Some Input on IFP Benefits

Feb 27, 2008

  1. Dave020
    Offline

    Dave020 Super Moderator Moderator

    Posts:
    3,354
    Likes Received:
    47
    State:
    California
    Hey Gang,

    Would love to get some input from you guys about some concerns I have run into lately with certain IFP plans. I know Somarco is on record as opposing plans with the words "right" "start" and such and I think with some good reason.

    I am curious, since most if not all plans (even the saver and basic) will cover the big bills up to lifetime max with a good carrier, how do you guys rank the preventative care and annual physical benefits when you consider which plans to offer?

    For example, until the recent introduction of Lumenos out here, some of BCCs non-maternity plans limit or even specifically exclude things like physicals and have stern requirements about who exactly can do certain preventative services (Health Check Center instead of private doctor).

    So is your take:

    1 - it's not that important even if it falls under deductible

    2 - it is important but does not necessarily need to be a copay outside deductible or with the patients doctor

    3 - it is very important and I make sure the plans I sell offer comprehensive preventative care with annual physicals upfront.

    Again, I'd appreciate your thoughts.

    Dave
     
    Dave020, Feb 27, 2008
    #1
  2. somarco
    Offline

    somarco That Medicare Guy

    Posts:
    28,783
    Likes Received:
    2,245
    State:
    Georgia
    Personally, I never gave much credence to preventive benefits. But then, I am a guy.

    It finally dawned on me that 80% of my clients are women and this is important to them. So . . .

    Every chance I get I talk up the "free" annual exam with carriers like Aetna, Humana, KP and Blue.

    Had a long discussion with folks at GR about this and they insist that the annual wellness should be at client expense.

    So when I am showing an HSA and it comes down to GR & Humana, the plans are almost identical in design & price but Humana comes with a "free" physical, guess who wins?
     
    somarco, Feb 27, 2008
    #2
  3. salpro22
    Offline

    salpro22 Guru

    Posts:
    1,954
    Likes Received:
    25
    State:
    Texas
    What do you consider comprehensive to mean? I'm not familiar with the CA, so perhaps a brochure or plan reference is in order.

    Personally, I like the copay select plan for people opposed to a HDHP, but I'm not a big fan of the preventative cap being so low as opposed to other carriers. Carefirst is so-so and KP has a few very nice benefit rich plans, but then they screw you with a low drug cap and other things.

    So, the question remains, would you rather have unlimited drugs or unlimited preventative care? I prefer the former as I've yet to hear somebody going into financial hardship because they couldn't afford a physical.

    Has anybody had a case where the client exceeded the cap for child immunizations w/GR?
     
    salpro22, Feb 27, 2008
    #3
  4. TXINSURANCE
    Offline

    TXINSURANCE Guru

    Posts:
    3,858
    Likes Received:
    28
    This is a good thread. There are two issues at hand - the educated agents perspective and the clients perspective.

    The agent usually pushes "life time max" and "unlimited RX" - 99% of clients I have dealt with over the years could care less - they usually are thinking two things "How much to go see the doctor" and "What does dental cover".

    These are two items I could personally care less about, but you need to satisfy the market demand. Blame Group Insurance , this is what people are conditioned to expect. It is 2008 and a lot of employers (and most governments) have 1958 group benefits (low deductibles, co pays, preventative, etc.,). The fact is group plans are out of touch with the times - and are just now SLOWLY starting to catch up.

    Even my own company is a good example we have a $1000 deductible and $20 unlimited visits that include lab and xray! I offered HSA plans and the premium was literally about $20 per month less and my employees looked at me like I was on crack.

    HSA pricing is another problem in my opinion should be FAR less.

    As an agent my rankings include (not in order): Unlimited RX (if possible), Reasonable lifetime max, no outpatient or silly caps on specifics, large carrier with deep pockets, etc., et.,

    My customer rankings include (not in order): Office visit co pays, well woman care, DENTAL, VISION, RX co pays, more dental and vision questions.

    The dental and vision drives me crazy since most individual markets have horrible dental and vision solutions.
     
  5. Dave020
    Offline

    Dave020 Super Moderator Moderator

    Posts:
    3,354
    Likes Received:
    47
    State:
    California
    Thanks Somaro and John, really appreciate the feedback.

    To Somarco, I agree that preventative benefits are far more important to my women clients than my men clients. I suspect men tend to go less often for even an office visit so to them it is no big deal. Women and children use the benefits more often. I should have prefaced my original post to include a 4th which would be differences for both sexes. The current RP client who just got a big bill for her daughter's prev care done in the office and not at a Health Check Center is a woman.

    To John, by comprehensive I mean that it includes most if not all of the nationally recognized preventative care including an annual physical. That would be things like vision tests, blood work to include diabetes, triglycerides, and so on, BP, BMI, PSA, PAP, Mammography, immunizations. I will try to post the list that Lumenos plans provide on their HSA plans at no charge (no copay or anything, just free and it's a huge list).

