New (ish) Individual Health Plans in Maryland

[somarco]

I have quite a few clients with the KP HMO in Atlanta and they love it. It is a different system, more regimented than a PPO, but works well once you understand the game.

Stomach pains that are something more than eating too many hot dogs at the game can be considered a medical emergency. Things like appendix, intestinal blockage, food poisoning, etc. can all warrant a trip to the ER.

Years ago some of my wife's family was visiting from CA when her uncle had a heart attack. He spent several weeks in the hospital before he was released to go back home. KP paid for everything.

 

[Guest]

Also remember that while the OOP is $5,250 any individual only has to meet $2,600 - much different from the other HSAs I sell where any individual has to meet the full $5,600.

You mean the deduct is $2,600? How can the OOP be $5250 but they only have to meet 2600?

Al

 

[Crabcake Johnny]

Deductible's $2,700 - my bad. Here's the stats - punch into "Blue Choice HSA Maryland."

https://www.carefirst.com/eSales/broker_groups.jsp?b=132

 

[Sam]

What he means is that the deductible is not aggregate, so if the husband gets sick and goes to the hospital and the bill is $4,000, then the insurance company will pay $1,300 of it, even though they didn't hit the "family" deductible.

Another nice thing about Carefirst is that their age bands are 10 years, so a 42 year old will not get an age banded increase, until he turns 49, and meanwhile, the regular rate increases must be approved by the DOI.

 

[Crabcake Johnny]

I was under the false impression when I went independent that domiciled carriers, since the rate increases had to be approved, would be less then association-group carriers. Howerver, Aetna just hit VA with 27% and the DOI approved it and hit MD with 19% and they approved it. Compare that to Assurant's 22% and it's not much difference. But take into account that Assurant gets to offer a 10% "healthy discount" that domiciled carriers aren't allowed to offer. Very strange. So what's the point of running rate increases through the DOI with state's like VA allow companies like Aetna to completely abuse their clients? 27% increase AND they took away the maternity benefit!

 

[somarco]

Rate adjustments have to be justified to the DOI with supporting data such as loss ratio's. Carriers such as Aetna have such a small block of individual health insurance it only takes a couple of hits to wipe out the loss ratio. Even with reinsurance they still will take a hit.

Nominal carriers such as Aetna, Humana & Celtic are going to have difficulty sustaining what they have, much less making progress and growing a block. All 3 of these carriers are minor players in GA and I do not see them making much headway in the near future.

Generally speaking, association carriers pool their business, sometimes across state lines, to lessen the impact of large claims. You cannot make the assumption that carriers with individually filed plans are more (or less) expensive & reactive than association plans.

In GA Blue is not only domiciled here but offers individual (non association) plans and their renewal rate increases have been higher than anyone the last several years.

 

[Sam]

Thanks Bob, I didn't know that. Good info!

 

[aufan]

Does anyone know if the Carefirst plans are available in MS? Can you get appointed to sell their plans here? I was told that Blue Cross is not accepting any brokers in the MS area. Anyone know?

Blue Cross is WAY strong here in MS.

Thanks in advance!

 

[Crabcake Johnny]

Rate adjustments have to be justified to the DOI with supporting data such as loss ratio's. Carriers such as Aetna have such a small block of individual health insurance it only takes a couple of hits to wipe out the loss ratio. Even with reinsurance they still will take a hit.

Nominal carriers such as Aetna, Humana & Celtic are going to have difficulty sustaining what they have, much less making progress and growing a block. All 3 of these carriers are minor players in GA and I do not see them making much headway in the near future.

Generally speaking, association carriers pool their business, sometimes across state lines, to lessen the impact of large claims. You cannot make the assumption that carriers with individually filed plans are more (or less) expensive & reactive than association plans.

In GA Blue is not only domiciled here but offers individual (non association) plans and their renewal rate increases have been higher than anyone the last several years.

Well that would seem to be a catch-22 for Aetna. You don't have a large block of business therefore claims kill you. Then you have to hike them 27% and there goes your healthy block of business since they simply cancel.

I can tell you know that 19% is killing my Aetna book of business in MD. Tough to tell my clients on the PPO 30 paying $512 a month that they'll now be paying $609. Carriers like Assurant offer a myriad of choices at renewal. Clients can simply raise their deductible by $1,000 or OOP limit and they're ok. Can't do what with Aetna plans. Suck it up or cancel. Most of my clients are chosing "cancel" and I'm writing them with other carriers.

They've also killed my new business sales. That $512 a month plan was a tough enough sales. Now that same plan is $616. No dice.

 

[Guest]

Dumb quesiton time: What do you mean by an "association plan"?

Al