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Health Insurance Underwriting Guidelines

One of the craziest things that has ever happened to me as a webmaster in health insurance happened when I started getting inundated with harassing phone calls and emails from the insurance companies for posting underwriting guidelines in my website.  I don’t know why these documents are so secretive and guarded but I can say I was threatened with losing contracts and lawsuits if I didn’t pull them.  As a result I caved in, sort of. I left the guidelines up but with no real way of navigating to them.  The links were down in other words.

Most health insurance companies do not pay attention what I do over here so it seemed odd that I was getting ganged up on a daily basis during this period.  What had happened was Blue Cross Blue Shield of Florida had found my postings and literally ratted me out to everyone.  Usually, these companies would murder each other given a chance, but they were working together to protect their awful secrets.

Well, what has changed? Not a whole heck of a lot though we have grown both in size and stature in the industry and my blog (where you are reading this) is not really part of a commercial website so if you are wondering, I am going to republish at least a few of them.  This blog doesn’t sell health insurance or make attempts to represent the carriers we work for in our professional lives so I am pretty sure it will fly unnoticed.

Why are these documents so carefully protected?  I am not sure as it is not like most agents and carrier personnel don’t have easy access to them, but for some reason if they got into the hands of the general public who gets declined it could potentially be used in a lawsuit?  I don’t know this is mostly conjecture.

Blue Cross Blue Shield of Florida Underwriting Guidelines

Cigna Underwriting Guidelines

Humana Underwriting Guidelines

Aetna Underwriting Guidelines

 

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Health Reform Update March 24, 2011

They’re Taking Our Jobs

The one thing that is becoming crystal clear about the ObamaCare health reform act is that no one understands it or more importantly understands its implications.  Recent data “published this week by a left-leaning policy think tank contradicted Republican claims that the law will exacerbate unemployment rates — but it also undercut the assertion by House Minority Leader Nancy Pelosi, D-Calif., that the law will create jobs.” So does this mean the net effect is 0 jobs?  Probably not, and if so no one can prove it.  The think tank the Urban Institute claims in its study, The basic conclusion is that the ACA will not have a noticeable effect on net levels of employment.” So essentially, this enormous change to the economic and social government has the potential to cause job losses, but that it should be under the right circumstances, ultimately be offset by employment increases triggered by other provisions.

Aetna Sues for Incredible Medical Bills

In the ultimate display of irony a recent news report has health insurer “Aetna Inc suing six New Jersey physicians over medical bills it calls ‘unconscionable,’ including $56,980 for a bedside consultation and $59,490 for an ultrasound that typically costs $74.”

Yes, you read that correctly.  I only wonder if Aetna even paid the bills and then sued or sued in lieu of paying the claims.  Bloomberg News adds, “The lawsuits could help determine what pricing limits insurers can impose on ‘out-of-network’ physicians who don’t have contracts with health plans that spell out how much a service or procedure can cost.” In particular, Aetna’s “lawsuits, filed in superior court in Camden, New Jersey, over the last eight months, allege the defendants violated New Jersey Board of Medical Examiners rules against excessive fees, and seek triple damages under state insurance- fraud laws against filing false or misleading claims.”  So this piece might not have much to do with current health care reform news but it might have long reaching effects down the line.

GAO Analysis Finds That Health Insurance Denials Frequently Reversed On Appeal.

The Government Accountability Office, the investigative arm of Congress, has been busy fulfilling the requirements of these denials laws, which call for reports on various concerns from credit and debit card fees to the advice that workers are receiving about their 401(k) plans to application and coverage-denial rates for private health insurance.” The GAO reviewed data that “indicated that health insurance denials are frequently reversed on appeal.” Notably, “the GAO found that 39 percent to 59 percent of appeals filed with insurers in those states resulted in the insurer reversing its coverage denial.” So, a good piece of advice is to file an appeal if you are denied coverage.

Insurers Seek Growth Elsewhere

One big change that has been reflected in the stock prices of the health insurance sector (its way up) has been worried insurers to new business lines.

Where are they investing? In acquiring less-regulated companies that could yield strong profits and make the main business – insurance – more lucrative. The purchases also could increase insurers’ control over more parts of the health system.

Some insurers have moved into technology (including United messing around with SEO), health-care delivery, physician management, workplace wellness, financial services and overseas ventures in wide-ranging efforts to mitigate the new rules imposed by the law. Since June 2009, seven of the nation’s largest insurers have made 25 major deals, and only six of those acquisitions run health plans, according to an analysis of data collected by FactSet Research Systems, a private company.

