U.S. Health-Freedom Life: Will "Secure Advantage" Be Legal After 2013?

[AllenChicago]

Hello Everyone,

There was a thread started in 2011 in the "Individual Health" forum regarding plans from the U.S. Health Group/Freedom Life.
Ref: http://www.insurance-forums.net/for...um/anyone-heard-ushealth-advisors-t33531.html

Of particular interest to me (and many other agents) right now is the U.S. Health/Freedom Life "Secure Advantage" Major Medical policy.
Here's the Brochure: http://www.usabg.net/uploads/product_brochure/1317142079_Secure_Advantage_Plan_Brochure.pdf

Why the Interest? U.S. Health Group is successfully recruiting entire independent agent groups to sell this plan by stating that it will continue as is, right through 2013, 2014, 2015, etc.. without having to comply with Affordable Care Act benefit mandates, thereby avoiding the associated huge premium increases. In fact, as the brochure illustrates, none of the 2010 Affordable Care Act Preventive Care benefits are part of the base plan. They are added via an optional "Wellness Rider", if the insured wants them.

As most of us know, most health insurers will allow current (post-3/23/2010) individual policy owners to keep their plans...but only up until they reach their 2014 renewal date. And then...BAM! The insurer will have to add every single health benefit mandated by the A.C.A. to the policy, thereby causing the premium to instantly skyrocket 30% to 160%.

United Health Care/Golden Rule says that they are "toying" with the idea of developing a policy that can continue year-to-year without having to follow all of the Affordable Care Act mandates, but if they decide to participate in the new Federal Exchanges, UHC/GR will not be allowed to market any non-compliant ACA plans. The last "official" statement from the president of United Health is that the company is planning on participating in some of the U.S.A. exchanges.

I have sold U.S. Health Group/Freedom Life major medicals in years past. In fact, I still have a few clients with them. The company pays it's claims. But their premiums became too high in 2008, so I stopped. The next year, the company cancelled my contract for "low production".

The BIG QUESTION is this.. (finally..) Is there someplace in the law which prohibits, or allows, health insurance plans like the Secure Advantage to continue into the future indefinitely, without having to comply with the ObamaCare mandates? (I understand that there will be the IRS penalty-tax.)

The brokerage I'm a part of is composed of agents and General Agents across several states. A couple of the G.A.'s are preparing to leave, and take their agents with them, to market this Secure Advantage policy exclusively. I don't want to see them get hurt financially and emotionally if U.S. Health is, well... flat out lying to them, just to pump up 2013 sales while this plan is still legal.

Any knowledge-based feedback, or directions to official HHS rules would be GREATLY APPRECIATED. Thanks in advance!

-Allen in Chicagoland

 

[Yagents]

I'd rather be a broker, the rest of the market will fill that gap if the public demands it, and I'll be able to sell it. If HHS doesn't put them out of biz, then others will come out with better products.

You want to be a an indy agent if you want to be part of selling the exchange, so you can offer everything and be in a position to do what's best for the client.......oh by the way..... Billions in premium subsidies being handed out to help lower income.

Who would want to restrict themselves to just one product (captive), and take time for F2F meetings. Too many people, too little time.

IMO, anyone who jumps from indy to captive, is taking a risk. My thoughts on the product are in a different thread you reference.

 

[taterpeeler]

What I want to kow....and not interested in reading about the pros and cons of the play design... I Fing want to know if these plans will be marketed post jan 1..... Are they legal?

 

[Ann H]

I guess I'm waiting for big name carriers to tell us if they are legal for 2014. And then I'm waiting for a better product. The USHA one is better than most that I've seen but it falls so far short that I couldn't sell it.

 

[AllenChicago]

What I want to kow....and not interested in reading about the pros and cons of the play design... I Fing want to know if these plans will be marketed post jan 1..... Are they legal?

I've read in a few publications that ANY non-grandfathered plan effective after 12/31/2013, which pays directly to the medical provider, MUST be an Affordable Care Act-Qualified Health Policy(QHP).

If the health plan pays directly to the medical provider and it's not a QHP, it is illegal to sell. That is my understanding, Taterpeeler.

