MLR Discussions

[stuy119]

This came out today:

http://www.lifeandhealthinsurancene...nel-Ponders-Initial-MLR-Calculations.aspx?nul

Insurers will use a 3-year average of medical loss ratios when calculating rebates, PPACA Actuarial Subgroup members say.

The subgroup is helping the NAIC develop rules for calculating loss ratios and for compensating enrollees with rebates when the minimum MLR standards are violated.

One of the IRDs the subgroup discussed, IRD071, proposes that rebates should be paid only to enrollees who were present during the last experience year.

Yes, problems are coming down the line.

Also, if most of the issues are "settled," why in the heck didn't they say what happens to comp? Seems like it's what is on everyone's mind right now.

 

[ABC]

Thanks for posting that.

I hope/pray that our comp has already been excluded from the MLR.

 

[somarco]

HHS is making all of this up as they go along. The recent concession to allowing an open enrollment period for kids is further evidence.

Also consider all plans will have to be retroactively adjusted to cover preventive care and even maternity. Have you seen any changes yet?

No, because HHS hasn't clarified all the details.

Obamacrap is a moving target and we won't know until we get there. As more is revealed on pricing for kiddie coverage expect more debate and back to the drawing board as we get closer to the November elections.

Obamacrap will not go away as a political issue no matter how much DC wants the public to believe it is nothing more than a bunch of whiny wingnuts who don't want Obamacrap.

 

[TXINSURANCE]

Also consider all plans will have to be retroactively adjusted to cover preventive care and even maternity. Have you seen any changes yet?

I have not heard anything about plans being required to cover maternity, certainly not pre 2014. Do you have some additional information on this?

 

[Crabcake Johnny]

To my knowledge, the plans only have to cover preventative, have no annual limits and offer GI for children. Everything else kicks at 2014.

 

[TXINSURANCE]

...and the government rescind panel...

 

[Crabcake Johnny]

Yes...can only rescind for fraud. I'm lost - was there any other reason carriers rescinded?

 

[somarco]

Carriers that offer maternity have to treat it as any illness. Goes back to the day Obamacrap was signed. That is why Time & GR quickly exited the maternity market. Obamacrap doesn't require carriers to provide maternity (yet) but does (as I understand it) require them to treat it as any other illness.

 

[TXINSURANCE]

Carriers that offer maternity have to treat it as any illness. Goes back to the day Obamacrap was signed. That is why Time & GR quickly exited the maternity market. Obamacrap doesn't require carriers to provide maternity (yet) but does (as I understand it) require them to treat it as any other illness.

Hmmm.... So if someone has World (only carrier with maternity in Texas individual market) and World has a maternity cap of $2000 1st year, that progresses to $3000 and $4000 over time - this is no longer permitted?

Will they have to modify the existing plans or simply drop the benefit? I assume they could just drop the benefit.

I had Unicare years ago which had maternity on the individual market, they simply dropped the maternity benefit from my plan, then again it was not a rider it was built into the plan.
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es...can only rescind for fraud. I'm lost - was there any other reason carriers rescinded?

Yes, material misrepresentation which is not necessarily fraud (intent). I have cases rescinded over what I consider to be complete BS. They are rare, but when they bite - they bite hard.

 

[Crabcake Johnny]

That would be true. I'll give you an example. My wife had gestational diabetes during her pregnancy. When we filled out an app three years later she completely forgot about it - I didn't, put it on the app which resulted in a rate-up.

If she had omitted that info, her policy would have been subject to rescision. Now, however, the carrier would have to prove fraud - ie: the intent for my wife to defraud the carrier which is a much tougher test.