 

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Save a Broker Day!

Published on 16 March 2011 by echealth in Health Insurance News

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Save a Broker Day!

In a substantial news piece today in both the New York Times and Politico, it seems that both parties are coming to the rescue of the endangered health insurance broker!  Don’t look now, but there are about a half million health insurance brokers that are buying new cars today!  (I bought one over the weekend).

Somehow, our weakened brethren have attracted bipartisan support for our beleaguered cause.  (Yes this is dripping wet with sarcasm!)  Currently, on individual health insurance, there is a new Medical Loss Ration of 85 cents of every dollar being paid to medical costs.  The first year commissions for most individual products was right around 20% up until this year (now it is closer to 10%).  Second year and forward commissions usually dropped to an average of  about 5% (and that stayed pretty close to that level).   This meant about a 50% drop in income for most health insurance brokers who have either left the business or figured out a way to cross sell other products such as life insurance or disability.

One of the best arguments I heard about health commissions was that because health insurance premiums increased every year, why should brokers get 10% raises every year?  This is a great point in theory, but in practice actually most consumers opted out of their plans and went with either another less expensive carrier or lowered their benefits to keep their premiums at the old rates.  In essence most brokers made the same money every year unless they pursued aggressive growth.  Still, I am of the opinion that most brokers were overpaid when compared to property & casualty insurance brokers who average about 10% across the board (I would have loved this).  But, most health insurance plans only last about 9 months before they are canceled as opposed to p&c which last considerably longer.  Some brokers have also discussed moving toward more of a fee-based system of being paid, where the person or company buying coverage would pay a fee for the broker’s services.

The other argument is that we as brokers will have increased volume once health insurance is available (and even mandatory) and in theory that is correct, though we will be competing with the US government and their healthcare site which has a huge amount of funding behind it.  Also, this volume will go to brokers/brokerages like me that have large internet presences, not the small guys that work alone that might actually visit you in your house.

Still in favor of brokers, I can tell you even with a comparative health insurance rater or quote engine like the one on this site, most people have no idea of what product to buy let alone how to weigh underwriting concerns.  Certainly, a good percent can figure it out (about 15% of people that come to this site buy a policy on their own without calling in.)
So, while acknowledging the important role brokers play in helping people buy insurance policies on their own,  the legislators that passed this bill did include the cost of commissions in their calculation of administrative expenses.  Thus, they think that commissions are in line.
One of the big surprises for me was that brokers had enough money to lobby, though the great organization NAHU which represents us seems somewhat strong.  For its part, the National Association of Health Underwriters, which represents the brokers, is arguing strenuously that its members’ very livelihood is at stake. The new rules are “currently having a devastating financial impact on the country’s approximately half-million licensed professional health insurance agents and brokers,” wrote the association’s chief executive, Janet Trautwein, to Secretary of Health and Human Services Kathleen Sebelius in a letter last January.

“Many agents are seeing a net reduction of their business incomes of 30 to 50 percent. This means that fewer agents and brokers will be able to afford to stay in business, and many will have to begin reducing services to their clients and cutting jobs,” she said.

In conclusion, I am not sure of what should be done about this commission issue as I am a broker and a in fact someone that believes health insurance is a right not a privilege.  But I also am sure that this new law will make us compete with the US government which to me reeks.

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Obama Allows States to Opt Out

In what might be the most under reported high profile endorsement in the history of health reform, Obama is endorsing the legislation originally proposed by Sens. Ron Wyden and Scott Brown which “would give states” the freedom to opt out of the legislation, though not “entirely,” by 2014.  The “entirely” refers to the fact that guaranteed issue referendum would stay as  and so would outlawing plan recissions.  The reason?

As we get closer to a Supreme Court hearing, this move is construed by most legal experts to be a way of making the bill “Constitutional.”   Almost every single Republican attorney general has filed claims to invalidate the new health care reform law based on being unconstitutional.  So I guess a good question would be, does this opt out provision make it constitutional?  Maybe, is the answer, and already Republicans are playing the fact that Obama realizes that this bill is a so called “job killer” and the fact that the law is being battered by courts and congressional Republicans.

