Claims Loss Ratio In Bill

[Winter_123]

I think if they go on the parents' policy. Gupta was going over it the other day on CNN and I can't remember exactly what he said about the GI part. HR summary says 2014.

It is confusing because some people are citing the language of the senate bill which could be approved by the house if the dems are lucky. However, the real action is in the language of the proposed amendment to that bill which they are still planning to implement through reconciliation. Setting the deem and pass thing aside does not change that. So are we looking at the language of the bill that is up for house approval or the proposed amendment that they are planning to ram through after the bill is passed?

Last I heard, the proposed reconciliation amendment had risk pools in it. Now we are talking about GI again. How do those go together?

What a mess.

 

[Dave020]

It is confusing because some people are citing the language of the senate bill which could be approved by the house if the dems are lucky. However, the real action is in the language of the proposed amendment to that bill which they are still planning to implement through reconciliation. Setting the deem and pass thing aside does not change that. So are we looking at the language of the bill that is up for house approval or the proposed amendment that they are planning to ram through after the bill is passed?

Last I heard, the proposed reconciliation amendment had risk pools in it. Now we are talking about GI again. How do those go together?

What a mess.

We must have been posting at the same time. I just updated that post with the information from CNN.

Basically, immediate GI for uninsured with pre-ex and children with pre-ex. All others not until the exchanges are operating in 2014.

 

[Winter_123]

We must have been posting at the same time. I just updated that post with the information from CNN.

Basically, immediate GI for uninsured with pre-ex and children with pre-ex. All others not until the exchanges are operating in 2014.

Being in a GI state I can see how GI works (except for how to pay for it) but I am not smart enough to figure out how the heck it works when some people are GI and some are not. How do you set the premiums for the GI folks when the rest of the applicants are rated. You still rate the others but put some extra on top to cover the GI sick people or you have GI but charge them higher rates which you know the feds are not going to allow?

I dont know. Just musing out loud. Probably no sense in asking detailed questions about aspects that they have given no thought to yet.

What a frigging mess.

 

[0b1kanobee]

Health Reform Bill Loss Ratio May Affect Agent Commissions

Health Reform Bill Loss Ratio May Affect Agent Commissions - Agent/Broker - Property and Casualty Insurance News
- - - - - - - - - - - - - - - - - -
http://www.lewin.com/content/publications/June25TestimonyUpdateJul09.pdf

"We estimate that the public plan under the House bill would have premiums that are 20 percent
to 25 percent less than for comparable private coverage. The bill specifies that the program
would pay providers at Medicare levels, which are 20 percent to 30 percent less than what
private plans pay for the same services. The bill would pay physicians at Medicare levels plus 5
percent if the provider agrees to serve both Medicare and public plan participants. Also, the
public plan does not require an allowance for profits and there would be no broker/agent
commissions."

 

[TXINSURANCE]

I think we can all agree public option or public anything = no commission.

 

[TXINSURANCE]

This article says claims loss starts 1/1/11

Short-term Benefits From Health Care Reform - Political Hotsheet - CBS News

 

[Dave020]

Rumor I heard is that AETNA will pull out of CA IFP because of MLR.

 

[TXINSURANCE]

Rumor I heard is that AETNA will pull out of CA IFP because of MLR.

They won't be the one if true!

 

[sunmed]

Heres an email from my MGA concerning Medical Loss Ratio. Thoughts??


I know many of you are concerned by the recent passage of health care reform and more importantly how it might affect your ability to earn a living as a health insurance agent. You will be pleased to know it is business as usual today with better things on the horizon for tomorrow. There were many pundits crying the sky was falling when Medicare was introduced and we as an industry survived just fine. This time around will be no different. In fact we as an industry prospered then and we’re confident Health Agents are likely to prosper by the changes coming our way this time as well. While no one can currently tell us what the exchanges will look like, rest assured we as agents are here to stay.

Health Agents are an integral part of the process and insurance companies will always fight for your business. Understand, if the playing field is levelized in the exchanges the value you hold as an agent will increase substantially. Insurance carriers will need you more than ever as a way of finding business. Carriers that dominated a market in the past will have competition like never before. Opportunities to sell competitively priced carriers and products that did not exist yesterday will create a more active market place than many states have seen in recent years. In short, markets that see more change need agents more than ever. Why, well carriers like BCBS in NC or AL will have to defend their market share for the first time in years. Faced with competition which they have never seen do you think they might like to have your help? Do you think the new carriers operating with parity for the first time might like your help? I bet they both would!

Finally, I have seen far too much emphasis on the LOSS RATO’s for Individual Plans being moved from 70 to 80%. According to AHIP, Insurers currently spend 87% of every premium dollar on direct medical care NOW! While yes some carriers may be paying less the Industry average is already above 80% so the likely hood of this putting us out of business is a bit like Chicken Little crying the sky is falling.

Change is coming for sure and it may be change that many of us don’t want but fear not for as Winston Churchill once said “We have nothing to fear, but fear itself”.



Regards,

Bill Rice
CEO Roy K. Messer
Chairman

 

[TXINSURANCE]

Thoughts?

He is off base commissions will be chopped big time. GI does not start until 2014 yet MLR starts 1/1/11.

Smaller carriers simply can not survive on 80% MLR.