Exchange Purchased Health Insurance: Rate-Ups Allowed???

[AllenChicago]

This question was posed to me ealier today and I had no answer. Can anyone help?

Assumptions: It's now 2014. Family of 4 purchases a "Gold" Exchange health plan underwritten by Blue Cross Blue Shield. No Smokers.

Question: Will this family, with the wife undergoing Cancer treatment, and a child with long-term Epilepsy, pay MORE for their health insurance than the 100% healthy family of 4 who lives next door.. for the Same Blue Cross "Gold" policy? (Also assume that ages of husband/wife/children are the same.)

Right now, even though Children are guaranteed of approval, their premiums can be doubled, quadrupled, etc.. Will exchange-purchased policies have selective rate-ups of families and/or family members based on health, weight, etc??

Thanks to whomever is willing to share their knowledge (or best guess) on this subject!

-Allen

 

[Yagents]

This question was posed to me ealier today and I had no answer. Can anyone help?

Assumptions: It's now 2014. Family of 4 purchases a "Gold" Exchange health plan underwritten by Blue Cross Blue Shield. No Smokers.

Question: Will this family, with the wife undergoing Cancer treatment, and a child with long-term Epilepsy, pay MORE for their health insurance than the 100% healthy family of 4 who lives next door.. for the Same Blue Cross "Gold" policy? (Also assume that ages of husband/wife/children are the same.)

Right now, even though Children are guaranteed of approval, their premiums can be doubled, quadrupled, etc.. Will exchange-purchased policies have selective rate-ups of families and/or family members based on health, weight, etc??

Thanks to whomever is willing to share their knowledge (or best guess) on this subject!

-Allen

The only rate up allowed is for smoking. Period.
And, only those whose name is Allen

 

[taterpeeler]

What billy bob said.... Back to porno

 

[AllenChicago]

Thanks YAgents and TaterPeeler for affirming what I suspected, but wasn't sure about. NO RATE-UPS ALLOWED.

That means the only difference from company-to-company will be the quoted price. And it won't actually be "quoted", but the actual final cost. What you're quoted is what you'll get...period.

It will be interesting to see what company is willing to assume the most risk by pricing the lowest. They guess wrong and incur a bunch of hefty claims, it's bankruptcy for sure. Except of course for the policy(s) that the U.S. government will be selling on the exchanges. If PCIP is any example, the Gov plans will be priced lower than the Private Ins Co plans...with little likelyhood of going away as long as the U.S. can borrow $$$ and print $$$.
-ac

 

[Yagents]

My bet is they will collude with each other initially on pricing. The fed health plans will not be subsidized like PCIP.

 

[somarco]

Community rating precludes rate up for health conditions.

 

[Quotebroker]

Don't mean to hijack, but I was asked a question along similar lines.

Say my 60 man group wants to move from Anthem to Kaiser. Pre-reform, Kaiser could decline to quote. Is this possible post 2014?

My Aetna rep indicated that they felt they still had the ability to do that.

 

[Ann H]

Don't mean to hijack, but I was asked a question along similar lines.

Say my 60 man group wants to move from Anthem to Kaiser. Pre-reform, Kaiser could decline to quote. Is this possible post 2014?

My Aetna rep indicated that they felt they still had the ability to do that.

Over 50 life group underwriting is a whole different enchilada. The GI from the HIPAA laws didn't apply to 50+ size groups, and I don't think PPACA changed that. Does anyone else know for sure? Some states have GI rules for groups that size, though.

 

[Quotebroker]

Over 50 life group underwriting is a whole different enchilada. The GI from the HIPAA laws didn't apply to 50+ size groups, and I don't think PPACA changed that. Does anyone else know for sure? Some states have GI rules for groups that size, though.

It may be academic, as Aetna indicated they would simply price it where it would be completely unrealistic to actually purchase.

 

[ABC]

Great question!

I thought small group will be defined as under 99 lives?

I don't think by law they could underwrite this case if that new definition is correct in 2014.

Great question.

Don't mean to hijack, but I was asked a question along similar lines.

Say my 60 man group wants to move from Anthem to Kaiser. Pre-reform, Kaiser could decline to quote. Is this possible post 2014?

My Aetna rep indicated that they felt they still had the ability to do that.