Income too high, plan expensive, client offered "Association Group PPO" family of 4, $500/mo.

yorkriver1

Guru
1000 Post Club
1,734
Virginia
Anyone heard about these offers sold as group insurance for individuals? Wouldn't the agents/agencies offering these plans get sued if people had catastrophic claims and found their insurance was not what they thought? Calling their offer group insurance sets the expectation that this is like the employer based, probably ACA compliant plans most employers offer.
Why wouldn't the client be interested in low cost plans that sound good, since the only ACA carrier's plans range from $1500+ to 1900+ per month. The family dropped off the group insurance a couple years ago to save money. Open enrollment is in the spring. I suggested they will probably do better on the working spouse's group insurance with spouse and 3 kids costing double + this year's $800 premium for a plan with a $5900 deductible.
I mentioned they absolutely need to see a summary of benefits and coverage if not a specimen policy for the "Association Group PPO" plan the working spouse found for $500 a month.
It can't possibly be anything comparable to an ACA compliant plan, even if it's got MEC features to avoid the penalty. The spouse says they were told pre-existing conditions are covered.
I can offer an STM with some interesting features for just the right situation, and I have a specimen policy I send out, so they know the limitations.
I am fine with the client getting something great, but concerned this is being sold in a deceptive manner.
 
Anyone heard about these offers sold as group insurance for individuals? Wouldn't the agents/agencies offering these plans get sued if people had catastrophic claims and found their insurance was not what they thought? Calling their offer group insurance sets the expectation that this is like the employer based, probably ACA compliant plans most employers offer.
Why wouldn't the client be interested in low cost plans that sound good, since the only ACA carrier's plans range from $1500+ to 1900+ per month. The family dropped off the group insurance a couple years ago to save money. Open enrollment is in the spring. I suggested they will probably do better on the working spouse's group insurance with spouse and 3 kids costing double + this year's $800 premium for a plan with a $5900 deductible.
I mentioned they absolutely need to see a summary of benefits and coverage if not a specimen policy for the "Association Group PPO" plan the working spouse found for $500 a month.
It can't possibly be anything comparable to an ACA compliant plan, even if it's got MEC features to avoid the penalty. The spouse says they were told pre-existing conditions are covered.
I can offer an STM with some interesting features for just the right situation, and I have a specimen policy I send out, so they know the limitations.
I am fine with the client getting something great, but concerned this is being sold in a deceptive manner.
This is not insurance.
 
Anyone heard about these offers sold as group insurance for individuals? Wouldn't the agents/agencies offering these plans get sued if people had catastrophic claims and found their insurance was not what they thought? Calling their offer group insurance sets the expectation that this is like the employer based, probably ACA compliant plans most employers offer.
Why wouldn't the client be interested in low cost plans that sound good, since the only ACA carrier's plans range from $1500+ to 1900+ per month. The family dropped off the group insurance a couple years ago to save money. Open enrollment is in the spring. I suggested they will probably do better on the working spouse's group insurance with spouse and 3 kids costing double + this year's $800 premium for a plan with a $5900 deductible.
I mentioned they absolutely need to see a summary of benefits and coverage if not a specimen policy for the "Association Group PPO" plan the working spouse found for $500 a month.
It can't possibly be anything comparable to an ACA compliant plan, even if it's got MEC features to avoid the penalty. The spouse says they were told pre-existing conditions are covered.
I can offer an STM with some interesting features for just the right situation, and I have a specimen policy I send out, so they know the limitations.
I am fine with the client getting something great, but concerned this is being sold in a deceptive manner.
You are right, there is nothing comparable to the ACA compliant plans. You have to read the contract to find out if pre-existing conditions are covered. Check with your state to find out if the company is allowed to sell those plans in your state.
 
Check with your state to find out if the company is allowed to sell those plans in your state.

Which department handles this?

The Department of Non-Insurance?

Which non-insurance department in Georgia approved Alliera?
 
Which department handles this?

The Department of Non-Insurance?

Which non-insurance department in Georgia approved Alliera?
This is a notice from the state of Georgia:

According to Georgia Official Code 30-20-1, Health Care Sharing Ministries are not under the jurisdiction of the Commissioner of Insurance. However, the company does have approval to operate in the state of Georgia.

(a) As used in this Code section, the term "health care sharing ministry" means a faith-based, nonprofit organization that is tax exempt under the Internal Revenue Code which:

(1) Limits its participants to those who are of a similar faith;

(2) Acts as a facilitator among participants who have financial or medical needs and matches those participants with other participants with the present ability to assist those with financial or medical needs in accordance with criteria established by the health care sharing ministry;

(3) Provides for the financial or medical needs of a participant through contributions from one participant to another;

(4) Provides amounts that participants may contribute with no assumption of risk or promise to pay among the participants and no assumption of risk or promise to pay by the health care sharing ministry to the participants;

(5) Provides a written monthly statement to all participants that lists the total dollar amount of qualified needs submitted to the health care sharing ministry, as well as the amount actually published or assigned to participants for their contribution; and

(6) Provides a written disclaimer on or accompanying all applications and guideline materials distributed by or on behalf of the organization that reads, in substance: "Notice: The organization facilitating the sharing of medical expenses is not an insurance company, and neither its guidelines nor plan of operation is an insurance policy. Whether anyone chooses to assist you with your medical bills will be totally voluntary because no other participant will be compelled by law to contribute toward your medical bills. As such, participation in the organization or a subscription to any of its documents should never be considered to be insurance. Regardless of whether you receive any payment for medical expenses or whether this organization continues to operate, you are always personally responsible for the payment of your own medical bills."

(b) A health care sharing ministry which has entered into a health care cost sharing arrangement with its participants shall not be considered an insurance company, health maintenance organization, or health benefit plan of any class, kind, or character and shall not be subject to any laws respecting insurance companies, health maintenance organizations, or health benefit plans of any class, kind, or character in this state or subject to regulation under such laws, including, but not limited to, the provisions of this title, and shall not be subject to the jurisdiction of the Commissioner of Insurance.
 
would this be plan that they are looking at......
This family has spouse covered at work, & non working spouse on plan with the 3 kids. So 1 adult, 3 kids to be covered, supposedly for $500 or so a month, but these plans seem like the lowest for my client's family size (EE + kids) would be about $898/month (granted,lower than $1500+). What they are offered may be something like your link. I am interested in a few things about the plan doc you posted.
1. What is lifetime maximum out of pocket? 2. Is there a specimen policy available? 3. the pre-existing condition eligibility is not clearly stated on the forms.
This plan is not completely different from some pre-ACA plans. It will be hard to deal with all the assumptions people make about what is covered if plans like this become more common.
Several in this family had a virus that resulted in some lingering issues for one of the kids. I wouldn't sell them this plan.
They make over $100K a year, and would be ruined if they had catastrophic medical bills. Like many families, they probably are spending to the edge.
I do appreciate your quick response.
 
Back
Top