- Staff
- #21
They're Gaming the System Already
- Thread starter Ann H
- Start date
- 15,041
The 30 day rule exists irregardless of maternity.
- 3,384
True. In CA, carriers had gone over to individual-only type plans instead of family plans. Pregnant women are always a decline, but the spouse/boyfriend/baby-daddy can still buy one of these plans because no other family member can be added on. They are still rolling them out but not as much as a couple of years ago. Tonik is a good example. It will quote for a family rate but after underwriting they divide up the members onto individual Tonik plans (rate works out to the quoted family rate as long as there were no rate ups).
- 15,041
I'm all for managing risk, but that is going too far. I'm surprised the regulators let it pass without the ability to spin off a new policy for newborns, no underwriting required. A newborn never had a chance to buy insurance before becoming unhealthy.
- 3,384
It's only available on PPO plans designed this way which are registered with the CDI. All DMHC registered health plans (all HMO and a few PPO with maternity) are family plans. CDI allowed it. DMHC does not. CA is strange in that carriers can register PPO plans with either entity depending on what they want to register.
DMHC = Knox-Keene
CDI = not so much
DMHC = Knox-Keene
CDI = not so much
- Thread starter
- #26
CA rules must be very different than AZ rules. In AZ we cannot cover an expectant PARENT (male or female, married or unmarried) because the insurance company is on the risk to add the newborn from moment of birth. As Somarco said, we have 30 days to add the baby, and then it's retro effective back to the moment of birth. To make matters worse, sometimes there's a temporary 30 day enrollment of the baby, but it's deleted if the baby isn't technically "added" by the policyholder. The insurance company will take the hospital's word for it that the baby was born, and they will begin the 30 day temporary coverage, but until the policyholder notifies the insurance company that it is the policyholder's intent to buy insurance on the baby from moment of birth, the baby is not really added. Confusing, I know. But in any case, I can't see why UHC would terminate COBRA for an entire family over newborns not being enrolled properly. Agreed, there's more to the story.
Now, back to my own story, which started this thread...
I quoted the family individual/family plans, and also the PCIP (thank-you Somarco, for recommending PCIP). I quoted full family coverage for the family of four, and I quoted child-only through PCIP, since PCIP is the only carrier in AZ that will do child only. I stressed the family's need for coverage, and the risks of going uninsured, (as Healthagent so eloquently reminded us in a prior post). I cringe, because I really think the family will choose child-only through PCIP, get through the hospitalization and then terminate coverage and go uninsured again.
If they do an IFP app, I made it clear to them that they must fully disclose the pre-existing condition and the intended hospitalization, even though they paid cash. If they don't disclose fully, I'll say goodbye to the client.
Thanks for all your advice, input and wisdom. I agree with all of it, except just the part where some feel this is not "gaming the system". Yes, it is legal, and yes they are playing by the rules. But it's the "on the bus, off the bus" concept that's gaming. No, it's not gaming the system to play by the rules to get HIPAA, or Group coverage, or the new GI coverage for children, if in fact, the client keeps insurance. But getting "on the bus" for an intended hospitalization, then "off the bus" when it's resolved is gaming. I realize it's legal, however I question whether it's ethical. I'm worried about the effect this has globally. It raises premiums for the rest of us. It doesn't solve the uninsured issue. It doesn't cover an unexpected catastrophic event that could have happened in this family, as Healthagent mentioned earlier. I'm also worried about what this does to families. With today's high premiums, and tomorrows undoubtedly higher premiums, more families will be forced to take this option, whether it's ethical or not, and whether it's disastrously risky or not. I just cringe to see this happening already in the new GI rules for children, and I worry about what will happen in the future if 2014 brings national GI rules for everybody.
Now, back to my own story, which started this thread...
I quoted the family individual/family plans, and also the PCIP (thank-you Somarco, for recommending PCIP). I quoted full family coverage for the family of four, and I quoted child-only through PCIP, since PCIP is the only carrier in AZ that will do child only. I stressed the family's need for coverage, and the risks of going uninsured, (as Healthagent so eloquently reminded us in a prior post). I cringe, because I really think the family will choose child-only through PCIP, get through the hospitalization and then terminate coverage and go uninsured again.
If they do an IFP app, I made it clear to them that they must fully disclose the pre-existing condition and the intended hospitalization, even though they paid cash. If they don't disclose fully, I'll say goodbye to the client.
Thanks for all your advice, input and wisdom. I agree with all of it, except just the part where some feel this is not "gaming the system". Yes, it is legal, and yes they are playing by the rules. But it's the "on the bus, off the bus" concept that's gaming. No, it's not gaming the system to play by the rules to get HIPAA, or Group coverage, or the new GI coverage for children, if in fact, the client keeps insurance. But getting "on the bus" for an intended hospitalization, then "off the bus" when it's resolved is gaming. I realize it's legal, however I question whether it's ethical. I'm worried about the effect this has globally. It raises premiums for the rest of us. It doesn't solve the uninsured issue. It doesn't cover an unexpected catastrophic event that could have happened in this family, as Healthagent mentioned earlier. I'm also worried about what this does to families. With today's high premiums, and tomorrows undoubtedly higher premiums, more families will be forced to take this option, whether it's ethical or not, and whether it's disastrously risky or not. I just cringe to see this happening already in the new GI rules for children, and I worry about what will happen in the future if 2014 brings national GI rules for everybody.
- 3,352
F it and let obama figure out the rotten mess he created
- 8,707
You assume he cares!
On one hand, I say that is their problem, not yours.
On the other, PCIP is supported by taxpayers. Every time someone does something like this and screw the rest of us, all of us pay.
The system is set up to allow people to legally obtain coverage. The underlying question is a matter of ethics and enticing people to make immoral decisions.
The designers of the system either failed to understand what they had created or they simply did not care.
Medicare runs the same way.
They take anyone, regardless of health, and cover them from the first day, including their pre-ex conditions.
- 3,352
NorwayGuy: You bring up a good point. Does the most aloof prez. in history care about anything? Does obama have a pulse? Maybe when filling out his NCAA bracket he gets a hard on.
