Company Medical Loss Ratios Now Available at Healthcare.gov

[AllenChicago]

The Medical Loss Ratios are now posted for each company on a state-by-state basis.

Link: Your Insurance Company & Costs of Coverage | CompanyProfiles.Healthcare.gov

I didn't know that companies with less than 1,000 customers in a given state didn't have to comply with the MLR guidelines in that state. Now I understand why the smaller health insurance companies are still paying +20% major medical commission.

Also, I see that here in Illinois, CELTIC has a 102% MLR and a 20% rate increase request filed. I suppose 102% means that they're paying out more in medical claims than what they're receiving in premiums?

-Allen

 

[moonlightandmargaritas]

Also, I see that here in Illinois, CELTIC has a 102% MLR and a 20% rate increase request filed. I suppose 102% means that they're paying out more in medical claims than what they're receiving in premiums?

That's exactly what it means.

 

[somarco]

Celtic just reduced rates about 20% in GA, have so few policyholders they are not subject to MLR.

Aetna, United and Cigna also are not subject to MLR due to lack of policyholders.

KP has a 126% MLR on individual but that is exaggerated by their old block. They started a new policy series in January 2011 and have reduced rates twice.

 

[Yagents]

Check out mega life in az with 65 percent mlr and avg payout of $950. Gotta love those LB plans

 

[somarco]

CELTIC has a 102% MLR and a 20% rate increase request filed.

How much do you want to bet that HHS will knock them down to 10% for violating their pre-set standard increase?

 

[Yagents]

First, that 10% cap on rate increases is not so certain. I have many clients at many insurance companies getting higher than 10% increases. One at Assurant just got a 40% rate increase in AZ. Same with FL. These DOI's are asleep at the wheel.
Second, just got off the phone with prospect at Midwest Natl of TN who pays $220/mo for LB plan. He just got a $750 MLR refund check in the mail today = 3.5 months premium refund.

 

[AllenChicago]

How much do you want to bet that HHS will knock them down to 10% for violating their pre-set standard increase?

Since Illinois is one of the states that cannot deny a rate increase request, the state is now (under the glaring eye of Sebelius) simply refusing to do anything with requests that are above 10%.

For example, United Security Life and Health is headquarted in Illinois and has over 1,000 individual policyholders here. Their 2011 MLR was 81.5%. In December 2011 they put in a request for a 12% to 23% rate increase on their individual plans. As of right now, those requests are still listed on the website as "Pending/Open".

United Security was one of the companies that Sebelius targeted in March for having unreasonable rate increase requests. With an 81.5% MLR, a 12% to 23% rate increase wouldn't do the company any good since they would have to refund much of it in 2013.
-ac

 

[somarco]

that 10% cap on rate increases is not so certain. I have many clients at many insurance companies getting higher than 10% increases. One at Assurant just got a 40% rate increase in AZ.

The cap is applied to filed rate increases, not per case renewals.

the state is now (under the glaring eye of Sebelius) simply refusing to do anything with requests that are above 10%.

Including those exempt from MLR?

This game that is being played by H-SS is part of the final solution to eliminated carriers from the market.

1) Mandate popular benefits

2) Eliminate benefit caps

3) Make some benefits (such as colonoscopy's) purposely ambiguous so the public will continue to blame the carrier

4) Limit rate increases

5) Limit admin fees

6) Require carriers to rebate "excess profits" but do not provide allowances for recapturing "excess losses"

7) Eliminate risk based underwriting

Now convince me this is not part of the final solution to eliminate carriers.

 

[stuy119]

Now convince me this is not part of the final solution to eliminate carriers.

I agree, but why is someone not bringing up what the elimination of the health insurance carriers will do to unemployment? REAL unemployment is at 14.5% or so, and this would be a giant hit to the system and likely take us to 20-25%. That's a huge issue.

 

[somarco]

why is someone not bringing up what the elimination of the health insurance carriers will do to unemployment?

The govt deems those positions to be unnecessary.

Underwriters will start to be laid off summer 2013 with most if not all gone by the 4th quarter.

Sales reps will follow a similar pattern

In house legal staff and actuaries will be pared.

As carriers like Aetna, Celtic and others leave the market their claim staff will be gone within 6 months.

At least agents have options. Not so much for salaried staff, especially those over age 45.