John Boehner’s spokesman described the president’s announcement as an admission of the reform law’s flaws.” And everyone’s favirote spokesman Michael Steel went even further, “The administration has conceded that ObamaCare is unworkable.” Larry Kudlow, on CNBC’s The Kudlow Report (2/28), similarly suggested that the President was “finally admitting he made a mistake.”

Still the Obama administration is trying to get clarification on the court’s ruling striking down ObamaCare.   In a memo to Vinson, the Justice Department wrote, “Clarification is appropriate so that defendants know how to proceed in this litigation and in implementing the Act, and to dispel the confusion of the public and many plaintiff states regarding their rights and obligations going forward.” Meanwhile, Washington Gov. Chris Gregoire (D) “asked Vinson if she could weigh in on the suit, arguing that the state’s attorney general (who is party to the suit) shouldn’t stop the state from getting the benefits of the reform law.”

In other bad news for health reform…

In a Wall Street Journal op-ed, John E. Calfee criticizes the healthcare law,pointing out that every single benefit from health reform has failed in Massachusetts, most importantly costs have continued to rise at pre-reform levels.  And more that it lacks any real means of keeping costs from increasing. To prove his point, Calfee refers to Massachusetts’ health reform which was used as a template for the law, and notes that since Massachusetts’ health reform was implemented in 2006, costs have not decreased, as anticipated. Rather, they have gone up, and emergency room visits have continued to increase as well, despite the fact that almost all residents now have health coverage. Meanwhile, premiums have also risen each year. According to Calfee, all of this bodes ill for national health reform.

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Repeal This!

Published on 20 January 2011 by echealth in Health Insurance Reform

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Repeal This!

With news of the House Republicans offing the health reform bill, one can only think what wonderful symbolic action might be next for them.  Maybe they should consider symbolically voting away bad dreams for children as who wants that?  Or maybe the should symbolically vote on extending Christmas to be everyday of every year.  Both of these symbolic votes would be equally effective to the vote this morning on repealing health reform.

So who voted to repeal the bill from the democratic ticket?  Writing in the Huffington Post (1/20), Lucia Graves notes that the three Democrats who backed the repeal were Dan Boren (OK), Mike McIntyre (NC), and Mike Ross (AR). The Hill (1/20, Millman) reports in its “Healthwatch” blog, “Democratic support for the repeal measure fell far below the projections of some high-profile Republicans. Earlier this week, Rep. Steve King (R-Iowa) predicted this week that 15 Democrats would vote for repeal.” Meanwhile, “earlier this month, Energy and Commerce Committee Chairman Fred Upton (R-Mich.) predicted the repeal vote would gain some bipartisan backing.”

A Promise Kept

So now that the GOP in the House has met their campaign promise to voters, they will have more time to start working on other important issues like these crazy death panels.  But what does the public feel about health care reform now you may ask?   On NBC Nightly News (1/19, story 3, 2:10, Williams), Chuck Todd discussed the new NBC News/WSJournal poll, which found that “45% oppose repealing” the healthcare law, and “45% favor repealing it. And it is ideological. Democrats are against it, Republicans are for it. It really does split down the middle.”  However what the NBC poll doesn’t show is that many that favor repealing, want to repeal it because it is not “liberal enough,” and does not completely socialize medicine as it is in the rest of the free, bankrupt world.  (To be fair we are bankrupt too).

So Now Save Us (Symbolically Speaking) from Death Panels & Abortion Funding

“House Republicans will follow their health care law repeal vote with a more targeted attack: legislation to take down provisions that they contend allow for taxpayer funding of abortion.” Politico adds that “anti-abortion legislators will introduce the No Taxpayer Funding for Abortion Act as H.R. 3 on Thursday. The bill intends to prevent federal funding for abortion procedures by codifying the Hyde Amendment, which has long barred federal agencies from paying for abortions.” However, “supporters of abortion rights have long argued that the health reform law does not allow for taxpayer funding of abortion and has the necessary safeguards to prevent public funds from being spent on the procedure.”

Where Do We Go From Here?

Now that the repeal passed through the House it heads to the Senate where it will be debated literally to death, before being upheld by the entirely Democratic Senate.  ” While the “Senate showdown may not begin for several weeks,” it “promises to be substantially messier and more drawn out than the debate just completed in the House.” The Times says, “The result could be a return to bitter, partisan gridlock ahead of a budget confrontation in March, when the health law repeal could become intertwined with a debate over federal spending.”

