc (ATH)

-------------------------------------------------


http://www80.anthem.com/jsp/antiphona/home.jsp
Anthem

http://www80.anthem.com/jsp/antiphona/corp/int_primary.jsp?content_id=PW_007413
Anthem History

The company known today as Anthem is the outgrowth of two
Indianapolis-based corporations formed in 1944 and 1946 as mutual
insurance companies. Those two companies were created to provide
health insurance to residents of Indiana as Blue Cross of Indiana and
Blue Shield of Indiana.

In the mid-1980s, the health care industry began rapidly
consolidating. Blue Cross and Blue Shield of Indiana wanted to find a
better way to serve their customers, and knew they needed to change in
order to do so. The company began to diversify and expand, primarily
through Blue Cross and Blue Shield mergers and acquisitions.

In 2001, Anthem demutualized and conducted an initial public offering
of common stock. Now a public company, Anthem is listed on the New
York Stock Exchange under the trading symbol ATH. Anthem is the fifth
largest publicly traded health benefits company in the United States.


=======================================
BLUE CROSS AND BLUE SHIELD HEALTH PLANS
=======================================

http://www.bluecross.com/
http://www.bcbs.com/whoweare/index.html
Blue Cross and Blue Shield Association

The Blue Cross and Blue Shield Association is the trade association
for the independent, locally operated Blue Cross and Blue Shield
Plans.

***** Use this website as your starting point for issues involving the
national Blue Cross/Blue Shield organization. Currently there are 41
local member companies ? two in California.

-------------------------------------------------


http://www.westernconference.org/general1.htm
History 1948-1995
The Western Conference of Prepaid Medical Service Plans

By 1954, the plans developed and adopted an Interplan Transfer
Agreement. Several years later, the Blue Shield organization concluded
a similar Agreement among its member plans.

***** This paper refers to the existence of an Interplan Transfer
Agreement among the Blue Shield plans. I was not able to find a
specific reference to this agreement on the Blue Cross/Blue Shield
Association website but I found many references from various Blue
Cross/Blue Shield plans that imply and confirm their existence. The
general rule seems to be that if you move and are covered by a Blue
Cross/Blue Shield health plan you can ask for a transfer of your
coverage to the new Blue Cross/Blue Shield provider in you new
location. This provider many have different coverage rules than the
provider in your old location. Your question seems to ask about
individual (rather than group) coverage to be continued in California
from another state.

-------------------------------------------------


http://www.bluecrossca.com/
http://www.bluecrossca.com/sitemap/
Blue Cross of California

Blue Cross of California, together with its branded affiliates,
provides health care services to more than 6.8 million members.

***** This is a comprehensive site that offers information for the
many constituents of the Blue Cross organization including members,
providers, brokers, employers, and visitors. Learn about health plans
under the Visitors tab.

-------------------------------------------------


http://www.bluecrossca.com/user_groups/visitors/Individual/
Plan Finder ? Individuals and Families

***** This page describes the various requirements for qualifying for
a Blue Cross policy. Click on the COBRA Comparison tab to find out
information about coverage options available when you have to convert
from group coverage to individual coverage. Your question did not
specify why you?re interested in conversion coverage. If your group
coverage has been terminated because

-------------------------------------------------


http://www.or.regence.com/agent/communication/notification/120503CompanionPlansMaterials.html
NEW OREGON COMPANION PLAN MATERIALS AVAILABLE / TRANSFER RULES
December 2003

***** This is Blue Cross Oregon website. It provides the rules of
agents on how to determine interplan transfer eligibility. I assume
that the California Blue Cross site has similar instruction but I?m
unable to confirm this since the California Blue Cross site requires
Agents/Brokers to log in. I hope that you will find the Oregon
instructions to be sufficient for illustrating the issues involved.

-------------------------------------------------


https://www.mylifepath.com/
https://www.mylifepath.com/bsc/home/home.jhtml
https://www.mylifepath.com/bsc/findaplan/ifp/
Blue Shield of California

Mylifepath.com is Blue Shield of California's online resource for our
members, employers, producers and providers.

***** This website offers you full information about the Blue Shield plans. 



===========================================================
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
===========================================================

http://www.dol.gov/ebsa/newsroom/fshipaa.html
Fact Sheet -- The Health Insurance Portability and Accountability Act (HIPAA)

The Health Insurance Portability and Accountability Act (HIPAA),
signed into law on August 21, 1996, offers new protections for
millions of American workers that improve portability and continuity
of health insurance coverage.