However, I started this thread to see if anyone could refer me to official rules or regulations affirming this belief. So far, the well is pretty dry isn't it? Guess I'd better go to the relevant government websites and scour the "government-speak" to see what I can find.

My colleagues will reach a decision early this week whether or not to go from being a broker, to becoming a captive U.S. Health-Freedom Life agent. As YAgents said, they'd be giving up a lot to pursue this unknown!
-Allen

 

[taterpeeler]

I've read in a few publications that ANY non-grandfathered plan effective after 12/31/2013, which pays directly to the medical provider, MUST be an Affordable Care Act-Qualified Health Policy(QHP).

If the health plan pays directly to the medical provider and it's not a QHP, it is illegal to sell. That is my understanding, Taterpeeler.

However, I started this thread to see if anyone could refer me to official rules or regulations affirming this belief. So far, the well is pretty dry isn't it? Guess I'd better go to the relevant government websites and scour the "government-speak" to see what I can find.

My colleagues will reach a decision early this week whether or not to go from being a broker, to becoming a captive U.S. Health-Freedom Life agent. As YAgents said, they'd be giving up a lot to pursue this unknown!
-Allen

it does not appear that anyone can point to the doc that states they are doa...... we all feel that the language indicates they will die but the govt is very quiet on the subject..... SPEAK NOW HHS OR FOREVER HOLD YOUR PEACE... give direction!

 

[AllenChicago]

I did find an update on the AETNA website which indicates that plans like the "Secure Advantage" will be able to continue "as is" through 2014 and beyond, without putting insured's into IRS penalty status.

From the Q&A at: https://www.aetna.com/health-reform-connection/questions-answers/individual-mandate.html

Q: How does “Minimum Essential Coverage” differ from “Essential Health Benefits”?

A: Essential health benefits are required to be offered by certain plans starting in 2014 as a component of the essential health benefit package. They are also the benefits that are subject to the annual and lifetime dollar limit requirements.

This is different than Minimum Essential Coverage, which refers to the coverage needed to avoid the individual mandate penalty. Coverage does not have to include Essential Benefits to be Minimum Essential Coverage.

-----snip----

 

[Ann H]

Does that mean that indemnity plans can be sold on the private IFP market, though?

I've heard it said that large group's minimum essential coverage can be bare bones, even something similar to the mini-meds this law was trying to replace.

However, I don't think that was our issue with plans like USHA, or our hopes that better indemnity plans will hit the market. I think our issue is that PPACA says it cannot skirt Obamacare rules (like no inside limitations, medical underwriting, MLR, etc.) unless it is NOT a major medical plan. Then HHS defined indemnity plans that were not major medical.

I know that Humana, Cigna, Aetna and UHC all currently have fixed indemnity plans, particularly for the very large group market. When they have a FI plan hit the street for IFP, then we will know their lawyers see a green light ahead. I know that HHS has heard from consumer advocacy groups about their fears of a market of FI plans, so there is some reason to believe it could happen.

 

[AllenChicago]

I've heard and read (someplace) the same thing about minimum essential coverage with large groups.

If you recall the UHC-GR webinar, they also said that the EHB's didn't have to be on an individual plan to make it a MEC plan.

If this is the case, there doesn't have to be many modifications made to today's major medical plans to make them MEC 2014 compliant. That's the type of plan UHC-GR is supposedly developing right now for immediate sale. The biggest requirements will be that the insuring company is not on the Exchange and that the plan accept anyone and everyone? Perhaps the 3:1 price ratio and 50% smoker rate-up doesn't have to be adhered to either?
I suppose the next step is research "What is a Minimum Essential Coverage policy" in the IFP market.
ac

 

[Ann H]

You may be onto something. I really wonder what GR-UHC is up to. I heard recent news that UHC might be in some exchanges, and I wondered if perhaps GR would not be in the exchanges but UHC might??? I can't wait until we hear more about alternative plans that skirt some of the most expensive parts of Obamacare. If they are truly comprehensive in scope instead of limited benefit, I'm happy.