Remember the Republicans have a great old plan to strangle the health bill to death by withholding funding.  But of course now the GOP’s real work begins. “The next steps — hearings, testimony from administration officials, funding cuts — lack the punch of a straight repeal vote, but Republicans said they will keep at it, hoping the end result is the same: stalling implementation of the $900 billion law.” In addition, “Republicans promise to hold a series of hearings and oversight investigations into the law, attempt to repeal individual provisions and craft an alternative health care plan. Some of the first issues they will tackle are the cost of the law, the mandate on larger employers to provide coverage and the impact of the legislation on the states.”

And What About Malpractice?

Most importantly (and rightfully so) are proposals to revamp the medical malpractice liability system. Changing the liability system is a longtime priority of many physicians and Republicans, who blame it for increasing health care costs. That is the focus of a Thursday hearing in the House Judiciary Committee that Chairman Lamar Smith said will lay the groundwork for replacing the law.” In contrast, “Democrats have resisted changes — such as proposals to cap damages — and sided with trial lawyers and consumer groups who say injured patients deserve to be compensated,” although “President Obama has said the current system does not serve patients or doctors and indicated he would support alternatives.”

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Get Used To It! Florida Health Insurance Reform.

I know that many of my fellow health insurance brokers are just itching for the House vote next week preying for a vote against the health bill by the new Republican House members which of course could lead to a total recission at the Senate, and then finally a crescendo when Obama signs to repeal his own law!  I also know that many Christian evangelists are holding out hope that Jesus may return this year and end the earth except for the agnostics and non believers who of course will have to walk the earth which won’t be a fun place without the Christians.

The question is which of these things have a better chance of happening in 2011.  Well, I am Jewish so I really hope number 2 doesn’t happen, but on the other hand, number one seems like a bad break for my thriving health insurance brokerage which is doing pretty well these days at the top of Google.  But of course the question wasn’t which one would I rather see happen but which one has a better chance, and sadly I am picking number 2 based on the fact that according to many versions of the bible it happened once before.  The same can’t be said for a President repealing his own legislation.

In any event there were a couple of great Florida health insurance articles (the link points to my own great site on the topic not the articles which I am about summarize anyways) about the fact that Florida has done absolutely 0 so far in preparing for 2014 regarding setting up a health exchange.  Many of my fellow brokers are preying that we don’t become like the extinct travel agent or worse like those people that sell their organs on Craigslist (that’s not a great analogy, but I wanted to reference that great money making idea for my fellow brokers looking for alternative ways to generate money).

The two main threats being that MLR will make it impossible to pay commissions and worse that health exchanges will be the only avenue to buy health insurance, and that the exchanges won’t need agents.

Our state (Florida) has a NAHU meeting yesterday and some top insurance reps warned us to take an active role in setting up the health insurance exchanges in order to be like the great state of Utah which in fact already has a health insurance exchange albeit with awful commissions at 7 percent.  Don’t ask me how agents will be involved when someone shops for health insurance in Utah as that seems as ridiculous as WalMart letting me open a mini Walmart in my car where I can sell guns and ammo near an Arizona shopping center.

The four executives on the panel at Thursday’s forum, which was hosted by Tampa Bay Association of Health Underwriters (TBAHU, we are a member of the Miami chapter in fact) included Jonathan Anderson of Blue Cross Blue Shield of Florida and Sherry Baker of Aetna.  Sherry Baker is currently trying to figure out if she can afford to pay my agency higher commissions based on our outrageously high production than most other brokers.  So if you read this Sherry, for the love of God, please say yes and I in return will get an Aetna tattoo on my genitals.

The four had remarkably similar views on the health-reform law, mostly positive. It has some flaws, they said, but it will bring coverage to many millions of uninsured Americans, most of them healthy enough to improve the risk-pools. In other words: Lots of new business.

Bottom line, said Anderson from Blue Cross, “4.2 million Floridians don’t have insurance, and we have got to find a way to help them find coverage.”

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Health Reform December 30, 2011

Published on 30 December 2010 by echealth in Health Insurance News

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Health Reform December 30, 2011

Well first of all congratulation America on your shiny new car!  As of Monday health insurance commissions will end up in the toilet for us brokers and agents.  Many brokers will be forced to find new work perhaps even illegally, this guess is based on the exploits of some of our peers and the selfish, mean things they do the uninsurable and insurable alike.  As for me, I will be spending much of next year with my head held high and my back slightly crooked from begging on the street much of the day.  (Just kidding folks, I won’t have my head high).

