The Death of the Mini-Med.

[somarco]

Sounds like you are describing a Mega plan

 

[Ann H]

Sounds like you are describing a Mega plan

Not at all. The Mega plan is the very type I think they need to avoid. I didn't say this in the last post (and perhaps I should have), but it needs to be comprehensive coverage, not just hospital and lab like some of the limited benefit plans out there. It needs to include doctor visits, prescriptions, and all the other medical services typically covered now on an IFP plan.

 

[taterpeeler]

Sounds like you are describing a Mega plan

yea, and show of hands... how many agents want that lawsuite chain around their necks....

judge: so mr agent, you knew that your plan was limited and that the ACA was availiable to the client correct? So the 500K transplant that my client could not have because you stuck them in a fixed benefit plan could have been covered in the ACA plans? The dead guys wife says you never properly explained the ACA and jammed them into the fixed benny plan because you get 30% commission. we find you guilty of business homicide and sentence you to 50 years in the state penn

meet your bunk mate brutus.....

 

[Yagents]

How about a signed letter from the client stating they understand the limited benefits, and that they will still owe the penalty? Will that avoid me meeting Brutus (tater's brother)

 

[Ann H]

yea, and show of hands... how many agents want that lawsuite chain around their necks....

judge: so mr agent, you knew that your plan was limited and that the ACA was availiable to the client correct? So the 500K transplant that my client could not have because you stuck them in a fixed benefit plan could have been covered in the ACA plans? The dead guys wife says you never properly explained the ACA and jammed them into the fixed benny plan because you get 30% commission. we find you guilty of business homicide and sentence you to 50 years in the state penn

meet your bunk mate brutus.....

Well, you have a point if you're talking about limited benefit plans. But bust me a break here. You guys know me, and you know that I don't sell and won't sell limited benefit, or anything like Mega.

The point is that there will be a lot of people who can't afford the QEHB plans. You saw the rates in Austin for the metal tiers. How many non-subsidized families can afford that? Many will go without insurance and pay the penalty.

Speaking of lawsuits, what if you have a guy who went without insurance and paid the penalty, then he has a $500,000 transplant and he says, "Hey! You could have sold me a fixed indemnity plan that would have paid all my hospital bills except for what amounts to an extra $500 for the first 5 days of hospitalization. It would have paid for ICU, surgery, transplants, and all the rest. It just would have done so with fixed dollar payments rather than a percentage of billed charges. But instead, I went without insurance. Here's my lawsuit."

Remember, we are talking about a COMPREHENSIVE set of benefits, with the same covered services as the IFP plans that you are selling right now. The only differences are 1) the payment method is indemnity rather than a reimbursement as a percentage of billed charges; 2) it does not have to include all the EHB's of Obamacare; 3) the rates are affordable.

What if a carrier provides an indemnity plan with all the same covered medical expenses as the IFP plans you are selling right now, just the payment was a fixed amount instead of a reimbursement percentage? There's no deductible. You just pay more for the first 5 days in a hospital than for the other days. There are no copays. If the in-network doctor visit allowable amount is $60 for that code, and the fixed indemnity payment is $40, isn't that the same as a $20 copay? If they can find a way to make an out-of-pocket maximum, isn't that the same as your current IFP major medical policy with an out-of-pocket maximum? I'm not talking about limited benefit here. I'm talking about today's major medical plan, with a reverse method of payment.

 

[taterpeeler]

Well, you have a point if you're talking about limited benefit plans. But bust me a break here. You guys know me, and you know that I don't sell and won't sell limited benefit, or anything like Mega.

The point is that there will be a lot of people who can't afford the QEHB plans. You saw the rates in Austin for the metal tiers. How many non-subsidized families can afford that? Many will go without insurance and pay the penalty.

