News & Info Related To 2017 Open Enrollment

[MBSC]

Buried on page 361:

We are finalizing, for the 2018 and later benefit years, a modified §156.230(e) to count services provided by an out-of-network ancillary provider in an in-network facility towards the in-network annual limitation on cost sharing if the issuer does not provide timely notice.

Comment: Commenters asked if §156.230(e) would apply to QHPs with tiered networks or QHPs that do not provide out-of-network services.

Response: We clarify that §156.230(e) applies to QHPs, both on and off Exchanges, and to QHPs with tiered networks, but it does not apply to QHPs that do not cover out-of-network services. It also does not apply to emergency services, which are governed by other Federal regulations.

 

[AllenChicago]

The number of stand-alone dental plans applying to be on the exchange for 2017 is higher than 2016.

Ref: http://www.lifehealthpro.com/2016/0...uer-counts-are?page_all=1&slreturn=1457490810

Since the interest in offering dental is stronger, is this an indicator that health insurance plan participation will be higher as well, as the article implies?

I think dental is lucrative for the insurers, because most of it is universally crappy coverage. (Big coinsurance percentatges, waiting periods, $1,500 coverage limit, etc..) Sure, children's ACA-qualified dental is much stronger than the adult version, but how many children need root canals and crowns. Are braces as common now as they used to be?

 

[RayNY]

I think dental is lucrative for the insurers, because most of it is universally crappy coverage. (Big coinsurance percentatges, waiting periods, $1,500 coverage limit, etc..) Sure, children's ACA-qualified dental is much stronger than the adult version, but how many children need root canals and crowns. Are braces as common now as they used to be?

I'm selling the crap out of a specific dental plan for just the reasons you describe. No annual max, no waiting period, no coinsurance (defined co-pays, including at specialty providers), no deductible, no cost cleaning/xray/preventative (2x per year per person), no referrals, no waiting period (except on multiple implants, or bridges of more than 2 teeth), and defined ortho benefit ($2,910 for standard 24 month procedure). One page app, $612 per year for a family (In NY!), fully ACA/PED compliant, and parents get the same great care as the kids.

It's a no-brainer. I have plans that cost as much, with the same size network, that are traditional 100/80/50 $1500 max plans. Put them side by side and it sells itself.

And, yes, braces are still common.

 

[AllenChicago]

I'm selling the crap out of a specific dental plan for just the reasons you describe. No annual max, no waiting period, no coinsurance (defined co-pays, including at specialty providers), no deductible, no cost cleaning/xray/preventative (2x per year per person), no referrals, no waiting period (except on multiple implants, or bridges of more than 2 teeth), and defined ortho benefit ($2,910 for standard 24 month procedure). One page app, $612 per year for a family (In NY!), fully ACA/PED compliant, and parents get the same great care as the kids.

It's a no-brainer. I have plans that cost as much, with the same size network, that are traditional 100/80/50 $1500 max plans. Put them side by side and it sells itself.

And, yes, braces are still common.

OMG Ray, I didn't know such an animal still existed! With those benefits, $612 for a family means that it's a money loser for the company. What's their strategy?

Braces must be almost invisible now, as I rarely see kids with the bright metal.

 

[Yagents]

Yah, that money losing dental product won't last long

 

[TN_agent]

Is it an HMO with a small network? You can buy the coverage but good luck getting an appointment with a participating dentist and, oh-yeah no out of network benefits sort of thing?

 

[RayNY]

TN_agent, DHMO, but the network is pretty damn big, on-par with the best options in the state. The same product with the smaller network is just $414/year/family. I've had no complaints about being seen, it's actually very good.

Allen/Yagents; Not a loser, product has been pretty darn stable from what the reps say. Most popular product from the biggest stand-alone carrier in the state. For some reason, no one I mention it to had any clue it exists.

It even includes a name brand vision discount program, and great commission, as if it the benefits weren't a good enough reason to sell it.

There's golden nugget products buried in carrier portfolios. I've been spending quite a bit of time digging through the less-used products and carriers looking for solutions to specific problems. This just happens to be a solution to a LOT of problems, and I'm sure you all see why.

 

[Tkruger]

Is it only available in NY?

 

[AllenChicago]

TN_agent, DHMO, but the network is pretty damn big, on-par with the best options in the state.

Allen/Yagents; Not a loser, product has been pretty darn stable from what the reps say. Most popular product from the biggest stand-alone carrier in the state. For some reason, no one I mention it to had any clue it exists.

It even includes a name brand vision discount program, and great commission, as if it the benefits weren't a good enough reason to sell it.
.

Ray, you're among the smartest, level-headed agents in this forum. In your estimation, HOW does a company make money on a superb dental/vision product like this that only costs $50 a month for a family, and pays a great commission?

 

[RayNY]

Ray, you're among the smartest, level-headed agents in this forum. In your estimation, HOW does a company make money on a superb dental/vision product like this that only costs $50 a month for a family, and pays a great commission?

They don't pay me to worry about that, they pay me to sell it.

If they go out of business, I'll just move the block to the next best option and collect a sweet first year production bonus. I couldn't care less, my clients expect their carrier to go out of business every year at this point.