Here are some of the highlights from todays health insurance news that I found to be interesting followed by me making snide comments about the authors and belittling their haircuts.

Rep. Andrews Says Dems Might Support A Health Reform “Fix.”

The Hill (12/30, Pecquet) reports in its “Healthwatch” blog that Rep. Robert Andrews (D-NJ) “said Tuesday Democrats could be open to compromising with Republicans on a ‘fix’ of healthcare reform — but only if congressional budget scorekeepers back off their opinion that the bill cuts the deficit.” Notably, the “comments on Fox News come as Democrats have been accusing Republicans of being hypocritical for pushing repeal even though it would violate their campaign pledge to tackle the deficit.” Andrews said, “If [Republicans] would make the repeal of the law contingent upon the Congressional Budget Office certifying that it wouldn’t increase the deficit to repeal it…maybe that is something we could compromise on,” although “later in the interview, Andrews seemed to back away from any suggestion that Democrats could support outright repeal even if CBO issued an unfavorable score.”

This is some crazy news, but much of it is impossibly hard to decipher.  I am not catching or understanding anything but the first sentence and I do this for a living.  C’mon people write clearly!!!  In any event if the Dems are ready to fix this mess of a bill, then perhaps instead of fighting through repeal we should be negotiating for fixes bilaterally.  Of course this will never happen, but I have many other fantasies as well that I use as a vehicle for making my life less dreary, if you would like a list of my “bright and sunny fixes,” please write to PO Box (just kidding).

Op-Ed Accuses Administration Of Rationing Healthcare.

Attorney David B. Rivkin, Jr. and law professor Elizabeth Price Foley write in a Wall Street Journal (12/30, subscription required) op-ed that the Obama Administration has resurrected “death panels,” although it argued previously that a provision that was cut from the healthcare bill was not akin to these death panels. Rivkin and Foley say that the government is intruding more and more into people’s lives, and that recently, the FDA even voted to remove a breast cancer drug, Avastin (bevacizumab), from the market, thereby denying patients access to it. They argue that taken together, these actions constitute rationing, and pose a threat to Americans that must be challenged.

A quick note on death panels, who cares?  That last sentence is so ridiculous that I refuse to acknowledge it.  Death panels are not as the name would infer, death panels.   I mean really, death panels, is that the name we are using for allowing people to pass quietly on their own terms?

Thats like calling a sheet of paper that give you a paper cut, AIDS Spreaders.  I have a few more of these analogies/punchlines if you would like a list of them please send $5 and a picture of your parents kissing to PO Box (just kidding).

Columnist: Palin Right About “Death Panels” In Healthcare Law. Columnist Cal Thomas writes in the Washington (DC) Examiner (12/30), “Sarah Palin deserves an apology,” because “when she said that the new health-care law would lead to ‘death panels’ deciding who gets life-saving treatment and who does not, she was roundly denounced and ridiculed.” But “now we learn, courtesy of one of the ridiculers — the New York Times — that she was right. Under a new policy not included in the law for fear the administration’s real end-of-life game would be exposed, a rule issued by the recess-appointed Dr. Donald M. Berwick, administrator of the Centers for Medicare and Medicaid Services, calls for the government to pay doctors to advise patients on options for ending their lives.”

Well alrighty Sarah, you called one the NY Times a hypocrite successfully!  Yes the NY Times has at least more than 2 writers and one of them is called an editorial writer.  The editorial writer and the hard news writer might actually have different angles of stories.  If you would like to read more about journalism, I would suggest the great book, “Journalism for Ignorant Dummies”, for a free copy of this great book, send $5 and a picture of exploding dynamite next to your car to PO Box, (alright that’s the last one).

Interpretation Of Commerce Clause Will Decide Health Reform Cases.

The Washington Times (12/30, Conery) reports, “Congress has used the Constitution’s Commerce Clause to fight prostitution and domestic violence, to break monopolies and to combat segregation — but its biggest test could come over the Obama administration’s claim that it can compel individuals to buy health insurance.” Recently, “a federal judge…struck down part of the new health care law on the grounds that Congress had stretched the Commerce Clause too far,” but “other federal courts…have upheld the law, and its fate is certain to be decided eventually by the Supreme Court.” The Times notes, “The battle is just the latest in a long line of showdowns over the clause,” and “while some see it as a critical tool to give power to the most important pieces of legislation, others believe Congress has applied it too broadly.”

