Does anyone know of any carriers offering deductible credits for policies that are terminated beyond the insured's control due to being non-grandfathered? One of my clients just racked up a big hospital bill and their current policy has a $6k OOP max, but they are being automatically changed over to the new ACA plan as of February 1 and I would think the deductible and OOP max would start over again on a new plan.
Deductible Credits?
- Thread starter dgoldenz
- Start date
- 8,448
DGoldenz, not sure what state you're in, but BCBS of Nebraska says that the portion of the 2013 deductible that has been met IS carried over to the newly acquired 2014 plan.
Ref: https://www.nebraskablue.com/~/media/Broker%20Communications/2013%20Plan%20Renewal%20FAQ%2012313.pdf
(See Page 2)
ac
Ref: https://www.nebraskablue.com/~/media/Broker%20Communications/2013%20Plan%20Renewal%20FAQ%2012313.pdf
(See Page 2)
ac
Generally a state by state thing. GA has deductible carryover by law. Believe it or not some carrier reps don't know this.
Although the cost for carryover is nominal, I would be surprised if a carrier included it on IFP absent a mandate.
Yeah, I know. Shocking.
Although the cost for carryover is nominal, I would be surprised if a carrier included it on IFP absent a mandate.
Yeah, I know. Shocking.
- 8,448
November 12, 2014
I'm taking the BCBS-IL 2015 Plans and Strategy online course tonight. (You have to do it, or you can't sell their 2015 plans off/on exchange.)
HELP. I Just had a brain seize-up on this section:
"Outpatient surgery
As an example, imagine a member has an outpatient patient surgery procedure that costs a total of $450, and his or her plan has an outpatient surgery per-occurrence deductible of $150. The $150 per-occurrence deductible is subtracted from the $450 total claims, and the remaining $300 in claims are subject to the annual deductible. When that deductible is met, the rest of the member's claims are subject to coinsurance. The $150 per-occurrence deductible is paid in full directly to OPX but not to plan deductible. $300 paid towards the annual deductible will accumulate towards the OPX total."
Is the Per-Occurrence deductible applied to the annual deductible, or not? The two highlighted sentences seem to conflict.
ObamaCare has really botched these plans up! You should see the Prescription Rx portion of the training... Our poor clients!
ac
I'm taking the BCBS-IL 2015 Plans and Strategy online course tonight. (You have to do it, or you can't sell their 2015 plans off/on exchange.)
HELP. I Just had a brain seize-up on this section:
"Outpatient surgery
As an example, imagine a member has an outpatient patient surgery procedure that costs a total of $450, and his or her plan has an outpatient surgery per-occurrence deductible of $150. The $150 per-occurrence deductible is subtracted from the $450 total claims, and the remaining $300 in claims are subject to the annual deductible. When that deductible is met, the rest of the member's claims are subject to coinsurance. The $150 per-occurrence deductible is paid in full directly to OPX but not to plan deductible. $300 paid towards the annual deductible will accumulate towards the OPX total."
Is the Per-Occurrence deductible applied to the annual deductible, or not? The two highlighted sentences seem to conflict.
ObamaCare has really botched these plans up! You should see the Prescription Rx portion of the training... Our poor clients!
ac
Wow, that's messed up.
This is just a wag but it appears they are treating OP surgery the way some carriers treat an ER "visit". But I don't recall seeing an ER deductible PLUS a plan deductible applied before the plan pays.
With what you have posted it does not appear the OP surg deductible applies toward the plan deductible but SHOULD apply towards the total MOOP.
This is just a wag but it appears they are treating OP surgery the way some carriers treat an ER "visit". But I don't recall seeing an ER deductible PLUS a plan deductible applied before the plan pays.
With what you have posted it does not appear the OP surg deductible applies toward the plan deductible but SHOULD apply towards the total MOOP.
ALL of our Texas Blue Copay plans look like this. Inpatient/Outpatient/ER/Labwork
Copay, then ded/coins. Its ugly.
Here's the scenarios:
$5K Deductible
$6250 OOP
80% Coins
$2K claim
You have NOT met the deductible: you are paying all of it
You HAVE met the deductible: You pay the copay of $150. Then you pay $370. (20% of $1850) The total of $520 goes towards the OOP.
Its a huge PIA to explain to clients
Copay, then ded/coins. Its ugly.
Here's the scenarios:
$5K Deductible
$6250 OOP
80% Coins
$2K claim
You have NOT met the deductible: you are paying all of it
You HAVE met the deductible: You pay the copay of $150. Then you pay $370. (20% of $1850) The total of $520 goes towards the OOP.
Its a huge PIA to explain to clients
- Thread starter
- #7
That's not confusing at all. Health insurance is simple! Like ordering a plane ticket on Orbitz! Surely every subsidy-eligible client will understand.....when they get the bill.
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