Paid Arrangement?

[James]

I'm rereading the book "The New Health Insurance Solution" by Pilzer, I notice he lightly mentions that companies small, medium and large should consider paying an agent to aid them from converting to a traditional group arrangement over to a Defined Contribution (HRA and HSA) arrangement. On other threads here if I remember correctly people have ran into owners not wanting the cost of forming true group coverage so I'm thinking maybe Pilzer is onto something here. My first thought was I wouldn't want to be in the position of offering Individual Plans in an enviroment that is ending group (heavily or moderatly subsidize by employer) coverage, in this arrangement you would only deal with a Class of employees such as New Employess, Commissioned or Management Class of employees. You would then recieve a fee for consultation, say XX amount per day or employee to set up in the benefit consulting to the Classified employees of their choices.

Yet the downfall is obvious, the desire end result either way would be to end the Group Coverage. I'm sure others all employees would pick up on this fairly quickly once again making the agent the bad guy. Yet that in Pilzer book moderated as the specific class of employees would have a better deal then the other Class of employees having group coverage. I know of several small to moderately medium size business (about 70 employees) that I could easily pitch this idea too that now heavily subsidize their health coverage and offer little or no Voluntary Coverage like Life or DI.

 

[Crabcake Johnny]

I think all group coverage needs to end. Everyone should be able to shop for, purchase and own their own plan. Cobra and shopping for another job offering good group benefits is a huge flaw.

Instead, non-underwritten individual plans need to be created and employers attract employees by offesetting either the entire cost or a portion of the cost.

Bascially, this is already the way it is. Company A attracts key employees by offering to offset the cost by 50%. Company B wants to compete and offers 100% of all health costs paid.

Obviously this cannot even begin to be enacted this most states don't have guaranteed issue individual plans. But I imagine a day when you get a job and can choose from one of 5 different companies and simply keep that same plan job to job.

Group is already in the toilet. You're lucky to get 100% of the cost picked up - forget about adding your family.

 

[James]

This is what gets me, definitions!

Notes: This chart is applicable to HIPAA eligible individuals. For rules that apply to non-HIPAA eligible individuals, refer to Individual Market Guaranteed Issue

Definitions: "HIPAA Eligible" individuals are guaranteed the right to purchase individual coverage with no pre-existing condition exclusion periods when they leave group coverage. To be HIPAA Eligible, a person must have had at least eighteen months of prior coverage, not interrupted by a gap of more than sixty-three days in a row, and the last day of prior coverage must have been in a group health plan. In addition, upon leaving group coverage one must elect and exhaust any available COBRA continuation coverage or similar state continuation coverage. A HIPAA eligible individual cannot be eligible for any other group coverage or Medicare, and must apply within sixty-three days for HIPAA coverage.

HIPAA requires all coverage sold in the individual market must be available to eligible individuals, unless insurers elect to make only two policies available. Insurers can designate their two most popular individual market policies for federally eligible people, or they can designate two "representative" policies that are similar to others they sell in the individual market. These policies cannot impose pre-existing condition exclusions, but HIPAA does not limit premiums that can be charged. This is called the Federal Fallback approach.

State can adopt different approaches to guarantee access to non-group coverage to HIPAA eligible individuals and most states have done so. For example, some states require community rating from guaranteed issue HIPAA policies. Many states guarantee access to non group coverage in a high risk pool instead of in the private health insurance market. These different approaches are called Alternative Mechanisms.

Sources: Data as of December 2006. Data compiled through review of state laws and regulations and interviews with state health insurance regulatory staff. For more detailed information on consumer protections in any state see Georgetown University's "Consumer Guides For Getting and Keeping Health Insurance" available at http://www.healthinsuranceinfo.net/.

Now according to TN Insurance Dept http://tennessee.gov/commerce/insurance/documents/needinsurance/pdf/Hipaalist_2005.pdf
I would think that the uninsurable can purchase a HIPAA plan if truly unisurable?

 

[natem2112]

Now according to TN Insurance Dept http://tennessee.gov/commerce/insurance/documents/needinsurance/pdf/Hipaalist_2005.pdf
I would think that the uninsurable can purchase a HIPAA plan if truly unisurable?

That is one of the biggest things they need to fix, access for truly AFFORDABLE coverage for those who are currently uninsurable.

I am trying to work on a case right now taht is giveing me a headache, a couple who are in their 50's.

He is healthy.

She is not, about 50 lbs overweight, high cholesteral, high blood pressure & takes meds to sleep.

Currently they have a Mega Policy.

Paying around $580.00 per month, if they were health I'd put them on a $5,000D HDHP Assurant plan and save them at least $200.00 per month plus giving them about 70% more coverage...and with a rate that will stay locked in for 3 years.

But the HISRP (Wisconsin High Risk Plan) is over $500.00 per month for HER ALONE!

What do you do with a case like this?

I can't find a company that will take her on the individual side. If anybody knows one who will, let me know and I'll call them to get appointed.