    In CA it must be different, our majors on IFP do not have any caps on Rx benefits, just generics at a rate, brand with a deductible then copay, but no limits either annual or lifetime. Also, all plans provide up to lifetime max for major services inpatient/outpatient so that is never an issue even with the most basic plans.

    Dave
     
    Dave020, Feb 27, 2008
    #5
  6. Dave020
    Offline

    Dave020 Super Moderator Moderator

    Posts:
    3,354
    Likes Received:
    47
    State:
    California
    John,

    Here's what Lumenos covers on their plans at no cost for preventative care (this is probably identical to the services BCC requires at Healthy Check Centers).

    ADULT PREVENTATIVE CARE:
    -Office visits after age 18
    -Screening for coronary artery, colorectal cancer, prostate, diabetes & osteoporsis. Also includes mammograms, pelvic exams, PAP, & Contraceptive management
    -Immunizations - Hep A&B, Diptheria, Tetanus, Pertussis, Chix Pox, Flu, Pneumonia & HPV

    WELL BABY AND WELL CHILD:
    -Office visits through age 18
    -Screening for vision, hearing and lead exposure. Also Pelvic, PAP and contraceptive for females age 18 or sexually active
    -Immunizations - Hep A&B, Diptheria, Tetanus, Pertussis, Chix Pox, Flu, Pneumonia, HPV, H. Influenza Type B, Polio, Measles, Mumps Rubella (MMR)

    Dave
     
    Dave020, Feb 27, 2008
    #6
  7. TXINSURANCE
    Offline

    TXINSURANCE Guru

    Posts:
    3,858
    Likes Received:
    28
    Lumenos is like our Solaura in Texas.

    Pricing is too high on our version, the only major attraction I see is the colonoscopy coverage - they must have some good contracted rates on this, as I would imagine people over 50 and agents are pushing this as a selling point. Claims might start rolling in.

    We have sold ZERO of this plan in Texas, it is really not selling well at all. When my family was on a HSA $5750 (or so..) the Solaura $10,000 was around $2 cheaper per month (to double my deductible essentially) - no thanks.

    HSA plans prices have to come down to earth one of these days.
     
  8. Sam
    Offline

    Sam Founder Administrator

    Posts:
    1,532
    Likes Received:
    58
    It would be very interesting to see the spread between copay plans and HSA's in each state and across carriers. I only deal with group plans, but I have seen some plans that will compensate 5% to move everything behind the deductible and some will go 50%.

    With large groups I have seen moving to an HSA and keeping the deductible levels the same have a 24-38% claims differential. Most of that gets passed on in the premiums. However, this is only from 4 cases, so it can't be treated as anything more than anecdotal. I did have one case where the claims were higher with the HSA, but that was because of a few shock claims.

    On the small group side, I see some states where almost every carrier offers a very small spread. You see this a lot in HMO land, even though HMO HSA's also work well.

    Anyone have stats on the spread from the states you are active in for individual?
     
    Sam, Feb 27, 2008
    #8
  9. Dave020
    Offline

    Dave020 Super Moderator Moderator

    Posts:
    3,354
    Likes Received:
    47
    State:
    California

    TX, same initial problem in California, Lumenos is really sweet 100% preventative upfront and deductible=OOP on all plans. Pricing was high.

    They just came out with Lumenos Non-Maternity portfolio and built in some coinsurance ($1500 deductible + $2000 Coinsurance=$3500 OOPM) to bring the rates down. Same benefits, just no maternity and added coinsurance segment and it is coming in way below the older portfolio RightPlans and stuff like that.

    They also introduced something called SmartSense (Somarco, add that one to you list!) which is way too stripped down - 3 office visits per year, no preventative care until deductible is met then only in Dr. Office (higher cost than Healthy Check Centers). They are cheap, I will give them that.

    Truthfully, I think Blue Cross CA might just as well delete their entire portfolio except for the Lumenos plans.
     
    Dave020, Feb 27, 2008
    #9
  10. Guest
    Online

    Guest Guest

    HSAs are all I pitch these days... and the Lumenos plans are OK... I like the Blue Shield 2400 HSA better.

    Make a note that BC does one insidious thing. They quote their non-mat 70% co-pay $1500 deduct with a $3500 max out of pocket... but if you read the fine print the OOP is IN ADDITION to the deduct... making the true OOP $5,000.

    I hate crap like that. It is plain dishonest and the DOI should not allow them to market it using those words. See: http://tinyurl.com/384jen

    One other thing about Lumenos is that it is not age banded. So people can get two increases a year... the age increase and most likely an across the board increase.

    Al
     
    Guest, Feb 27, 2008
    #10
Loading...