- 14,808
Re: Health Insurance Across State Lines, Competition, and Premium
This bill puts smaller carriers out of business.
This bill puts smaller carriers out of business.
Health Insurance Across State Lines, Competition, and Premiums
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Re: Health Insurance Across State Lines, Competition, and Premium
They are already headed that way. More consolidation and retreating to come. Small, regional players will not have the deep pockets to compete in the health insurance business, no matter what happens in DC.
They are already headed that way. More consolidation and retreating to come. Small, regional players will not have the deep pockets to compete in the health insurance business, no matter what happens in DC.
- 14,808
Re: Health Insurance Across State Lines, Competition, and Premium
True, the smaller carriers don't have the reserves necessary to handle the type of claims they will experience once legislation is enacted. They also won't have the marketing capital to build their book fast enough to collect more premium dollars.
And if we think this is all a mistake, I assure you it's not. The "powerhouse" carriers want nothing better than to see their smaller competitors vaporize.
True, the smaller carriers don't have the reserves necessary to handle the type of claims they will experience once legislation is enacted. They also won't have the marketing capital to build their book fast enough to collect more premium dollars.
And if we think this is all a mistake, I assure you it's not. The "powerhouse" carriers want nothing better than to see their smaller competitors vaporize.
Re: Health Insurance Across State Lines, Competition, and Premium
Small carriers are not a threat.
Cigna came to Georgia 6 months ago and their local rep is complaining that Coventry is giving them fits. Heck, Coventry gives everyone a hard time until you try to get a policy issued or a claim paid.
Cigna doesn't care. They don't consider Coventry to be a long term player (and neither do I). They are more focused on Blue and Aetna.
Small carriers are not a threat.
Cigna came to Georgia 6 months ago and their local rep is complaining that Coventry is giving them fits. Heck, Coventry gives everyone a hard time until you try to get a policy issued or a claim paid.
Cigna doesn't care. They don't consider Coventry to be a long term player (and neither do I). They are more focused on Blue and Aetna.
- 14,808
Re: Health Insurance Across State Lines, Competition, and Premium
True. I don't believe Carefirst is too concerned with Celtic in MD. That said, if they had an opportunity to get rid of them do you think they would? You betcha.
True. I don't believe Carefirst is too concerned with Celtic in MD. That said, if they had an opportunity to get rid of them do you think they would? You betcha.
- 685
Re: Health Insurance Across State Lines, Competition, and Premium
To sell across state line, wouldn't you have to eliminate the individual mandates that each state has? And if they did that would there be a need to buy across state lines?
To sell across state line, wouldn't you have to eliminate the individual mandates that each state has? And if they did that would there be a need to buy across state lines?
- 14,808
Re: Health Insurance Across State Lines, Competition, and Premium
This is already done with association-group plans that do not have to adhere to state mandates. These carriers offer coverage for a few MD mandates but MD has 58 mandated benefits.
This is already done with association-group plans that do not have to adhere to state mandates. These carriers offer coverage for a few MD mandates but MD has 58 mandated benefits.
Re: Health Insurance Across State Lines, Competition, and Premium
This is what I have said many times.
States have (at least) two sets of mandates. One for individual plans, another for group. Some of the mandates are universal for any type of health coverage, such as STD testing, immunizations, etc. Others are specific to the product line.
Association plans are a different animal altogether and the regulation, or lack thereof, varies by state. More often than not the association "package" is done to avoid filing individual policy language and rates. States use the deemer provisions whereby if the policy is filed and approved by a fellow deemer state it is "deemed" to be approved in that state as well.
In those cases the carrier may be required to file certificate addendum's to comply with provisions such as psych or complications of pregnancy. Beyond that, the policy is essentially the same from state to state.
There are some association plans that are sold in GA, such as World but GR has opted (or been told) to file a separate policy here. So GA is not a FACT state.
It doesn't mean the World policies don't comply with mandates, probably just means no one really bothered to check.
GA has mandated psych benefits that apply to individual plans but carriers such as Aetna who did file their policies with GA do not offer a psych benefit except by amendment. Others, such as BX, GR and others have a watered down psych benefit that (presumably is in compliance) plus a buy-up to a much richer benefit that is close to mental health parity rules.
This is what I have said many times.
States have (at least) two sets of mandates. One for individual plans, another for group. Some of the mandates are universal for any type of health coverage, such as STD testing, immunizations, etc. Others are specific to the product line.
Association plans are a different animal altogether and the regulation, or lack thereof, varies by state. More often than not the association "package" is done to avoid filing individual policy language and rates. States use the deemer provisions whereby if the policy is filed and approved by a fellow deemer state it is "deemed" to be approved in that state as well.
In those cases the carrier may be required to file certificate addendum's to comply with provisions such as psych or complications of pregnancy. Beyond that, the policy is essentially the same from state to state.
There are some association plans that are sold in GA, such as World but GR has opted (or been told) to file a separate policy here. So GA is not a FACT state.
It doesn't mean the World policies don't comply with mandates, probably just means no one really bothered to check.
GA has mandated psych benefits that apply to individual plans but carriers such as Aetna who did file their policies with GA do not offer a psych benefit except by amendment. Others, such as BX, GR and others have a watered down psych benefit that (presumably is in compliance) plus a buy-up to a much richer benefit that is close to mental health parity rules.
- 685
Re: Health Insurance Across State Lines, Competition, and Premium
I knew it came from someone wise!!
I knew it came from someone wise!!
- 2,455
Re: Health Insurance Across State Lines, Competition, and Premium
Going back to post #8', how can anyone "overutalize" benefits since they are contractually proscribed?
ALSO....
1) Would eliminating state barriers allow for larger actuarial groups which will help to mitigate cost increases????? (Right now you have 50 different markets, 50 differnet reporting rules, payment rules, etc.)
2) Is it a bad thing that larger companies take on or out the smaller companies???? With such a large base of clients, the companies that come out surviving might bring premiums down?
I would like opinions on these points. I'm actually debating with another guy on this issue and he is for no state regulations and I'm for state regulations due to some of the things I read above like zero sum game, small companies going out of business, ect..
His argument is basically, well let me give you an example: If a group experiences large claims in a period that wasnt priced they have to adjust- you have a couple of fertiitly teatments which result in multiple premature babies and you will see an increase to cover the millions of dollars that get used to support them, some heart transplants etc..A larger group will smooth these costs, AND if state boundries are taken down it will be effective and limiting rising costs.
Going back to post #8', how can anyone "overutalize" benefits since they are contractually proscribed?
ALSO....
1) Would eliminating state barriers allow for larger actuarial groups which will help to mitigate cost increases????? (Right now you have 50 different markets, 50 differnet reporting rules, payment rules, etc.)
2) Is it a bad thing that larger companies take on or out the smaller companies???? With such a large base of clients, the companies that come out surviving might bring premiums down?
I would like opinions on these points. I'm actually debating with another guy on this issue and he is for no state regulations and I'm for state regulations due to some of the things I read above like zero sum game, small companies going out of business, ect..
His argument is basically, well let me give you an example: If a group experiences large claims in a period that wasnt priced they have to adjust- you have a couple of fertiitly teatments which result in multiple premature babies and you will see an increase to cover the millions of dollars that get used to support them, some heart transplants etc..A larger group will smooth these costs, AND if state boundries are taken down it will be effective and limiting rising costs.
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