Odd Question

[newmindfashion]

John,
Just to clarify CT, GR is not association in CT and there is no actual law against riders here. GR and Celtic use them here. For some reason Assurant is not any longer using riders mainly because they're in hot water w/ the Attorney General here. The carriers that don't do riders do so becasue they chose not to.

 

[newmindfashion]

Regarding mandates with GR, their generic (FACT states) Health Plans brochure on page 14 indicates state variations such as in MD, "The limited exclusion for AIDS does not apply."

In FL, well child care services are not subject to the deductible. In AZ, references of 12 and 24 months are changed to 6 months in regards to pre-ex conditions. Also in AZ, dependent children don't have to live with you.

In CO, there are all sorts of specific rules GR has to follow.

Point being, if they were able to get around things via the association, why are there these state variations? One must assume there is a law in FL that makes them cover upfront preventative care...

 

[somarco]

All plans, association or otherwise, must be filed with the respective state DOI and approved before the product can be legally sold in that state. Mandates have all kinds of exceptions and carriers know how to capitalize on those provisions.

If you feel a carrier is violating DOI rules & regs, it is incumbent upon the agent to report such to the DOI.

 

[bluemarlin08]

Where can I get a copy of each states mandates? I specically looked for Tennesse at the DOI site and google without success, any help?

 

[J.R.]

Where can I get a copy of each states mandates? I specically looked for Tennesse at the DOI site and google without success, any help?

Enjoy.

 

[bluemarlin08]

Thanx sal!

 

[Crabcake Johnny]

The bottom line is simple; the individual carriers are not abiding by all the state mandates. If anyone can explain that I've love to hear the explanation - it's still incredibally confusing to me. Neither GR nor Assurant in MD comes close to abiding by the 60 state mandated benefits. I'm looking at the Georgia mandates and neither GR or Assurant complies there either. GR is not association based in GA so why they don't follow all the mandates I guess will be a mystery.

 

[newmindfashion]

Damn good question John. It seems they abide by some but not all and not the sames ones as each other.

 

[Crabcake Johnny]

True. Maybe Somarco can shed some light on why GR and Assurant are not compliant in Georgia when one is associated based and one isn't.

 

[somarco]

The grid is a nice summary, but by no means comprehensive. Most states have such a hodge-podge of rules & regs that you cannot get the information you seek in one place. I have information on GA mandates because I asked someone rather high up in the DOI for a copy. In a reply email, here is what I was told about GA laws.

Mandated health benefits have been addressed in somewhat of a patchwork type of way over time by the Georgia Legislature. As such, they aren't all located in one easy to digest area within Georgia law, nor do they apply universally to all product types (major med, limited benefit, etc.). This makes their research or presentation in any listing or chart a bit hard to clearly show, and it makes compliance in policy drafting and administration of benefits across product types somewhat challenging for insurers.

Here's a summary of what we have pulled together in response to requests over the years as a list of "mandates" that apply to individual health. This list has its own qualifications, in that some "mandates" are really only mandated offers. But as far as I know, this listing is as close as anyone will get to any official on unofficial listing on this topic. The revision date on the list says 9/2003, but the list's information is still accurate and up to date, as no new health mandates affecting individual or group health were enacted in the 2004, 2005 or 2006 sessions of the General Assembly.

You might be interested to know that there was a law passed which dealt with mandated benefits, indirectly, and allows insurers to offer individuals or small employer groups an alternative health policy type which protects certain mandates from being excluded but does allow exclusion of some historically mandated benefits. The bill was Senate Bill 174 from the 2005 session of the General Assembly. To date, very few insurers have considered submitting such a "mandate-lite" product for our Office's review and potential approval. To our knowledge, only Aetna and Kaiser are in the product development stages of a "mandate-lite" product.