No More Wellpoint Policies for Kids

[somarco]

HHS position on open enrollment is . . . (drumroll please)

Question #2: Do these interim final rules require issuers in the individual health insurance market to offer children under 19 non-grandfathered family and individual coverage at all times during the year?

A: No. To address concerns over adverse selection, issuers in the individual market may restrict enrollment of children under 19, whether in family or individual coverage, to specific open enrollment periods if allowed under State law. This is not precluded by the new regulations.

For example, an insurance company could set the start of its policy year for January 1 and allow an annual open enrollment period from December 1 to December 31 each year. A different company could allow quarterly open enrollment periods. Both situations assume that there are no State laws that set the timing and duration of open enrollment periods.

Question #3: How often must an issuer in the individual market provide an open enrollment period for children under 19?

A: Unless State laws provide such guidance, issuers in the individual market may determine the number and length of open enrollment periods for children under 19 (as well as those for families and adults). The Administration, in partnership with States, will monitor the implementation of the pre-existing condition exclusion policy for children and issue further guidance on open enrollment periods if it appears that their use is limiting the access intended under the law.

In other words, it depends . . .

I have been told by Anthem, UHC, and Humana over the phone that they are still able to decline children post 9/23.

I haven't heard that, but I have heard they can and will decline a family application without regard to identifying any specific individual that caused the decline.

 

[Crabcake Johnny]

Well, if this isn't a get out of jail free card I don't know what is. Accept all apps, take the ones you want, decline the rest on the basis of "it's not OEP" yet no one will define OEP at this time.

This couldn't be a better gift to the carriers if it was wrapped up in a bow. For agents? No so much. Submit an family app with an unhealthy child? Maybe you get paid...maybe you won't.

During one of my conversations my rep had this to say (paraphrasing) - "In theory an agent could walk through the child cancer ward of a hospital and write apps so long as they got one parent on the policy."

 

[IndividualHealthGuy]

Re: Wellpoint

BCBSIllinois let agents know about three weeks ago that they would no longer take kids on a stand alone basis.

They are coming out with a new child-only plan design (that is available by direct sale at bcbsil only). They just won't offer child only on their existing portfolio.

 

[dgoldenz]

I haven't heard that, but I have heard they can and will decline a family application without regard to identifying any specific individual that caused the decline.

Just got a call from UHC that changes the info and now says kids will be GI. Who knows...

 

[somarco]

UHC that changes the info and now says kids will be GI

The 30 day wait between submitting the app and coverage effective date is a virtual open enrollment period. My guess is they would have gone out further if they thought they could get away with it.

This 30 day window will have a significant impact on new business.

 

[Crabcake Johnny]

Please...anyone, submit a GR app post 9/23 - family case with a child currently incurring thousands a month in medical costs and let me know the outcome.

 

[dgoldenz]

Please...anyone, submit a GR app post 9/23 - family case with a child currently incurring thousands a month in medical costs and let me know the outcome.

Asked this question today, still no answer.

 

[Crabcake Johnny]

Submit an app. You'll get an answer real fast.

 

[somarco]

Agent - Hello, I can't find the app on the Munster family on eStore.

GR - App? What app? We don't got no stinkin' Munster's in our system. Submit it again.

 

[YouGotMyMoney]

Please.......in re: uhc 30 day wait:

you market to currently insured people, and write a uhc 400 mo app and you're replacing coverage.....they pay now and have to wait 30 days for coverage....plus they just paid their current plan 2 weeks ago.....in this economy......tuff.