High deductible HMO

***Melmunch3*** · 09-20-2006, 02:23 PM

In Maryland, Carefirst (BCBS) just rolled out a hdhp for their HMO. Previously, you could only get one for a ppo, so any company that had an hmo was not a candidate for a hra/hsa. The rates are incredible and they have a 1200/2400 with small copays after the deductible and an embedded drug card. I have sold a few group on fully funding the deductible with a TPA with the total price showing significant savings.
Does anyone know if the carriers have any recourse to this? We are esentially circumventing most of the responsibility and deliberation that comes from the hdhp, and i wonder if that would be grounds to penalize a group.
Also, are there other carriers that offer such plans? I know that Aetna has a healthfund plan, but not a true hdhp for hmo's. United, guardian and Cigna do not. (To the best of my knowledge)

somarco · 09-20-2006, 02:51 PM

Most carriers aren't that bright and it may take them a while to figure out what you are doing. Several years ago a local TPA fed his family by writing a "high" deductible with Great West. Essentially a $1500-$2500 deductible then 100%.

Took GW at least 2 years to figure out why their loss ratio's were so lousy on groups administered by that TPA.

***Melmunch3*** · 09-20-2006, 02:55 PM

With Maryland small group, it works beautifully. The products are gauranteed issue, so it is easy to quote fully mature rates, and once you get on, the claims are pooled with all the hdhp plans, so trend could be even lower than the regular plans.
I just enrolled 38 people from a private school last week. They saved $40,000 after fully funding and assuming 100% usage. You can also build in a nice monthly fee to the TPA costs, and since the savings are so great, everyone is happy.

newmindfashion · 09-21-2006, 11:39 AM

Melmunch3,
Did Carefirst offer this for individual plans as well?

***Melmunch3*** · 09-21-2006, 11:53 AM

Absolutely not. Their individual plans suck, with a small cap on drugs they are virtually undellabel. Only for group.

healthagent · 09-21-2006, 12:24 PM

When I run into people who have Carefirst invididual I say to "do me a favor and find out what your benefit is for durable medical equipment, skilled nursing, hospice, chemo or physical therapy." Go ahead and try to find that in their brochures which is odd since every other carrier goes over those benefits in their brochures.

And a $500 cap on drugs is completely abusive.