Indivual non-subsidized waivers not accepted by Blue Cross

mass connector authorityOver the past few months we have been inundated with talk about Health Insurance Exchanges.  On the local level the Commonwealth of Massachusetts did not participate in the Federal Exchange, but has their own exchange that is called the Connector Authority.

When a person calls the Connector Authority the first thing that is determined is if they qualify for a subsidy.  The line between whether or get a subsidy or not is if you earn above or below 300% of the Federal poverty level.

At the same time, you have employers that are getting health insurance for their companies and insurance companies have participation requirements; for example, insurers typically require small companies to have 100% participation to get health insurance.  It sounds worse then you think at first since people who have coverage through their spouses are not included; for example, a company has 6 employees but 2 have coverage with their spouses then the insurance company would require the remaining 4 to sign up .

Recently tried to sign up a company with Blue Cross but one of the employees had gone on their own to the Connector Authority and bought an unsubsidized individual plan. Since it was not subsidized, Blue Cross will not accept this as a valid waiver as it would, for example, if this same employee had waived for spousal coverage.

The problem is that since Blue Cross will not accept this waiver, the company is not at 100% participation and the company can not get health insurance for their company as long as this one employee keeps their individual unsubsidized coverage!

Here we have set up an exchange to make health insurance easier for everyone to get, but in this case the existence of the exchange and one person signing up has made it impossible for this subscriber’s employer to buy group health insurance!!!


Affordable Care Act, Blue Cross of Massachusetts, Massachsuetts Connector Authority

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