***** This is a good starting point for reviewing the Federal
legislation covering health insurance conversion laws and policies. Be
sure to check the Special Enrollment Rights section.

-------------------------------------------------


http://www.dol.gov/dol/topic/health-plans/portability.htm
U.S. Department of Labor
Health Plans & Benefits -- Portability of Health Coverage (HIPAA)

The Health Insurance Portability and Accountability Act (HIPAA)
provides rights and protections for participants and beneficiaries in
group health plans. HIPAA includes protections for coverage under
group health plans that limit exclusions for preexisting conditions;
prohibit discrimination against employees and dependents based on
their health status; and allow a special opportunity to enroll in a
new plan to individuals in certain circumstances. HIPAA may also give
you a right to purchase individual coverage if you have no group
health plan coverage available, and have exhausted COBRA or other
continuation coverage.

***** This website provides a wealth of resources for information
about health insurance portability and conversion of coverage in
certain situations.

-------------------------------------------------


http://www.cms.hhs.gov/hipaa/online/
HIPAA OnLine

http://www.cms.hhs.gov/hipaa/online/individual/coverage/Coverage_default.asp
HIPAA OnLine > Individual > Coverage

Welcome to HIPAA OnLine. This interactive tool, provided by the
Federal Government, helps answer your questions about health coverage
and your rights and protections under the Health Insurance Portability
and Accountability Act (HIPAA).

http://www.cms.hhs.gov/hipaa/online/individual/coverage/ChangingCoverage_default.asp
HIPAA OnLine > Individual > Coverage > Changing Coverage  

http://www.cms.hhs.gov/hipaa/online/modules/terms.asp?record=010512
Conversion Policy 
A conversion policy is an individual health insurance policy that you
may be able to get after losing group coverage. An insurance issuer
may allow you to ?convert? to an individual policy once you have lost
group coverage. This means you would still have a policy with the same
issuer, but it will be an individual policy. The benefits may not be
the same, and generally, the premiums will be more expensive.

Remember: If you buy a conversion policy, you no longer qualify as
HIPAA-eligible for purchasing individual coverage. Conversion policies
are individual policies, and you can only be HIPAA-eligible if your
most recent coverage was under a group health plan.

***** This is another good site to explore the HIPPA provisions that
apply to individuals who want to convert their coverage.


==============================================
CALIFORNIA ? DEPARTMENT OF MANAGED HEALTH CARE
==============================================

http://www.hmohelp.ca.gov/coverage/conversion/
Department of Managed Health Care

What I Need to Know About Individual Coverage If I Lose My Group Coverage
If you lose the group health care coverage provided by your employer,
there are several kinds of individual (non-group) health care coverage
you may be able to purchase as replacement coverage. Two types of
individual coverage provide special protections that you do not get
with traditional individual health care coverage. These two special
types of individual coverage are:

 -- Individual Conversion Coverage
 -- HIPAA Individual Coverage

***** This is the website for the State of California laws on
regulations on implementing the Federal HIPAA laws. Follow the links
to explore the issues you?re concerned about.

-------------------------------------------------


http://www.hmohelp.ca.gov/coverage/conversion/faq/default.asp
Department of Managed Health Care
AB 1401 Individual Conversion Coverage - Frequently Asked Questions

Are there any laws that protect my health care coverage when my group
coverage is terminated?

Yes. Federal law known as the Health Insurance Portability and
Accountability Act of 1996 (HIPAA) protects health insurance coverage
for workers and their families when they change or lose their jobs.
California law provides similar and additional protections.

Individual Conversion Coverage Under California State Law
As of September 1, 2003 if you lose group health care coverage you are
entitled to convert to individual health care coverage with the same
health plan, without evidence of insurability or (new) preexisting
condition exclusions, subject to certain conditions. This is commonly
referred to as "Individual Conversion Coverage." You are entitled to
purchase individual conversion coverage only from the same health plan
that provided your group coverage. This may be an HMO or a Preferred
Provider Organization ("PPO") product.

****** This is the specific section that addresses your question about
Individual Conversion Coverage.



==========================================================
BLUE CROSS AND BLUE SHIELD  -- INDIVIDUAL CONVERSION PLANS
==========================================================

https://www.mylifepath.com/bsc/findaplan/download/A16251.pdf
Shield Spectrum PPO Conversion Plan 2000 Summary of Benefits and
Provisions ? Effective January 1, 2004

https://www.mylifepath.com/bsc/findaplan/download/A16170_7-4.pdf
Conversion to Individual Coverage Request Form

https://www.mylifepath.com/bsc/findaplan/ifp/look/icp.jhtml
Individual Conversion Plan

Our Individual Conversion Plan, the Shield Spectrum PPO Conversion
Plan 2000*, is available to those whose Blue Shield group health plan
coverage is ending, or who are relocating to California and losing
Blue Shield or Blue Cross health plan coverage in another state.

