Health Net cracks down on agents

[Guest]

Again, carriers want at least the appearance that the employee is not receiving 100% first dollar coverage (which escalates utilization through the roof).

OK, if the carriers want to prevent first-dollar coverage why do they allow the employer to fund all or part of the HSA? Where is the logic here?

There must be a better way for the carriers to prevent first-dollar coverage in HDHPs than to club the agent to death or threaten the client.

And here is something else I don't get. Say the deduct is $5,000. And say I work for XYZ company who will insure it or reinburse me. Why does the carrier care. The money is not coming out of their pocket. Why do they care that the deductible is paid by the client or the boss? Is the argument that employees will run through their deductible "faster" and thus get carrier-paid benefits sooner? I'd like to see an independent study on that because I don't believe anything out of the mouths of any of the carriers on this issue.

I wonder what would happen if some boss decided to fund everyone's deduct by paying 100% on a Colonial or Aflac "medical bridge" plan that paid all of or a large percentage of the deductible. Or maybe the boss might pay for $5,000 accident plan for each employee which just might be the deductible (should there be an accident)?

I wish I practiced law because I see a big juicy law suit against a deep-pocketed carrier if they actually tried to rescind a group plan because of the above.

Life insurance is so much easier and gives you far fewer ulcers... and the carriers never threaten to pull your ticket. They actually like us!! To bad it is so much harder to sell than health.

Al

 

[Dave020]

OK, if the carriers want to prevent first-dollar coverage why do they allow the employer to fund all or part of the HSA? Where is the logic here?

I have to assume that the carrier's see less utilization of the employee's "owned asset" versus reimbursement by the employer.

There must be a better way for the carriers to prevent first-dollar coverage in HDHPs than to club the agent to death or threaten the client.

Yes, by adding in a co-insurance component above the deductible and HSA contributory maximum which we see going on with the Lumenos-styled plans now.

And here is something else I don't get. Say the deduct is $5,000. And say I work for XYZ company who will insure it or reinburse me. Why does the carrier care. The money is not coming out of their pocket. Why do they care that the deductible is paid by the client or the boss?

This type or reimbursement apparently creates increased utilization. I am sure the actuaries know what they are looking at on this.

Is the argument that employees will run through their deductible "faster" and thus get carrier-paid benefits sooner? I'd like to see an independent study on that because I don't believe anything out of the mouths of any of the carriers on this issue.

A state-wide 34% premium increase on Lumenos would indicate that this is exactly what happened.

I wonder what would happen if some boss decided to fund everyone's deduct by paying 100% on a Colonial or Aflac "medical bridge" plan that paid all of or a large percentage of the deductible. Or maybe the boss might pay for $5,000 accident plan for each employee which just might be the deductible (should there be an accident)?

These "bridge" plans are also discouraged. Carriers want the employees using thier own money under the deductible, whether from thier own pocket or from an owned asset even if it was funded by the employer.

I wish I practiced law because I see a big juicy law suit against a deep-pocketed carrier if they actually tried to rescind a group plan because of the above.

Or maybe a 250% premium increase to offset legal fees and discourage the plans entirely so that there would be no more issue.

Life insurance is so much easier and gives you far fewer ulcers... and the carriers never threaten to pull your ticket. They actually like us!! To bad it is so much harder to sell than health.

Al

Yes, it is. Because life insurance companies only pay ONE claim, if any. And the insured has to be DEAD to receive it. Doesn't much matter whose pocket the first dollar money is coming out of when the person is DEAD.