Major Medical Benefit Maximums Being Eliminated.

AllenChicago

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Major Medical Internal Benefit Maximums Being Eliminated.

Today I learned of a new aspect of health reform. A major medical plan can no longer contain limited-medical plan attributes.

One of our carriers is canceling, as of today, sales of it's most popular policy. It's a major medical that limits Outpatient Diagnostic Testing (CT Scans, MRI's, etc.) to $500 and Outpatient Surgery to $20,000 in a given policy year. What a bummer. It was one of my favorite plans due to its low premium.

In addition, the option to limit the dollar amount of the outpatient testing and surgery benefit (in order to reduce the premium) on all their other plans is being removed.

So it appears that there will be Major Medical and Limited Benefit medical policies, but the two cannot be intermingled.

This company is also removing the options for premium guarantee periods beyond 12 months in duration for all of its plans with effective dates of 10/1/2010 and later.

-A.C.:no:
 
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All In-Patient benefits are unlimited and all Out-Patient costs are limited, making the policy a "hybrid". It's very inexpensive and very popular among sole proprietors. World, Standard Security, Fidelity and probably some other companies have these benefit limitation options available with their plans. But alas, all polices of this type are going bye-bye this year thanks to Obamacare.
-Allen
 
All In-Patient benefits are unlimited and all Out-Patient costs are limited, making the policy a "hybrid". It's very inexpensive and very popular among sole proprietors. World, Standard Security, Fidelity and probably some other companies have these benefit limitation options available with their plans. But alas, all polices of this type are going bye-bye this year thanks to Obamacare.
-Allen



IMHO junk by another name is still junk.

"Nearly everything" is done on an outpatient basis nowadays.

What happens when one of those clients gets cancer and has to have chemo that is admitted in a doctors office? Does that fall under the 20k cap?

How about common outpatient surgeries, like sports injury surgeries or kidney stone operations that are routinely performed on an outpatient basis?


Why not simply sell a comprehensive HDHP with a higher deductible?
 
IMHO junk by another name is still junk.

"Nearly everything" is done on an outpatient basis nowadays.

What happens when one of those clients gets cancer and has to have chemo that is admitted in a doctors office? Does that fall under the 20k cap?

How about common outpatient surgeries, like sports injury surgeries or kidney stone operations that are routinely performed on an outpatient basis?


Why not simply sell a comprehensive HDHP with a higher deductible?

The $20,000 outpatient cap is only for surgery. None of the outpatient surgeries have ever reached the cap. The policy has a $10 deductible + 80/20 to satisfy first. We sell supplemental plans with each policy to cover the injuries and serious illness.

Fifty agents (the size of our brokerage) have been selling this plan as our #1 policy for 6 years and no complaints have been received. In fact, the premium actually dropped for these insureds 2 years in a row..Hundreds of happy small business owners year after year. But, that's all coming to an end because this plan is discontinued. New prospects will have no choice but to get a more expensive HDHP or some other high-deductible plan. We'll help them as best we can until 2014, when even the High Deductible plans might be going away.
-AC
 
All the limited type benefit plans are gone.

The legit plans that carved out outpatient therapies and outpatient diagnostic are also gone. I sold these plans on a group basis and saved clients 50%-60% from traditional.

I have about 7 small groups that are going to get crushed at renewal.
 
Abc why would you or anyone sell limited medical benefit plans especially to groups? Glad you are not my broker
!
 
Abc why would you or anyone sell limited medical benefit plans especially to groups? Glad you are not my broker
!

They are limited medical plans from an outpatient therapies standpoint and outpatient diagnostic services.
All in patient is covered as any other illness. So you would pay out of pocket for a MRI but still get the network discount around 35%-45%. If you went impatient and had an MRI it would be covered under the plan design just like a traditional plan.

This type of approach to health risk is where the owner puts a plan in place that covers the most expensive aspect of health care and thats inpatient.

Its about cost. You have small group employers that could not afford a traditional plans anymore so this was an option to keep something in place.

Is some start up groups ownership wanted something to attract employees but with limited budget.

Another option with this was to put it into a dual option as the base plan. The employer could set up defined contribution and say go ahead and pick your plan. You want better benefits then you pay the difference.


So those are a few of the reason why you would sell this type of policy from Anthem/Wellpoint called Essential.

If you can not get created for your small group clients you will not keep them very long. If you limit yourself to just the same old plans to sell then you will get the same old results.
Especially in a recession!

Does this make send to you? I am sure you have a huge block of business and you keep a really high retention.
 
ABC: I get it but this sounds like a nightmare administratively. I appreciate the explanation however.
 
ABC: I get it but this sounds like a nightmare administratively. I appreciate the explanation however.

But that is what it means to be creative for your clients.

Not just present status quo but to come up with group plans outside the box.
 
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