Major Medical Benefit Maximums Being Eliminated.

[AllenChicago]

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.

An Executive V.P. from one of the insurance companies called my MGA and explained that the way Washington/HHS is handling implementing health reform is a real mess. The order to IMMEDIATELY quit mixing Limited Benefits into Major Medical policies came through from HHS suddenly on Friday 9/3/2010 without warning. The people in power in D.C. are hurriedly trying to get positive aspects of health reform (as they see it) in place ahead of the November election to give politicians good things to say while campaigning.
-A.C.

 

[Crabcake Johnny]

I agree and any negative actions the carriers implement (like ditching child-only policies) will be twisted into "See what the evil profit-crazy carriers are doing? We need even more reform."

 

[Post Quartermaster]

Abc why would you or anyone sell limited medical benefit plans especially to groups? Glad you are not my broker
!

Cosigned.

I'd rather use HRA's & FSA's than swiss cheese plans to save money.

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.

You sure about that?

I would be very wary of telling people that a non-covered service would get a PPO discount. Because they don't necessarily receive one. Could they negotiate one with the provider, most likely, but........

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.

"Most Expensive" is relative.

I disagree to the extent that more care is now provided in outpatient settings, even at the hospital, and quite frankly, there are better ways to skin a cat IMHO than cutting benefits in areas that are more likely to be utilized.......I see plenty of $20k - $50k+ surgeries that are done on an outpatient basis......

 

[AllenChicago]

I thought this story was fairly interesting and relative to the conversation.

Growing Number Of Patients Find A Hospital Stay Does Not Mean They

Apparently more hospitals are choosing NOT to treat on an Inpatient basis. Perhaps the government did a GOOD thing by eliminating benefit maximums inside of major medical polices?

-Allen

 

[Post Quartermaster]

I thought this story was fairly interesting and relative to the conversation.

Growing Number Of Patients Find A Hospital Stay Does Not Mean They

Apparently more hospitals are choosing NOT to treat on an Inpatient basis. Perhaps the government did a GOOD thing by eliminating benefit maximums inside of major medical polices?

-Allen

Welcome to the last decade.

Just out of curiosity, how long have you been in the health business? Real major medical health plans? Not supplemental, accidental or anything like that?

Honest question.

 

[AllenChicago]

Welcome to the last decade.

Just out of curiosity, how long have you been in the health business? Real major medical health plans? Not supplemental, accidental or anything like that?

Honest question.

Welcome to the last decade? The last before what..Armageddon? Please try to be more concise, Quartermaster.

To answer your question honestly, I have been a licensed insurance agent since 1987 when I left Computer Programming for the freedom and upside potential of insurance sales. Started at Prudential and transferred to the brokerage side in 1997. Didn't start focusing on Health Insurance until 2001. Now, health insurance is 90% of my business revenue.

HONEST (and thorough) ANSWER. Hope it helped!

-A.C.

 

[ABC]

Cosigned.

I'd rather use HRA's & FSA's than swiss cheese plans to save money.

This approach does not have enough savings. A HSA plan might bring 12%-20% saving to a small group. Maybe!
The FSA still has to be funded by the employer.

The reason for this approach is to save significant money to the employer so they can keep some type of plan in place. You would not sell this to a company that is white collar.



You sure about that?

I would be very wary of telling people that a non-covered service would get a PPO discount. Because they don't necessarily receive one. Could they negotiate one with the provider, most likely, but........

Yes 100%! With this type of plan design they will give a very small benefit like $300 with of diagnoistic treatment per year.The reason they put that in is that the insured can recieve the network discount.

"Most Expensive" is relative.

I disagree to the extent that more care is now provided in outpatient settings, even at the hospital, and quite frankly, there are better ways to skin a cat IMHO than cutting benefits in areas that are more likely to be utilized.......I see plenty of $20k - $50k+ surgeries that are done on an outpatient basis......

There is a huge difference from outpatient procedures being carved out and outpatient services. Surgeries would be covered either on an outpatient or inpatient basis. Now the outpatient therapies are not.

I really enjoy go up against incumbent brokers that do the same old approach. Every Month I pick up AOR because the owner is tired of looking at the same old spreadsheet with the same old information.

 

[HealthGuy]

ABC: Your approach still seems piecemeal. How many complaints to you get from angry employees who dont understand why the health plan doesnt pay for certain things. Fun taking those calls from your owners isn't it? I just don't buy your approach here.

 

[AllenChicago]

My MGA had a heated discussion with the Sales VP of one of our carriers this morning.

He's saying that our clients/customers who own individual health plans with effective dates between 3/23/10 and 9/22/10 will have to convert to another (higher cost) policy on January 1st, IF their current policy contains internal benefit limits other than an Annual or Lifetime dollar limit.

As discussed in this thread, we knew that sales of these type of plans had to be discontinued prior to 9/23/10, but the insurance company attorneys have now determined that this rule goes retroactive back to March 23rd policies, on January 1, 2011.

Combine these new skeletons being discovered in the Healthcare Reform bill with the MLR restrictions and we could be looking at total anarchy in the health industry. Many companies will simply decide that it's not worth it. In fact, I'm wondering what's taking so long for a good number of the smaller ones to call it quits...not just the 2 or 3 that we've heard of already.
-AC