For individuals who are relocating to California and losing Blue
Shield or Blue Cross health plan coverage in another state, we must
receive your application within 30 days of your transfer from another
Blue Cross/Blue Shield Plan outside California.

***** This is the provision that spells out the rules regarding
conversion of individual coverage when moving to California from
another state.


==========================
HIPAA CONSUMER INFORMATION
==========================

http://insurance.yahoo.com/lh/hipaa.hin.html
http://insurance.yahoo.com/lh/hipaa2.hin.html
The HIPAA Law: Your Rights to Health Insurance Portability

If you're worried about keeping your health benefits when you change
jobs, you should know about a federal law called HIPAA. It's the
Kennedy-Kassebaum Act, also known as the Health Insurance Portability
and Accountability Act of 1996, or HIPAA for short. While HIPAA offers
only little protection if you're switching from a group health plan to
an individual health plan, and even less if you don't have insurance
at all, it can help you from losing benefits you already have when you
move from one group plan to another.

HIPAA's rules apply to every employer group health plan that has at
least two participants who are current employees, including companies
that are self-insured. States have the option of applying the group
rules to "groups" of one, which some have opted to do ? a big bonus
for the self-employed. Some states also have enacted their own laws
protecting health care consumers, and in many cases they afford more
rights than federal law.

Unfortunately, there is one huge exception to HIPAA: It provides no
protection if you switch from one individual health plan to another
individual plan. That's what makes buying individual plans especially
difficult for people who have chronic medical problems ? the insurers
can simply turn them away time after time.

-------------------------------------------------


http://insurance.yahoo.com/lh/hipaa2.hin.html
Individual Health Plans and HIPAA

In some cases, you might not have the option of switching to a new
group health plan when you lose coverage under your old group health
plan. That could happen, for instance, if you work for a small
employer and it decides to discontinue health benefits because of
rising costs. If you have medical problems, that's enough to send you
into a panic.
But under HIPAA, you might be able to buy an individual health plan
without the threat of exclusions for pre-existing conditions. In order
to do so, you have to qualify as an "eligible individual" ? and the
rules are tougher than for group health plans.

In some cases, you might be offered a conversion plan when you lose
your group health plan coverage. That essentially lets you convert
your group plan into an individual plan, with certain restrictions. Be
careful choosing that option, though. Because conversion plans are
individual plans, once you buy it, you'll no longer qualify as an
eligible individual for the individual market.


***** This is an easy to read article on the HIPAA laws. See page two
for a discussion of individual plans.

-------------------------------------------------


http://www.healthinsuranceinfo.net/ca00.html
A Consumer?s Guide to Getting and Keeping Health Insurance in California

This guide describes your protections as a resident of California.
Chapter 1 gives an overview of your protections. Chapters 2 and 3
explain your protections under group and individual health plans.
Chapter 4 highlights your protections as a small employer. Chapter 5
summarizes help that may be available to you if you cannot afford
health coverage.


===============
SEARCH STRATEGY
===============

blue cross
blue cross California
blue shield
blue shield California
blue cross transfer plans
blue cross interplan transfer California
blue cross transfer requirements
blue cross continuing coverage requirements
hipaa individual conversion out of state

---

Request for Answer Clarification by lew1234-ga on 13 Jun 2004 10:39 PDT

Thank you so much. This has been very helpful. I was trying to find
out about what you're calling interplan transfers--from one state to
another. Is there any more information on what the California
guidelines are for offering plays? Is there a national BCBS
requirement that these plans be offered? I would like to be able to
read the requirements so that I can determine whether or not they are
being followed? Again, thak you very much--you did a wonderful job.

---

Request for Answer Clarification by lew1234-ga on 13 Jun 2004 10:53 PDT

The site you recommended at Oregon BCBS was about transpering from an
Oregon BCBS plan to one of their medicare suplemental plays. Is there
more about transpering from State to State?

