State Mandate Confusion

[Crabcake Johnny]

Mandates have always confused me. Even when I sat down with the DOI back in 2004 (regarding Mega Life) I couldn't get a clear answer.

Aetna came into MD offering maternity with low initial rates. Then after 2 years the rates literally doubled. When I called to inquire I was told that maternity is mandated in MD (which is true; hence Carefirst BX and Kaiser cover it) and because of this the rates had to be increased. Remember, mandated maternity was Aetna's response to me regarding the rate hike.

A few months ago Aetna switched to Value plans as the only option and dropped maternity. I called again - this being my question "In 2006 you doubled the rates citing that maternity was required in MD. Now you've lowered the rates and dropped maternity."

So far, speaking with three different Aetna reps no one has been able to give me an answer. The clear answer seems to be "Yes, it's a mandate...unless we don't feel like covering it."

 

[somarco]

The bottom line is, the DOI decides what is an approved plan design and what isn't . . . along with rates and underwriting guides. It does not matter if the plan is filed as a state specific plan (such as GR does in GA) or an association plan (such as World). In both cases, the carrier cannot legally offer a plan unless it has the states blessing.

Beyond that, I can't offer any insight.

GA requires all carriers to cover complications of maternity, but if someone applies for coverage and had a prior complicated delivery, the carrier may be allowed to rider that condition if they are a "rider" carrier.

This happened to me with Time a few years ago as well as CGI.

 

[Crabcake Johnny]

To me it's "pick one." Either they doubled the rates because maternity is mandated or they just ditched maternity because it's not a mandate.

You're correct; the new "Value" series had to be approved by the DOI and Aetna is domiciled - not association-group.

BTW, in 2004 Assurant also told me they had to offer at least one plan that included maternity, even through they were association-group. Well, maternity goes away next month.

I guess anything's a mandate...until it gets too expense to cover.

 

[somarco]

Look at it this way.

Health insurance for all will soon be mandated.

Unless you decide to opt out . . .

 

[Crabcake Johnny]

It won't matter. The One made sure none of this takes effect until he's a lame duck president. When it fails he'll blame the greedy carriers and start rattling off executive comp numbers.