How Many?

These econcomy plans are cheaper than HSA plans. They are major medical plans with a couple of bells. On these plans I know if someone has a $100,000 surgery it will pay.
Calling these economy plans "major medical" is quite a stretch. You can't even call the "catastrophic".

Let's say your client has a need for $38,000 worth of outpatient benefits, and the policy you sold them caps that at $25,000...

What happens then? Who pays the other $13,000?
 
Calling these economy plans "major medical" is quite a stretch. You can't even call the "catastrophic".

Let's say your client has a need for $38,000 worth of outpatient benefits, and the policy you sold them caps that at $25,000...

What happens then? Who pays the other $13,000?

We are not talking about the same policy
Anthem Blue Access Economy
EX. $1,000 deductible out of pocket including deductible $4,000 in network/ out of network $8,000
OV co pay $30 with 3 visits per person per calander year.
4th visit goes towards deductible
30% co insurance
Now here is where the economy really kicks in is on drugs
There is a max benefit of $500 a year.
So if you have a client on brand name drugs there is no way you would sell them this plan. Shoot with underwriting the way it is they would not get approved anyways.


This plan design is cheaper than the HSA plans.
 
Now here is where the economy really kicks in is on drugs
There is a max benefit of $500 a year.
So if you have a client on brand name drugs there is no way you would sell them this plan.

Just curious.

What do you tell the client who bought one of those plans when they were healthy, then later NEEDED one of those pricey, brand name drugs . . .?

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The problem is, you are thinking like a consumer. They look for coverage for their current (or past) medical situation. They never think in terms of what might happen in the future.

That is very shortsighted and foolhardy.
 
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Great point Bob, it's like price vs. cost. Great comment!
Just curious.

What do you tell the client who bought one of those plans when they were healthy, then later NEEDED one of those pricey, brand name drugs . . .?

InsureBlog: But is it Worth it?

InsureBlog: Driving Home a Point

InsureBlog: Oh Yeah, It CAN Happen here

The problem is, you are thinking like a consumer. They look for coverage for their current (or past) medical situation. They never think in terms of what might happen in the future.

That is very shortsighted and foolhardy.
 
Can somebody explain to me the differences between what makes a plan major medical or catastrophic????

I've scoured the internet, contacted the DOI and nadda...
 
Can somebody explain to me the differences between what makes a plan major medical or catastrophic????

JR, I don't think there's any one standard definition, but I'll give you mine.

"Major medical" to me handles anything that is medically necessary, without limits on Rx, outpatient, etc.

Some refer to a "Hospital and Surgical" policy as catastrophic - which I believe is a misnomer. There's a lot of catastrophic medical things that can happen to you that aren't hospital...or surgical.

I define "catastrophic" as major medical with a 10-25k (and higher) deductible.
 
JR, I don't think there's any one standard definition, but I'll give you mine.

"Major medical" to me handles anything that is medically necessary, without limits on Rx, outpatient, etc.

Some refer to a "Hospital and Surgical" policy as catastrophic - which I believe is a misnomer. There's a lot of catastrophic medical things that can happen to you that aren't hospital...or surgical.

I define "catastrophic" as major medical with a 10-25k (and higher) deductible.

That's exactly my point Paul.

Say I wanted to market a plan and get it approved by the DOI... To make people happy the name of the plan will be called "Bull%%!" Now, I have to get Bull%%! approved by the DOI, but how do they determine what type of plan is it? Does a plan become a mini med if it caps prescriptions @ 100K, outpatient at $30,000. Where are the guidelines???
 
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