Speaking of lawsuits, what if you have a guy who went without insurance and paid the penalty, then he has a $500,000 transplant and he says, "Hey! You could have sold me a fixed indemnity plan that would have paid all my hospital bills except for what amounts to an extra $500 for the first 5 days of hospitalization. It would have paid for ICU, surgery, transplants, and all the rest. It just would have done so with fixed dollar payments rather than a percentage of billed charges. But instead, I went without insurance. Here's my lawsuit."

Remember, we are talking about a COMPREHENSIVE set of benefits, with the same covered services as the IFP plans that you are selling right now. The only differences are 1) the payment method is indemnity rather than a reimbursement as a percentage of billed charges; 2) it does not have to include all the EHB's of Obamacare; 3) the rates are affordable.

What if a carrier provides an indemnity plan with all the same covered medical expenses as the IFP plans you are selling right now, just the payment was a fixed amount instead of a reimbursement percentage? There's no deductible. You just pay more for the first 5 days in a hospital than for the other days. There are no copays. If the in-network doctor visit allowable amount is $60 for that code, and the fixed indemnity payment is $40, isn't that the same as a $20 copay? If they can find a way to make an out-of-pocket maximum, isn't that the same as your current IFP major medical policy with an out-of-pocket maximum? I'm not talking about limited benefit here. I'm talking about today's major medical plan, with a reverse method of payment.

I hear ya little anney.... I just find it hard that the insurance. Commissioner in chief will allow a land shark of her plan

 

[Ann H]

I hear ya little anney.... I just find it hard that the insurance. Commissioner in chief will allow a land shark of her plan

I'm glad you hear "little anney". I was about to call Brutus (oops, I mean my friend HealthGuy) to help me out here!

As for Sebellius, I'm sure she'll try to close all loopholes. How dare the private sector solve the problem with self-funded plans or indemnity plans, or whatever else will circumvent these rich-benefit, rich-premium QEHB plans.

I think Sebellius and all the supporters of PPACA, are quaking and fearing right now, because they know that rate shock is coming. There's bound to be a correction. They must cut those rich EHB benefits, or the plans aren't affordable.

It actually will collapse the house of cards if private industry finds a work-around in plans like indemnity, or self-funded group, or whatever... In that way, the healthy can get lower premium plans, leaving the sick ones on the exchange. So, I expect her to fight it.

 

[HealthGuy]

Lil Anney I have spoken with a regional sales manager with Assurant recently. He keeps repeating that products like Health Access will be all the rage when people dont buy exchange plans and go without major med. The Health Access can help them through to an enrollment period for GI Obamacrap. The Obamacrap Nazis cant outlaw mini meds they are gonna be big. Assurant and others have spent millions developing these plans and are already selling alot of them.

 

[taterpeeler]

Sounds like annh has developed a nickname.... Little anney.... Cool

 

[AllenChicago]

The Obamacrap Nazis cant outlaw mini meds they are gonna be big. Assurant and others have spent millions developing these plans and are already selling alot of them.

Your statement brings back memory of a rousing speech in 2009 from an insurance company Senior Vice President during one of those fancy retreats that we used to enjoy. He almost knocked over the podium, banging on it with his fist, while proclaiming, "There is no way the Federal Government will be able to limit how much profit our industry can earn. Not in the United States of America.. NO WAY!" This guy was demoted a few months later, after the ACA/MLR rule was enacted.

The "Obamacrap Nazi's" can and will pick and choose what to outlaw. Their goal (to keep from looking foolish) is 75% of all eligible Americans enrolled on an exchange plan before 2016. If too many people enroll in something other than an exchange plan, the offending plans will be squashed by either a frontal assault, or with a back-door method, like increasing the IRS penalty-tax.

In fact, the Operations Manager of a large brokerage told me today it's looking MORE likely that companies who choose not to participate in the Exchange in a given state will not be able to sell Qualified Health Plans outside of the Exchange in that state. Particularly if the state is one where HHS is running the Exchange. States who are running their own Exchange will make their own decisions regarding inside/outside participation rules.
-ac