- 500
OK, maybe I have missed something...or I could just be slow. Will health insurance companies even offer plans outside of the exchange? Won't they still be required to meet certain mandates which may make plans outside the exchange hard to price?
Will There Be Health Plans Offered Outside of the Exchanges?
- Thread starter insurehound
- Start date
- 14,808
Yes, they will offers plans outside of the exchanges but no information has been given regarding benefits or pricing.
- Thread starter
- #3
- 500
Why? Why would an insurance company take the time to develop a plan outside of the exchange if they have to adhere to many of the same rules of selling a plan inside of the exchange? If the Goberment is fixing the playing field through the exchanges (like tax credits), then the insurance companies will most likely concentrate their resources on exchange plans.
- 14,808
I don't believe they have to adhere to any of the exchange rules. The only thing the bill says is carriers can sell "excepted coverage" outside of the exchanges. It does not elaborate beyond that.
In my opinion the plans offered outside of the exchanges can be anything that carriers want but they will not count as creditable coverage.
The bill also states that only carriers that sell in the exchanges can sell plans outside of the exchanges. This was obviously put there to prevent all the carriers from opting out of the exchanges.
In my opinion the plans offered outside of the exchanges can be anything that carriers want but they will not count as creditable coverage.
The bill also states that only carriers that sell in the exchanges can sell plans outside of the exchanges. This was obviously put there to prevent all the carriers from opting out of the exchanges.
- Thread starter
- #5
- 500
Really? See bottom of page 1 and all of page 2.
http://www.nahu.org/legislative/res...th Ins Inside V Outside Exchanges_June 10.pdf
http://www.nahu.org/legislative/res...th Ins Inside V Outside Exchanges_June 10.pdf
- 14,808
I scanned it. Where does this address the clause in the bill pertaining to excepted coverage?
- Thread starter
- #7
- 500
I have no idea...my point is that the title reads "Non Group & Small Group Plan Requirements Inside & Outside an Exchange". Seems pretty cut and dry no matter what "excepted coverage" is...
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Somarco? Dave?
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Somarco? Dave?
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- 15,319
This is simply my opinion, but if you expect to make a living selling insurance in the not so distance future, you are wrong.
Health Care (not just insurance) will soon be provided by the government.
Rick
Health Care (not just insurance) will soon be provided by the government.
Rick
- Thread starter
- #9
- 500
I agree that it is not looking good. As usual, no one is sticking up for the agent, the carriers will dump us as soon as possible and most importantly, nothing the Goberment is doing is encouraging capitalism. What Goberment program does anyone know of that encourages free market ideas?
- 901
Ok, here we go. Buckle up and follow closely.
Sec. 102 of the PPCAA provides:
(c) Limitation on Individual Health Insurance Coverage-
(1) IN GENERAL- Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of [2014] as an Exchange-participating health benefits plan.
(2) SEPARATE, EXCEPTED COVERAGE PERMITTED- Excepted benefits (as defined in section 2791(c) of the Public Health Service Act) are not included within the definition of health insurance coverage. Nothing in paragraph (1) shall prevent the offering, other than through the Health Insurance Exchange, of excepted benefits so long as it is offered and priced separately from health insurance coverage.
Thus, the question turns on what constitutes "excepted coverage." To find that answer, we turn to sec. 2791(c) of the PHS Act, which provides:
(c) Excepted benefits For purposes of this subchapter, the term "excepted benefits" means benefits under one or more (or any combination thereof) of the following:
(1) Benefits not subject to requirements include:
(A) Coverage only for accident, or disability income insurance, or any combination thereof.
(B) Coverage issued as a supplement to liability insurance.
(C) Liability insurance, including general liability insurance and automobile liability insurance.
(D) Workers' compensation or similar insurance.
(E) Automobile medical payment insurance.
(F) Credit-only insurance.
(G) Coverage for on-site medical clinics.
(H) Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.
And there you have it. In a nutshell, "supplemental" type plans seem to be "generally excepted" from the Exchange mandate.
I suspect you are going to see lots of new and wild variations of "supplemental" health plans.
Caveat: Everything in the law is subject to final regulations as promulgated by the Secretary.
Links:
HR 3200 (note: this is not the final version that passed the Senate, but close enough for Gov't work)
PHS Act
Sec. 102 of the PPCAA provides:
(c) Limitation on Individual Health Insurance Coverage-
(1) IN GENERAL- Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of [2014] as an Exchange-participating health benefits plan.
(2) SEPARATE, EXCEPTED COVERAGE PERMITTED- Excepted benefits (as defined in section 2791(c) of the Public Health Service Act) are not included within the definition of health insurance coverage. Nothing in paragraph (1) shall prevent the offering, other than through the Health Insurance Exchange, of excepted benefits so long as it is offered and priced separately from health insurance coverage.
Thus, the question turns on what constitutes "excepted coverage." To find that answer, we turn to sec. 2791(c) of the PHS Act, which provides:
(c) Excepted benefits For purposes of this subchapter, the term "excepted benefits" means benefits under one or more (or any combination thereof) of the following:
(1) Benefits not subject to requirements include:
(A) Coverage only for accident, or disability income insurance, or any combination thereof.
(B) Coverage issued as a supplement to liability insurance.
(C) Liability insurance, including general liability insurance and automobile liability insurance.
(D) Workers' compensation or similar insurance.
(E) Automobile medical payment insurance.
(F) Credit-only insurance.
(G) Coverage for on-site medical clinics.
(H) Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.
And there you have it. In a nutshell, "supplemental" type plans seem to be "generally excepted" from the Exchange mandate.
I suspect you are going to see lots of new and wild variations of "supplemental" health plans.
Caveat: Everything in the law is subject to final regulations as promulgated by the Secretary.
Links:
HR 3200 (note: this is not the final version that passed the Senate, but close enough for Gov't work)
PHS Act
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