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What's also nice about the release from HHS was what wasn't in it; any rules or regulations for agents regarding marketing. So basically, we won't have to deal with CMS.
Final Rule For Health Insurance Exchanges
- Thread starter CHUMPS FROM OXFORD
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If the states decide not to set up an Exchange, the federal government will step in an run it.
Why would states put their money in an Exchange when they can take a pass and let the fed's run it?
Let's think about this for a moment
States MUST levy fees on insurance companies that participate in the Exchange, but may not levy fee's on consumers.
Do you suppose the carriers might pass these fee's on to consumers in the form of higher premiums?
InsureBlog: Sorry, No Exchanges
Why would states put their money in an Exchange when they can take a pass and let the fed's run it?
.
Let's think about this for a moment
States MUST levy fees on insurance companies that participate in the Exchange, but may not levy fee's on consumers.
Do you suppose the carriers might pass these fee's on to consumers in the form of higher premiums?
InsureBlog: Sorry, No Exchanges
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"We are finalizing the provisions proposed in §155.150 of the proposed rule, with the exception of specifying the database for the projected coverage numbers upon implementation. i. Financial support for continued operations (§155.160) In 155.160, we proposed to codify the statutory provision that a State ensure its Exchange has sufficient funding to support ongoing operations beginning January 1, 2015 and develop a plan for ensuring funds will be available. Specifically, we proposed to allow a State Exchange to fund its ongoing operations by charging user fees or assessments on participating issuers or by generating other forms of funding, provided that any such assessments are announced in advance of the plan year. We invited comment on whether the final regulation should otherwise limit how and when user fees may be charged, and whether such fees should be assessed on an annual basis"
Response: A clearly defined plan for financial sustainability is essential to Exchange success and in §155.160(b), we codify section 1311(d)(5)(A) of the Affordable Care Act, which establishes that a State ensure that its Exchange has sufficient funding to support its operations beginning January 1, 2015. As noted in the preamble to the proposed rule, a funding plan is necessary for Exchange approval. States should conduct an analysis of various user fee structures as well as other financial support options before making a decision. This analysis could include, among other factors, the potential impact on risk selection, issuer participation, consumer experience, and provider contracting. We maintain the codification in this final rule.
The Affordable Care Act directs Exchanges to be self-sustaining and provides flexibility for Exchanges to generate support for continued operation in a variety of ways, such as through user fees. Accordingly, we do not limit Exchanges' options in the final rule by prescribing or prohibiting certain approaches. We believe that user fees parameters, as well as the need for other revenue-generating strategies, may vary by State depending upon several factors such as the number of potential enrollees and the Exchange's operational costs. Consistent with this flexibility, we have not finalized the proposal that the Exchange announce user fees in advance of the applicable plan year, and instead look to Exchanges that opt to charge user fees to establish a deadline and vehicle for such announcement, as well as the frequency
Response: A clearly defined plan for financial sustainability is essential to Exchange success and in §155.160(b), we codify section 1311(d)(5)(A) of the Affordable Care Act, which establishes that a State ensure that its Exchange has sufficient funding to support its operations beginning January 1, 2015. As noted in the preamble to the proposed rule, a funding plan is necessary for Exchange approval. States should conduct an analysis of various user fee structures as well as other financial support options before making a decision. This analysis could include, among other factors, the potential impact on risk selection, issuer participation, consumer experience, and provider contracting. We maintain the codification in this final rule.
The Affordable Care Act directs Exchanges to be self-sustaining and provides flexibility for Exchanges to generate support for continued operation in a variety of ways, such as through user fees. Accordingly, we do not limit Exchanges' options in the final rule by prescribing or prohibiting certain approaches. We believe that user fees parameters, as well as the need for other revenue-generating strategies, may vary by State depending upon several factors such as the number of potential enrollees and the Exchange's operational costs. Consistent with this flexibility, we have not finalized the proposal that the Exchange announce user fees in advance of the applicable plan year, and instead look to Exchanges that opt to charge user fees to establish a deadline and vehicle for such announcement, as well as the frequency
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Worse than that, it's only the federally administered PCIP program that offers comp. If the state administers their own program it's up to them as to whether or not any comp is offered.
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Reminds me a little bit of Geisinger Health System, who is a very good and well-respected carrier in Pa.
Their Network consists of about 40 Counties around Central Pa.
Oh...By the way... You only get paid if they are located in one of 10 counties. So yea...it's tough to sometimes spend an hour on the phone with someone from one of the non-paying counties, because you are working for free.
Their Network consists of about 40 Counties around Central Pa.
Oh...By the way... You only get paid if they are located in one of 10 counties. So yea...it's tough to sometimes spend an hour on the phone with someone from one of the non-paying counties, because you are working for free.
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We can't assume that carriers don't want to pay comp. In fact, I'll assume they do in order to drive enough clients.
So I can imagine a bit of a power play where, for example, UHC tells a state that's planning on not allowing broker comp that they won't be participating.
So I can imagine a bit of a power play where, for example, UHC tells a state that's planning on not allowing broker comp that they won't be participating.
It's looking good to me..........they can't be successful without us. Like in any crash, the weak are weeded out, the strongest survive and gain larger market share in the turnaround. Congrats to those who survived!
Obama Envisions Key Role for Agents, Brokers in Exchanges | LifeHealthPro
Obama Envisions Key Role for Agents, Brokers in Exchanges | LifeHealthPro
I've long held that a major key to our interests as agent/brokers is the ability to sell plans inside and/or outside the exchange, with fair compensation. Even the commission cuts are minor in comparison to this issue.
However, my views for my own financial interest as a career agent/broker are different than my views as a taxpayer, consumer, small business owner, and consultant to policyowners. I'm reserving judgment until after the Supreme Court decision and the 2012 national and state-level elections. Currently states are more republican controlled, and Congress has more republican members than before. I think the state control and congressional control will have more power than the presidential control when it comes to unraveling and/or fixing the PPACA mess. We'll see what happens...
However, my views for my own financial interest as a career agent/broker are different than my views as a taxpayer, consumer, small business owner, and consultant to policyowners. I'm reserving judgment until after the Supreme Court decision and the 2012 national and state-level elections. Currently states are more republican controlled, and Congress has more republican members than before. I think the state control and congressional control will have more power than the presidential control when it comes to unraveling and/or fixing the PPACA mess. We'll see what happens...
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Anybody sick of all of this conjecture yet about our very livelihoods? I for one think the discourse is good, but I can hardly mentally handle it anymore. What a stupid stupid piece of legislation.
