"Preventive Services Coverage" Mandate Effective 9/23/2010.

[IndividualHealthGuy]

I dunno, last time my doctor checked my prostate he had both hands on my shoulders. Is that the normal procedure?

Did you have it checked at the YMCA?

 

[ksigmtsu]

I thought that this went into effect on Sept 23 for all plans sold since the bill passed? That if a plan was bought in July, on Sept 23 free preventive care was included for it as well? If so, they should have priced in the preventive care back at the beginning of summer, not waiting for plans effective 10/1.

My understanding of that rule is that every policy sold after March 1 is going to have the new preventive services mandate added, including plans like assurant health access A, B and C that were categorized as major medical even though they're more like minimeds.

 

[arnguy]

Depends.

Did you both want a cigarette afterward?

I wanted to have a smoke, Bob, but the doctor said that it would be bad for my health.

 

[AllenChicago]

My understanding of that rule is that every policy sold after March 1 is going to have the new preventive services mandate added, including plans like assurant health access A, B and C that were categorized as major medical even though they're more like minimeds.

The official website owned by the people who wrote the Affordable Care Act (U.S. Govt) says that all new plans that go into effect on or after September 23, 2010 MUST include coverage for Preventive Services with no Co-Pay or Deductible.

Link to wording and the services that must be covered: The Affordable Care Act?s New Rules on Preventive Care and You

Some on this forum have downlplayed the cost of these benefits and the degree to which they'll be used. I feel that most the health insurers have also made this same under-estimation /mis-calculation.

In addition to expensive colonoscopies, the mental and weight-loss counseling/treament entitlements will also be major financial burdens to insurers. And we have to remember that insurers will be under additional scrutiny when filing for rate increases.

Combine the huge increase in claims with having to keep rate increases at a minimum, and you have the perfect storm for making insurers give serious consideration to getting out of the health business, or closing down now, while they're still earning a profit. (BCBS said on a conf call last month that they're SERIOUSLY considering leaving the individual market all-together before 1/1/11.)
-AC

 

[somarco]

HHS has yet to issue regs on preventive care, which is why so many carriers have not revised plans yet or put out new rates. Sebelius has no clue what she is doing so there is no way to know how this will end.

 

[HealthGuy]

AllenChicago: I love you man, but if BCBS exits the individual health insurance market I promise you I will kill myself....AL3 might like that but come on man, BCBS will be the LAST company standing in the individual health market.

 

[AllenChicago]

AllenChicago: I love you man, but if BCBS exits the individual health insurance market I promise you I will kill myself....AL3 might like that but come on man, BCBS will be the LAST company standing in the individual health market.

The statement from the BCBS exec that they might exit the individual market may have just been about Illinois, since it was said on an Illinois Brokers conference call. Since BCBS has a 90% to 95% MLR in this part of the Midwest, which is the best of all the major carriers, it does seem far-fetched that they, of all companies, would exit the market. I agree with you 100% on that point, HealthGuy.

 

[AllenChicago]

Today an expert explained why some companies are adhering to the Sept 23rd mandates and some are not.

Apparently it has to do with in what state the company is domiciled. Here in Illinois, the director of insurance has directed all health insurance companies domiciled in this state to comply fully with the HHS mandates effective 9/23/2010.

Therefore, Blue Cross of Illinois, Celtic, Humana, and others who are headquarted in this state must comply. I THINK they must do so with all individual policies sold in any state.

Some states are allowing locally domiciled companies to wait until January 1, 2011 however.

Now I understand why some of our carriers have programmed in the mandates for September 24rd, while others have said that they will not include them until 1/1/2011.

I didn't know that the states were given so much responsibility when it came to implementing, on an individual basis, this national reform program.
-Allen

 

[Dave020]

In California, Anthem Blue Cross is implementing 9/23.

All other carriers are implementing 1/1/11.

Draw you own PR (media) conclusions

 

[AllenChicago]

Dave, are you saying there's no rhyme or reason as to why some are doing it 9/23 and others on 1/1/11 there in CA?

The explanation made perfect sense for this state because I can see on the websites that Illinois-domiciled companies are all complying.