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Blue Shield Policy Closures Blocked in CA

Margaret Dick Tocknell, for HealthLeaders Media, July 11, 2012

Blue Shield doesn't see things that way, however. "Blue Shield is complying with all applicable laws. The law describes exactly what we have to do if we stop selling plans to new people, and we are doing it," Steve Shivinsky, a Blue Shield spokesperson, said in an e-mail response to questions from HealthLeaders Media.

"Everyone can stay in the plans they're in, if they want. No one is being forced to change plans." The insurer contends that since it is permitting members to "move into open blocks providing comparable benefits with no additional underwriting, there is no statutory pooling requirement."

The Blue Shield e-mail states that although the CDI can provide an opinion "as to whether the pooling plan complies with the block closure statute. That statute does not state that disapproval of a pooling plan prohibits Blue Shield from proceeding with its block closure."

Shivinsky says Blue Shield's pooling plan is sound, but that the insurer is working with the CDI "to see whether we can alleviate the department's concerns and agree on a mutually acceptable pooling plan."

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