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

[AllenChicago]

Hmmm... Isn't it UNUSUALLY kind of the U.S. Government to give carriers an option to wait for 3 months, especially with November mid-term elections during that 3 month time frame? The communiques from Humana, Blue Cross and Celtic all say that they will comply with the 9/23/10 mandates on all NEW business effective after 9/23/10 here in Illinois.

 

[somarco]

Isn't it UNUSUALLY kind of the U.S. Government to give carriers an option to wait for 3 months

You say that as if the folks in DC actually understand what they did.

Well, they didn't. Totally clueless. Making this stuff up as they go forward.

 

[Crabcake Johnny]

In looking at all individual plans in my state with effective dates post 9/23 I'm left to believe the carriers are going to play the "It wasn't clear" card.

Remember; easier to ask for forgiveness over permission.

 

[AllenChicago]

You say that as if the folks in DC actually understand what they did.

Well, they didn't. Totally clueless. Making this stuff up as they go forward.

I've asked around and nobody can point me to the wording, website, or whatever, that allows health insurance companies to wait until 1/1/2011 before implementing the mandates on new business effective after 9/23/2010. Do you know where this wording is Somarco?

Tomorrow I have appointments to show some local business owners what's available with these new mandates and I'd hate to have egg on my face (or to be shot!) after promising all the preventive care goodies on their new 10/1/2010 policies.

-Allen

 

[ksigmtsu]

BX of TN announced a 5.4% rate increase effective 9/23. Really not that drastic.

 

[somarco]

I can't tell you where the wording appears, but I do know the provision allowing parents to keep children on their plan until age 26 did not require plans to immediately accommodate the kids/parents in demand. Instead, the carrier could make the "child" wait until the next renewal before they could come on the parents plan.

I presume similar wording applies here.

Or at least that is how the carriers are choosing to interpret it until HHS figures out this is not what they intended.

BX of TN announced a 5.4% rate increase

Depends.

Annualized it is over 20%. The first bump for post 9/23 will be testing the water. Expect another bump that is more than just trend in January. It will probably be the 2nd quarter of 2011 before the carrier find the right rate for the new, expanded benefits and GI.

 

[AllenChicago]

Some news stories about the 9/23/2010 mandates taking effect this coming Thursday, from various news sources:

New Law Brings Changes To Health Insurance Rules This Week - Kaiser Health News

-AC

 

[northrngal]

There are two concepts that i see missing from this discussion... First, the fact that the more healthy people are insured, the lower the cost of insurance is for everyone. And with this economy, too many healthy 20/30 somethings are looking at that healthplan premium as an unnecessary cost. And then we have all the people working full time and having no option for health insurance or having to pick between eating or paying rent, and health insurance... look into it, a big portion of people without health insurance work.

Next, these "100%" coverages aren't the end of the world because $300 for a vaccine is peanuts for an Insurance company (even if it is), but because they used to pay at least 265 of that anyway (assuming a $35 deductable)... and the idea that $300 for 'each vaccine' on that chart is a bit misleading. the vaccines themselves are usually under a hundred, and most of the time under $50 for each shot... they may add up to that with 3 or 4 shots in the series, but that's not the same as $300 for each vaccination (which is one way to interpret how it was worded).
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As far as the dates, i think there may be some confusion between what a plan is and a policy. I believe the exact wording of the bill had to do with anytime the insurer sold a 'new plan' - not a new policy. (it's been a few months since i read it). That means that new policies for existing plans (individual market, etc) that some single person purchases on 10/1/10 is the same plan that was sold to someone else on 9/1/10...

Some insurers are choosing to update their plans/sell policies under new plans - possibly as a marketing strategy to get more business. If I was paying $700 a month and paying a deductible for my yearly PAP that was scheduled for November, I'd seriously consider switching if my current company was already so-so, and they chose to drag out every last second of not being forced to pay for something.

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As far as the 'cost' to the insurer of these... there is a logical argument to be made that they will save insurance companies money, especially given the removal of yearly and lifetime caps.

We've already mentioned that people that won't go to the doctor aren't going to go just because of this, but, if the screenings work, and they actually help people catch disease earlier and before it causes more complications, then the overall costs for the people who DO get screened will go down. Now, the amount of the savings may not go entirely to the insurance company, if the treatments would have previously maxed out the plan's caps, and now they have to pay for it.

At that point, it's in the best interest for the insurance companies to encourage research into really effective screenings, to reduce the false positives, and to make safer followup tests.

It's an effort to help them prevent future negative effects from the coverage caps going away, and is actually a good thing for the companies. Just like mandating insurance coverage is. The more healthy people in the pool *paying premiums*, the lower the overall cost per person.

 

[somarco]

As far as the 'cost' to the insurer of these... there is a logical argument to be made that they will save insurance companies money, especially given the removal of yearly and lifetime caps.

In the big picture, preventive care does almost nothing to impact loss ratio's. This is mostly because, even when free, most folks won't go to the doc except as needed.

Lifting caps does impact premiums, but not that much since it is mostly reinsured, especially LT caps. Bigger impact on rates is yearly caps, especially on Rx.

 

[Crabcake Johnny]

Theory vs reality. Was talking to an agent friend of mine in CT yesterday who told me Connecticare will indeed be accepting all children on family apps regardless of the risk.

Why? Reality. They are going to rate the entire family up to 100%. He ran what the rate would be for my family and it's just over $1,200. That's also a 10K deductible so total first year costs would be over $24K. How many takers? Not many.

Even if you're planning on gaming the system you'd still have to cough up 10K immediately.