---

Clarification of Answer by czh-ga on 14 Jun 2004 07:32 PDT

Hello again lew1234-ga,

Thank you for the clarification. Please tell me what state you are
leaving to move to California. Also, what type of plan were you
enrolled in and what type of plan are you transferring into. Are you
being transferred by your employer who had coverage under Blue
Cross/Blue Shield? Are they continuing group coverage? Were you under
an individual plan in the state you?re leaving? Which one? What type
of plan are you getting coverage for in California? You say, ?I would
like to be able to read the requirements so that I can determine
whether or not they are being followed.? Do you have any reason to
believe that the requirements have not been followed? The more
information you can share (without revealing you identity) the more
likely I can find exactly what you need. I look forward to your
clarification.

~ czh ~

---

Request for Answer Clarification by lew1234-ga on 14 Jun 2004 08:47 PDT

Thanks for your reply. I actually did this two years ago. I came from
an individual (not group) plan called HMO Blue in Massachusets. Now
I'm on a plancalled Californiacare Conversion. It is designated by the
number 1931. I have a preexisting condition that would exclude me from
coverage using the underwriting prosess so this plan and one other
were my only choice. By the way the Californiacare plan is in
California and is an individual plan. When I moved, it was very
difficult to find these plans. No one at Blue Cross seemed to know
about them. I had heard of this one, but even during the transfer
process, they said that they had never heard of it. Finally, I got my
lawyer to call and he was able to locate it and get me on it.

The plan in Mass was better in the sense that it had prescription
coverage and was much less expensive. Whenever I call the
Californiacare plan they don't know about my particular plan and tell
me that I have less benifits than I do. I have no direct reason to
believe that they did not follow the regulations, lawe, licensing
agreement, etc.; It's more of a feeling and a wanting to be sure. I've
done a lot of research and can't seem to come up with why they do
this.I don't think they're doing it out of the goodness of their
hearts so I think that it must be regulated somehow. Thanks again.

---

Clarification of Answer by czh-ga on 14 Jun 2004 14:39 PDT

Hello again lew1234-ga,

Thank you for the added information about your situation. I?m glad to
hear that you don?t have a concrete problem with your health plan and
are simply taking precautionary measures to make sure you understand
your rights and benefits. It is difficult to get specific information
about your situation because many of the resources for members and
agents require logging in.

I have reviewed the websites for the national Blue Cross Blue Shield
Association, Blue Cross of California and Blue Cross and Blue Shield
of Massachusetts for information about transferring coverage from one
state to another. None of these sites provide clear and unequivocal
information on this topic. Various statements seem to imply that if
you move out of a plan?s geographic area you simply notify the plan
you?re leaving and they will transfer your enrollment to the plan in
your new geographic location. I also couldn?t find confirmation that
you would have to be covered without meeting the enrollment
requirements of the new area. I think your best bet will be to log in
as a member and see if you can find specific information about your
plan. If you can?t find what you need I suggest that you contact the
agent/broker who handled your enrollment. If you still need additional
information, your best recourse may be to write to the appropriate
executives at Blue Cross headquarters.


http://www.bcbs.com/index.html
http://www.bluecrossca.com/user_groups/members/index.htm
http://www.bcbsma.com/common/en_US/index.jsp

http://www.bluecrossca.com/newsroom/
David S. Helwig
President and Chief Executive Officer
Blue Cross of California

Deborah F. Lachman
Senior Vice President
Individual and Small Group Division

Stephen Synott
General Manager
Individual and Small Group Division

Blue Cross of California 
1 WellPoint Way
Thousand Oaks, California 91362
818-703-2345
800-333-0912


In addition to investigating the specific provisions of you current
Californiacare Blue Cross coverage, you may want to review the HIPAA
right to purchase individual coverage provisions that may have come
into play when you moved to California. The links I provided in my
original answer will guide you through this.

If you can?t get satisfaction from any of these sources you may
contact the California Department of Managed Care.

http://www.hmohelp.ca.gov/gethelp/
The Department of Managed Health Care's HMO Help Center can help you
resolve problems that you are having with your health plan, including
issues about medical care, prescriptions, preventive testing and
mental health services. We will also help you with questions regarding
the complaint process and your health care rights.

Assistance is available 24 hours a day, seven days a week at our
Consumer Help Line toll free at:
(888) HMO-2219
 
I hope that the information I?ve collected will be sufficient for you
to track down the details of your Blue Cross coverage.

Wishing you well.

~ czh ~

Although I didn't learn all that I wanted, I feel that my
researcher,czh-ga went beyond the call of duty searching for it and I
appreciat his efforts very much.