Annual RX Maximums

[somarco]

This thing get's more convoluted every day. Had a long conversation with GR a couple of days ago. The reason why they pulled maternity was this. If you offer a benefit, it has to be as any illness and retroactive to the date the bill was signed into law.

At least that is their interpretation.

Then there is mental health parity. Will that apply to individual major med as well? If so, when does it start or has it already?

Unlimited lifetime is no biggie. There is reinsurance for that. Cost to bump a $5M plan to unlimited is peanuts.

It is the internal caps that will drive rates through the roof.

As for the Rx, if you don't offer an Rx benefit you don't have to comply with caps.

At least, that is the way I see it.

 

[Crabcake Johnny]

Just got off a conference call with my Assurant RSD. On Sept 24th clients will receive a letter with the new benefits and rates. If they can't deal with the new rates they can opt to apply for the new Clarity line - which involves a credit check.

For years Assurant was a major player in the MD market and I have a significant sized book. Come Sept 24th, IMHO, that book will evaporate.

 

[moonlightandmargaritas]

As for the Rx, if you don't offer an Rx benefit you don't have to comply with caps.

Although going forward, I believe plans have to offer a prescribed "minimum benefit" package, of which I would guess Rx will be included.

 

[somarco]

Maybe. Had lunch with Cigna. They are introducing new value plans 1st Q next year with generic Rx only. New plans from Aetna arriving July 1 including some with generic Rx only. New KP plans hit the streets in Oct with in house Rx only. No more getting filled at CVS. And no more maternity on the new plans.

I expect more tricks from carriers as we move forward.

Cigna did not have new 4th Q rates yet but hinted that kid rates might go up 20%.

Really???

Yes, that is for std rates. Risk adjusted could be +150% of the new std rate.

Got a meeting with H1 next week. That should be interesting as well.

 

[Phillip Arnn]

The subject of ancillary products has been discussed several times but I will raise it again in a new environment. With RX caps of $5k & $10k is it a good idea to offer a CI plan to augment the major medical plan?

If a client has a cap on rx and gets cancer how can they get treatment to save their lives at $5k a month for meds. Can chemo be given in a hospital and covered under major medical separate from the rx cap?
Phil

 

[Crabcake Johnny]

I can confirm that some new plans hitting the market will indeed have internet benefit caps. Only the lifetime max will be unlimited.

 

[YouGotMyMoney]

Can chemo be given in a hospital and covered under major medical separate from the rx cap?
Phil

Dunno about that, but my mother is undergoing chemo 2x a week and she goes to a doctor's office to get the treatments.

 

[dgoldenz]

I can confirm that some new plans hitting the market will indeed have internet benefit caps. Only the lifetime max will be unlimited.

The internets strikes again!

 

[Crabcake Johnny]

ummm, that would be internal...not internet.

 

[Phillip Arnn]

this is a statement from the Enrollment Guide of BCBS TX,

"Benefits of the medical portion of the contract are not available for:
* Drugs dispensed in a physician's office or during confinement while a patient in a hospital, or other acute care institution or facility..."

They are the #1 carrier in TX. I guess I answered my own question.
Are the uninsured and underinsured with cancer left to die or fall on the mercy of the drug makers?

Phil