Odd Question

[somarco]

Steph -

I would take what some say about carriers dodging state regs with a grain of salt.

ALL major medical plans must comply with state mandates. Doesn't matter if they are written thru an association or filed individually with the DOI.

Even limited benefit plans have to pass muster with the DOI although they are not always required to cover benefits mandated for individual major med policies.

And to further muddy the water, most states have different rules for group plans vs. individual plan.

If you think a carrier is suppose to cover a mandated benefit, and they are not, then bring it to the attention of the DOI. The DOI WILL most certainly follow up on it.

FWIW, replacement prostheses are usually not mandated by state law and as such may or may not be covered by the carrier at their discretion.

 

[Crabcake Johnny]

How would CoreMed and Right Start be compliant with the MD mandate that mental/nervous disorders must be covered.

 

[Crabcake Johnny]

Steph -

ALL major medical plans must comply with state mandates. Doesn't matter if they are written thru an association or filed individually with the DOI.
.

Let's try to put an end to this debate. I attatched the MD mandates. Please look over this list and compare it to Right Start, CoreMed and Copay Saver benefits and ask:

Do those plans cover dental anestesia, contraceptive drugs/devices, hearing aids, mental/nervous or infertility treatments or hardly anything else on that list?

Let's take a look at infertility. It's mandated if the carrier offers maternity. Assurant offers maternity yet doesn't cover any infertility or contracetive drugs/devices.

I called both Assurant at the MIA about this. Both told me the exact same thing - Assurant does not have to comply due to association rules.

Here's a screenshot of Coventry's infertility benefit. They're domiciled so they must comply.

 

[J.R.]

I'm surprised the DOI told you that. When I called and spoke w/ a DOI rep I could not get an answer to those very questions. It wasn't until I brought up my thoughts about the differences between domiciled and association based plans that I got a "you're an astute agent, but I cannot comment."

 

[Crabcake Johnny]

I met with the MIA so I had a few direct numbers. I was also highly confused with I left Mega and even more confused when I went indie.

I was selling Assurant's 192 series, mainly a plan called Physician/Hospital PPO. It had maternity and also covered contraceptive drugs. That lasted until the end of 2004 when Assurant switched to the Preferred 2000 series. I continued to sell maternity and tell my female clients contraception was covered.

Then I got my first complaint - that she got her birth control pills and got a letter from Assurant that they were not a covered benefit. I called. They told me because of the way they filed the Preferred 2000 series in MD they didn't have to comply with that mandate, nor any other mandate they choose.

I called my contact at the MIA who confirmed it - Assurant did not have to offer any mandated benefit if they chose not to. Obviously Mega plans along with Right Start, CoreMed and Copay Saver aren't remotely compliant with the MD mandates.

 

[SME]

Wow this has been a very enlightening thread. Thanks for all the info.

 

[Crabcake Johnny]

I really don't know where the argument is. I'd like nothing better than to have the association plans in MD all cover the mandated benefits. It's not even close.

 

[somarco]

Steph -

If you have an issue with a carrier that you feel is not in compliance, you can either resolve it with the DOI or simply refuse to use that carrier with your clients.

If I had a problem with a carrier that I felt was not in compliance I would not hesitate to cut them from my portfolio.

Similarly, if a carrier is not providing benefits that are on par with what my client can get through other carriers (or other plans) then I would not use them.

Up until July 2007, Aetna has limited Rx to $5,000 on all but one plan. The result is, when I use Aetna, I only sell the plan that does not have the Rx limit.

Similarly, I do not sell the Time Right Start, Save Right or Core Med plans. I am reluctant to offer the Max plan due to the Rx copay but have used it a few times with a caveat. While Core Med is better than Right Start or Save Right, it has a killer Rx copay that I do not like.

I don't offer my clients Copay Saver or HSA Saver from GR.

They don't buy World HSA plans that do not cover Rx from me.

Simply stated, I don't offer my clients anything that I would not buy. If it means selling a Blue plan (gag) because it is the best fit, I will. However I will warn my client who insists on Blue that their pre-ex conditions will not be covered for at least 12 months and the first renewal will be 40% or higher.

You can choose to make a living by making excuses or you can treat your client as if it were your mother and make a recommendation that is right even if it means deviating away from your "preferred" carrier.

I make no bones about my fondness for GR but there are times when the fit isn't there.

I am extremely fond of Aetna but unfortunately they are not competitive 90% of the time.

 

[Crabcake Johnny]

So you're not gonna address your statement that all major med plans have to comply with the state mandates? Clearly they don't and that was my only point.

 

[Crabcake Johnny]

Here are Georgia mandates:

Breast reconstruction
Cervical cancer screening
Clinical trials
Contraceptives
Dental anesthesia
Emergency services
Mammography screening
Maternity care
Mental health, parity
Minimum mastectomy stays
Minimum maternity stays
Off-label drug use
Prostate cancer screening
TMJ disorders
Well-child care

Any chance either GR or Assurant comply?