Ghost Town Reform Forum

Discussion in 'Health Care Reform Forum' started by Yagents, Jul 7, 2017.

  1. kgmom219
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    kgmom219 Well-Known Member

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    Yes.

    I think you are going way to grey.....
     
  2. STIBROKER
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    STIBROKER Super Moderator Moderator

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    not yet....have not tried this yet.....mainly doing Husb and Wife .....but the way things are going with ACA then if it can be issued as friends to get the best deal on health Insurance we will submit a copy of a payroll check's to get it issued....just got a h&w issued with only one listed on company paper and had to submit a copy of a check made out to the wife.....it issued....
     
  3. DS4
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    DS4 Well-Known Member

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    California not too bad. It is a volume game.

    Anthem still pays $12 PMPM

    Blue Shield of California now down to 2.5%
     
  4. somarco
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    somarco Well-Known Member

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    Trump and Repub's ran on the wrong platform. Replace only. Forget repeal.

    My first preference is to get DC completely out of the health insurance market. So far they have taken a system that worked reasonably well for 95% of the population and replaced it the Obummercare POS.

    Trump and company should have let Obummercare die (it's doing a pretty nice job of that without any help) and roll out something great in 2017 to be effective 2018 and later.

    No mandates. Return of catastrophic plans. Modified underwriting. National risk pool. Pool of money to states for Medicaid. Run this puppy out and let public decide if they want Obummercare or Trumpcare.

    Dang fools in DC would rather grandstand and do nothing than actually fixing what Obummer messed up.

    If the IFP market dies don't expect Medicare for all. Medicaid requires fewer federal dollars.
     
  5. tonyisme
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    tonyisme Well-Known Member

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    How could anything that Barack Hussein Obama II did while Commander & Chief go wrong? He is still on his well-deserved vacation bless his heart
     
  6. junkman
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    junkman Well-Known Member

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    @somarco, it may "only" have been x% but it effects 100% of my family when one of us cant pass underwriting.

    I've surveyed friends 50 and older. Only 1 can pass underwriting. All are healthy enough to peddle a bike 30 min. That's a problem.
     
  7. Ann H
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    Ann H Well-Known Member

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    Good conversation, guys. I don't know about the laws in TX, but I can speak for AZ and generally for the whole nation's group laws per the ACA.

    Generally, group insurance is for a legitimate business, with a legitimate employer/employee relationship. The term "legitimate" is key.

    I have several of these. In my case, most of them were already corporations who simply hired an extra employee to make it a group of 2. (In AZ, the 2nd employee only has to work at least 1 hour a week for minimum wage to qualify.)

    Whether they were active businesses, or had to form the company first, I made sure they were legit. It had to be real. A real company in a real business enterprise, making money, putting the 2nd person on payroll, etc. No funny business, tupperware, amway, babysitting, etc. No pretend companies that didn't actually sell a product or service.

    The deal is that it's easy to do that. Most IFP clients from pre-ACA were entrepreneurs, small business people, doctors, engineers, architects, etc. They were high-end folks, who ran small businesses and wanted quality PPOs, especially high deductible ones. So, the 2-person group is perfect for those OFF-exchange market folks. In AZ, the 2nd person can't be the spouse of an owner, but it's still easy to do. In TX, where you can do H/W, it would be easier, but even then I would make sure the 2nd person actually WORKS in the business, and it's an actual valid business. I think setting up an LLC for a fake business that has no product, no service, and doesn't plan to make any money at all would be circumvention of the group laws, but the market is so rich with legit situations, that an agent shouldn't be pressured to do that.
     
  8. kgmom219
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    kgmom219 Well-Known Member

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    This is a whacked-out, only TX thang. (Slang intended)

    In TX, for at least 19 years (thats when I went from a PBM to UHC),BCBSTX has done 2 person, husband/wife groups. Wife is EE #1 and husband is EE #2. Wage and tax not required. K1s not required. The ONLY requirements are the online submission form to the TX Secretary of State listing both people and the document that is returned, which includes the state seal. There are zero post implementation requirements. You don't have to show K1s or 1040s later.

    Humana and Aetna have come in and out. UHC has always said no. Last fall, BCBSTX stopped doing them on 9/1, with no warning and it was chaos. Then during Christmas week, we got a copy of the letter from TDI to Blue that said "you are required to write husband/wife groups" with the documents I listed. No other carrier received the letter. (This may or may not be payback for the 2017 60% increase)

    I've got some that have been on the books 10+ years. We did it pre ACA for pre-ex, mental health and maternity coverage.

    Is it legal? Yes.
    Is it screwy? Yes.
    Do you get the national Blue PPO at a 5% bump over the crappy HMO? Yes.


    What I am concerned with is trying to game the system. If they aren't married, then get a TWC.
     
  9. Ann H
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    Ann H Well-Known Member

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    Gotcha. I agree. If H/W is allowed, then they should be H/W, not live-ins. If they aren't H/W, then a TWC should show one as a true employee. Agree totally.

    You and I would also agree that there should be a true employee, not a fake employee on paper who doesn't actually work there.

    And we would agree that a true employee should work there all year, not just at enrollment time or renewal/audit time.

    I hope that agents who do the grey-area cases (or the totally fake ones) don't ruin it for us. If micro group is nothing short of IFP-look-alike and is fraught with scams, then commissions will be slashed and premiums will go up for everyone.
     

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