 

[James]

That is one of the biggest things they need to fix, access for truly AFFORDABLE coverage for those who are currently uninsurable.

I am trying to work on a case right now taht is giveing me a headache, a couple who are in their 50's.

He is healthy.

She is not, about 50 lbs overweight, high cholesteral, high blood pressure & takes meds to sleep.

Currently they have a Mega Policy.

Paying around $580.00 per month, if they were health I'd put them on a $5,000D HDHP Assurant plan and save them at least $200.00 per month plus giving them about 70% more coverage...and with a rate that will stay locked in for 3 years.

But the HISRP (Wisconsin High Risk Plan) is over $500.00 per month for HER ALONE!

What do you do with a case like this?

I can't find a company that will take her on the individual side. If anybody knows one who will, let me know and I'll call them to get appointed.

There is no fix for making health insurance affordable or inexpensive for those that have conditions such as you listed. Even though, under my original posted idea she would be a employee covered by a group plan that is being eliminated or soon to be, she would qualify in TN under the HIPAA Coverage. Sure the payments would be around 500 dollars if not more but the business would of course share in some expenses thru a HRA arrangement. Sure she would still pay more then other more healthy people but sooner or later those that have lived or for whatever reasons are unhealthy have to pay their fair share. Now some think that as being unfair, for those I have no answer outside of life isn't fair.

The only solution I can see in your case is place the husband in a inexpensive policy and her in a expensive policy, sure in the end they pay more then they did for a crappy policy that won't cover much to a real policy that will cover them. It's an obvious choice.

 

[Crabcake Johnny]

It's no more unfair then being the safest driver on the planet but paying one of the highest rates because you live in the city and park your car on the street. People have to pay more for coverage then others.

I agree with you James that there's no easy answer. Should someone who abuses their body and packs on 100 pounds pay the same rate as someone who manages their weight? But what about somone who has weight gain due to an uncontrolled medical condition? And that's where this all gets hard.

 

[wilkin]

Here in central PA Highmark BS offers a guaranteed issue plan with a $750 deductible 80/20 to $10,000, $250 Rx ded then 50/50 on meds for $293 per month at any age. There is a one year pre-ex exclusion. No one can beat this rate for this coverage for a 55 plus individual and did I mention it's guarantee issue! Sadly there is no broker commission. Its all done by mail.

Now certainly I can write the 20-30 year olds all day long with someone else for less, but I get many more people who want insurance who are 55+.

If our legislators make all individual health insurance guarantee issue there will be no need for agents! If you don't believe this you are living in a fantasy world.

 

[TriDad]

If our legislators make all individual health insurance guarantee issue there will be no need for agents! If you don't believe this you are living in a fantasy world.

since the majority of my business is group medical I think about this night & day! Recently, I asked another agent in a similar boat what he thought about the idea of universal healthcare. His response was "the government will need someone to sign everyone up"

That's not a good enough answer, buddy!

 

[TriDad]

I'm rereading the book "The New Health Insurance Solution" by Pilzer, I notice he lightly mentions that companies small, medium and large should consider paying an agent to aid them from converting to a traditional group arrangement over to a Defined Contribution (HRA and HSA) arrangement. On other threads here if I remember correctly people have ran into owners not wanting the cost of forming true group coverage so I'm thinking maybe Pilzer is onto something here. My first thought was I wouldn't want to be in the position of offering Individual Plans in an enviroment that is ending group (heavily or moderatly subsidize by employer) coverage, in this arrangement you would only deal with a Class of employees such as New Employess, Commissioned or Management Class of employees. You would then recieve a fee for consultation, say XX amount per day or employee to set up in the benefit consulting to the Classified employees of their choices.

Yet the downfall is obvious, the desire end result either way would be to end the Group Coverage. I'm sure others all employees would pick up on this fairly quickly once again making the agent the bad guy. Yet that in Pilzer book moderated as the specific class of employees would have a better deal then the other Class of employees having group coverage. I know of several small to moderately medium size business (about 70 employees) that I could easily pitch this idea too that now heavily subsidize their health coverage and offer little or no Voluntary Coverage like Life or DI.

I've read Pilzer's book twice. After the first read I started thinking about how to propose this to existing clients & prospects. It was only after talking with a few clients did I realize how revolutionary & provactive this concept is. Most of them did not want to entertain the notion so I backed off.

With the continued double digit increases, I'm wondering if I need to reread it a third time and rethink the best way to present to prospects. Hmmm...maybe I should just present to prospects and leave the clients alone for now. Your thoughts?

 

[Cenla Agent]

since the majority of my business is group medical I think about this night & day! Recently, I asked another agent in a similar boat what he thought about the idea of universal healthcare. His response was "the government will need someone to sign everyone up"

That's not a good enough answer, buddy!

I see where you are coming from, but consider that Medicare Advantage is guaranteed issue (with the lone exception of ESRD) and agents are needed to enroll people in that.