Very interesting report on the repeal possibility of the Supreme Ct vs. ObamaCare and how the Commerce Clause might affect the decision.  As it is not the Supreme Court’s business to write legislation they are just deciding if the law is “Constitutional,” which in this case it might not be from a strict interpretive viewpoint.  However, the law that makes it unconstitutional was written to apply to other non-related issues.  Its tantamount to using a legal clause that battles obesity and bans donuts to outlaw contraception.  In any case, neither side of this debate should get their hopes up as this case is likely to be decided along party lines with one or two going the wrong way, but to predict this is near impossible even with the info that we have on the judges that sit on the court.

Krauthammer Urges GOP Lawmakers Not To Tamper With Healthcare Law.

The Hill (12/30, Millman) reports in its “Healthwatch” blog, “Charles Krauthammer, a leading conservative voice, said House Republicans should keep their hands off the healthcare reform law to avoid blame for what he thinks will be the law’s inevitable failure.” The Hill adds, “Realizing that a Democratic Senate and president will make their wish to repeal the entire reform law impossible, House Republicans have said they will defund the law over the next two years,” but “Krauthammer, a Washington Post columnist and Fox News contributor who opposes the reform law, said the defunding strategy will result in a ‘clumsily enacted’ law, providing Democrats the opportunity to blame Republicans if it fails.”

This is silly.  Really silly.  Forget about the issue, the logic is wrong.  Its like allowing a rape to happen because you want to avoid liability should the victim die from your efforts.  If you see a perceived wrong and do nothing to fix it then you are just as bad as the wrong you allow.  Maybe Charles like rape, but I don’t.

Editorial: Federal Mandates Force States To Cut Medicaid Program.

The Charleston Daily Mail (12/30) editorializes, “The Medicaid program covers 48 million poor people, half of them children.” Because the “federal government sets the required elements for the program and pays a varying portion of the cost of each state’s program,” the states “must fund the rest,” and many states are facing budget deficits. Several of them, including Massachusetts, North Carolina, Arizona, and Virginia, have made cuts to the Medicaid program, severely impacting coverage for recipients. Meanwhile, “under Obamacare, tens of millions more Americans will get Medicaid coverage.”

Another drawback of health reform (though it is not a reason to not reform it), is that people on social programs now are likely to start getting less care now then before as more people enter these already bankrupt programs.  Medicare will get worse each year from now to the last baby boomer retires.

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The Obama administration released Tuesday new proposed rules that Health insurance companies seeking a rate increase of 10 percent or more in 2011 must publicly explain why the increase is needed.  Under this new proposal, the highlighted premium rate increases would be subject to review by the states or in some cases the federal government to make a decision if they are fair or not. Soon to come, each individual state will get their percentage rates adjusted by the Department of Health and Human Services. Due to differing medical costs per state, the limits will most likely not be uniform.

The proposal states it will only concern the insurance policies dealing with individuals and the smaller type businesses, but the larger employers will not be affected by the new health care law.  Statistics show that for the past three years, the majority of increases have been in the individual market and have been exceeding 10 percent each year, which exceeds some of the national measures of cost inflation according to the proposal.  While consumers may see any big increase as biased, the proposal says it is not possible to know whether an increase is unreasonable until its underlying assumptions are analyzed.  More final rules most likely will be issued in about six months, after a public comment period.  These would affect rate increases filed or effective after July 1, 2011.
The industry lobby, America’s Health Insurance Plans says rising premiums are caused by a variety of factors, including rapidly increasing medical costs. The regulation considers some of those costs, the group says, but doesn’t adequately factor in new benefit mandates and the recession, which is causing younger and healthier people to drop coverage, leaving fewer premium dollars to cover a pool of relatively older or sicker policyholders.
“For example, data from the state of Oregon show that prices of many medical services have increased at an average annual rate exceeding 10 percent,” says AHIP CEO Karen Ignagni. “California data show that
prices for a hospital stay increased by more than 150 percent between 2000 and 2009—an average annual growth rate of 11 percent. Trends likes these are being seen across the country.”
Some consumer advocates say the proposed regulation doesn’t go far enough. The proposal, for example, gives states discretion on revealing some of the detailed data provided by insurers, but states could reveal simpler summaries of the data.  The health care law requires review and justification for increases deemed unreasonable, but does not give the federal government authority to reject rate increases. Federal officials hope public disclosure will discourage unnecessarily large rate increases, encourage state regulators to take a closer look and help individuals and businesses make wise choices. State officials can also bar insurers with a pattern of
unreasonable increases from selling their products in new marketplaces, called exchanges, which are set to open in 2014.

