The Dismantling of ObamaCare - Ongoing Updates.

[hamben]

So you are saying it's legal for a self funded employer sponcered plan to pay premiums deductibles co pays and any other expenses of for an individual plan on behalf of an employee who is expected to have claims exceeding $50,000. Allowing the employee to leave the group plan to enrol in an individual plan file the claim and then come back to the group plan at any time?

 

[scagnt83]

So you are saying it's legal for a self funded employer sponcered plan to pay premiums deductibles co pays and any other expenses of for an individual plan on behalf of an employee who is expected to have claims exceeding $50,000. Allowing the employee to leave the group plan to enrol in an individual plan file the claim and then come back to the group plan at any time?

Ive never heard of this either.

First, how is that not violating discrimination regs? The only thing I can think of is they would have to designate a specific individual plan to use. But even then there will be different premiums for different ages.

Second, how is that a Qualifying Event to enroll back into the Group Plan?

There are others on here with more experience in the Self-Funded arena than I have. Maybe they can explain what Regs this falls under (if any).

 

[hamben]

that is my question. this goes against Erisa, ppaca, well ever law that governs group health insuance. I found several school districts and more than one city government using the program.

 

[junkman]

I want to know what individual plan will take me with a $50,000 expected claim. There have been trust products over the years without health questions. We used to move the sickies off the group plan to get the group through underwriting. Those plans are long gone.

 

[scagnt83]

I want to know what individual plan will take me with a $50,000 expected claim.

All of them as long as you have a Qualifying Life Event that allows you to enroll.

 

[AllenChicago]

I hear that Anthem is pulling out of two more States. Anybody know which two those are?

 

[Yagents]

Wisconsin and indiana

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I hear that Anthem is pulling out of two more States. Anybody know which two those are?

Anthem to withdraw from Wisconsin health insurance marketplace - WISC

Anthem, MDwise Marketplace pulling out of Indiana's Obamacare exchange for 2018 - TheIndyChannel.com Indianapolis, IN

 

[AllenChicago]

Wisconsin and indiana

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Anthem to withdraw from Wisconsin health insurance marketplace - WISC

Anthem, MDwise Marketplace pulling out of Indiana's Obamacare exchange for 2018 - TheIndyChannel.com Indianapolis, IN

Thank-you YAgents. Anthem only has 6% of Wisconsin's ObamaCare population. But the double-whammy to Indiana cuts their available companies by 50%... from 4 to just 2.

Horrible.

 

[junkman]

Carriers won't be able to predict claims until adverse selection is eliminated. I note that Farm Bureau ACA compliant plans administered by UHC go away in TN beginning 1/1/2018.

Oscar is coming in but given the narrow network, Kushner involvement, family history and under funding discussed in other threads, I wouldn't insure my dog there. Thieves assure stealing. They don't insure.

 

[kgmom219]

Oscar is coming in but given the narrow network, Kushner involvement, family history and under funding discussed in other threads, I wouldn't insure my dog there. Thieves assure stealing. They don't insure.

No clue on the network, but I have had a few people on Oscar in DFW and San Antonio, one of whom had some high dollar claims. No issues on claims or coverage. The network in DFW was lousy, but that's because they thought if you got a hospital network, it included the docs. In HMO states, that's usually true. In Dallas? Not so much.

If its a reasonable price and came back to DFW, I would have no problem putting people on the plan. I wouldn't count them out yet.