Odd Question

[J.R.]

So essentially we are at ground zero yet again. Makes me wonder if the state mandates really do increase the amount of health insurance premiums purported by various organizations or if that is another smoke screen.

If company X can get around state mandates, but domiciled company Y cannot, then where is the justication that state mandates cost more money so insurance premiums need to be increased, yadda yadda?? If company Y charges more per member because "State mandates" cost more money to maintain, and subsequently company X charges close to the same amount to compete with said company, but doesn't cover as many mandates, company X is ahead of the game already......somebody is FOS!

 

[Crabcake Johnny]

This is exactly what I understand to be true and what was explained to me - that carriers basicially don't have to follow the mandates, or at least some of them, at their will.

No carrier has to be complaint with all the mandates - which basically was my original point. What further baffles me is companies in MD like Blue Cross and Coventry offering infertility benefits because it's mandated yet Aetna doesn't offer those benefits and claims they don't have to. What would separate Coventry from Aetna?

I have Assurant covering contracaptive meds on the 192 Series as an associated-based company yet claiming because of the way they filed Preferred 2000 they don't have to comply.

In MD the mandated benefits don't apply to HIPAA plans, small group plans or the state risk pool. They also apparently don't apply to any of the individual carriers so the question is "who DO they apply to?"

But let's at least solve this; no individual carrier has to nor do they comply with hardly any state mandated benefit.

 

[bluemarlin08]

Guys I am totally confused. I am still in a learning curve in regards to health insurance, and this site has been a major source of valuable information. I work mostly in Tennessee and sell about equal Assurant, BC and Gr. What am I not telling/disclosing to clients? Have I totally screwed up in what I have sold to some clients?

 

[J.R.]

Guys I am totally confused. I am still in a learning curve in regards to health insurance, and this site has been a major source of valuable information. I work mostly in Tennessee and sell about equal Assurant, BC and Gr. What am I not telling/disclosing to clients? Have I totally screwed up in what I have sold to some clients?

NO, this is simply a battle between one bitter-alpha man and another

You want in?????

 

[bluemarlin08]

Still learning personalities!

 

[Crabcake Johnny]

It was simply a statement made that all major med policies had to follow the state mandates. That is not the case. If you are selling individual policies and telling your clients that the carrier must offer those mandated benefits and if they don't you can somehow file a complaint with the DOI that is misinformation.

 

[somarco]

if the state mandates really do increase the amount of health insurance premiums purported by various organizations or if that is another smoke screen.

No, state & federal mandates add quite a bit to the cost of insurance. How much varies by state.

If company X can get around state mandates, but domiciled company Y cannot

Has nothing to do with domiciled vs foreign, individually filed vs association. The policy benefits determine the rate. Each policy, whether tailored to the state or filed as an association plan, must be approved and stand on its' own merit.

As Al Pacino said in the Devil's Advocate, EVERYTHING is negotiable.

Some folks get too hung up over nit-picking policy provisions and how they are filed. All that really matters is, will the policy do what your client needs. If not, don't offer it.

There are plenty of policies that are approved for sale in GA and are bought & sold every day . . . but not by me.

 

[somarco]

Marlin -

If you want to know what is generally required in your state(s), then you need to do what I did . . . ask the DOI to provide you with information. While there are dead-heads who work there you will also find some that are more than willing to respond to a question from an agent who just wants to do things right.

I have a couple of contacts within the GA DOI that have been extremely helpful in explaining what can & cannot be done. All I had to do was ask.

Carriers do NOT operate outside the law and get away with it . . . at least not for long. If a carrier can, completely independent of the DOI, pick & choose which regs to follow then the DOI becomes meaningless.

There are a few things that are hard & fast in any state. Other items are negotiable.

If you want to get hung up on the intricacies of one policy over another then you will waste a lot of time on BS and miss a lot of sales.

OTOH, you can look for carriers & plans that you would buy if you were in the market, learn the particulars of those plans, and then go sell.

Personally, I have no idea which plan has the best preventive benefit nor do I care. And DAMN coverage is likewise mostly meaningless from carrier to carrier (in GA) with exception of one. KP has the best DAMN coverage of anyone.

The small claims will equal out from plan to plan & carrier to carrier. What is more important to me, and my clients, is how their big claims will be handled. That is why most of my clients have no copay, high deductible, 100% plans. Some are HSA qualified, some are not. They are all very simple and easy to understand. Almost everything you would think would be covered accrues toward the deductible. Once you satisfy the deductible, almost everything is covered at 100%.

No BS caps.

No BS copays for anything (especially Rx).

Just simple, easy to understand plans that don't cost a lot and don't have big increases.

Makes my life simple and my clients appreciate the simplicity of the design.

They also appreciate saving about 30% over the plan they would have bought on their own, or thru another agent.