State regulation of premiums varies widely. Some states review proposed rate changes and can deny increases before they go into effect; others allow insurers to put new rates into effect and examine them only if questions are raised.

HHS says it will look at several factors in determining whether rates are unreasonable, including whether an insurer meets a requirement that it spend at least 80 percent of its revenue on medical costs and whether it produces substantial evidence for the increase.

Insurers would have to post on their websites proposed increases above the thresholds and if the rates ultimately are deemed unreasonable they’d have to post that fact as well, in addition to explaining reasons for the increases. Insurers would need to publicly detail what they are spending on medical care, expected future claims costs and administrative spending, including executive compensation.
States would do their own rate reviews unless HHS determines they don’t have an effective system. Among other things, states must show they collect data sufficient to determine whether a rate increase is unreasonable and review that data effectively, the proposal says.

Forty-five states and the District of Columbia have already accepted about $1 million each in grants to help them bolster their ability to review rate increases. HHS officials said a substantial majority of states already have effective rate review.

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Updates

Published on 07 September 2010 by echealth in Health Insurance News, Health Insurance Reform

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Updates

With health care reform ready to sick its ugly teeth into our health care system, I have been at a loss in order to continue upgrading this site based on helping people shop and understand health insurance.  Because of the coming changes as of 9/23 and then even more changes coming on 10/1 and then even more unpredictable craziness to follow over the next three years, I am terrified of having to update this entire site with each change as I will end up spending my entire life rewriting the same articles again and again.

So what am I to do?  All I can think to recommend to people is that they call us at 888-803-5917 to get live assistance or email us with their unique situations.

I totally support this reform and lets not forget how bad health care was getting before it, but on the other hand I don’t remember it being this absurd.  I can’t even shop plans right now with an effective date of 2 weeks away as no companies have approved plans!  Yes that’s right I can’t sell health plans if they have an effective date of more than 2 weeks from now.   And prices?  They are even more unobtainable for most Americans.  With local government going bankrupt in the face of poor central banking planning, there are even less subsidies available for those Americans that can’t afford coverage.

Yes somehow, a bad situation has become worse.  Its not a question of politics or opinion, its a life and death situation and sadly there is no answers for people that can’t obtain health insurance right now nor is there a shining light on the horizon.  But like I said our brokers at East Coast Health Insurance know health insurance and health reform and can help you find the program or plan from the insurance companies or the government itself, so give us a whirl you have nothing to lose.

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Aetna Makes Positive Change

Your children will now be able to stay on your health insurance policy until they finally reach Medicare, good news for them bad news for you and your insurance company.

In a recent email from Aetna, Aetna has come forward with a new change for those people that have Aetna or plan on getting it, whether individual or group.  Good news!  Your children who still live with you can also stay on your insurance until they finally marry the neighbor’s kids and get off of your back! We know many families are worried about their dependents losing medical coverage when they graduate from high school or college or otherwise age out of coverage. Health care reform will address this issue nationwide later this year, when new regulations will go into effect. In keeping with the spirit of health care reform, Aetna will work with our customers to extend coverage to their medical plans’ current dependents ahead of schedule. This means current dependents under the age of 26 would not have to leave their plans when they would otherwise age out or are no longer full-time students (including those who would have lost eligibility effective May 31, 2010). Note: that this would not include reinstatement of dependents who previously aged out of their plan. It also does not affect dental, vision, standalone pharmacy or other benefits..

For individual medical plans Aetna will continue coverage effective June 1, 2010 for dependents under age 26 currently covered on a parent’s medical plan. Aetna will not change the plan’s premium until renewal. Regardless of whether a plan makes this change ahead of schedule, health care reform is bringing changes to all plans soon. On the next renewal date on or after September 23, 2010, all medical plans must cover all dependents up to age 26 (and older for plans in states that mandate coverage above age 26). This may include dependents who are not currently enrolled in the plan, in accordance with regulations. We will be able to tell you more when the federal government issues regulations telling insurers and employers how this must be administered. We are pleased to offer our plan members the ability to keep their dependents insured. This is one step toward the goal of health care coverage for all Americans. If you have questions about how this will affect individual members who are interested in making this change ahead of the health care reform law, please contact your Aetna representative as soon as possible.

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