Fixed Benefit Indemnity Plans - New Rules for 2015.

AllenChicago

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October 31, 2014

In May of this year, the Federal Government issued rules that were finalized this month. They apply to the sale of Fixed Indemnity health products on or after January 1, 2015.

Most Important for Agents: Scheduled Benefit, Fixed Benefit, Hospital Benefit, etc. plans are not to be sold to people who don't have Major Medical Coverage in force. (Private Ins., Group, Medicaid, Tricare, etc.)

Here's a plain language summary of the CMS Rule.
Ref: CMS Issues Final Rule on Fixed Indemnity Insurance - HighRoads


This bulletin from the Nebraska Department of Insurance applies to Insurance companies that sell Fixed Benefit plans. It defines how the new applications for these plans must be modified for 2015 sales. Even though it's a bulletin from Nebraska, the content applies to affected insurance companies in every state.

Ref: http://www.doi.nebraska.gov/bulletin/cb132.pdf

I looked at our IL online SERFF system and can confirm that the major insurers are complying with the rule, by adding the appropriate wording to their 2015 applications.
-Allen
 
How is Philadelphia American doing it then. I just spoke to them and they said they are approved without it? Just curious?
 
How is Philadelphia American doing it then. I just spoke to them and they said they are approved without it? Just curious?

Sam,
I see that in Oklahoma and Missouri PhilAmerican complied with half of the mandate, by stating in large fonts on the application that their Health Saver Plus indemnity plan is "Not major medical and may subject you to a tax penalty". But they left off the required wording for the applicant to attest that he/she has major medical coverage already.

Sam, in our state of Illinois, I see no 2014 filing at all from Philadelphia American related to their Indemnity plan. (ref: https://filingaccess.serff.com/sfa/home/il )

If you go to SERFF, check out Mutual of Omaha and Assurity. They (as usual) are following the law/rules to a tee. One of them (I forget which one) has even modified their Critical Illness plan application to comply with the new rule, because it's registered with the states as a "health" product.
ac
 
Last edited:
September 11, 2015

Fixed Benefit Indemnity Insurance plans can once again be purchased by anyone who wants them...even by people who do NOT have "ObamaCare" coverage.

Excerpt:
WASHINGTON (CN) - A federal judge on Friday threw out a provision of the U.S. health care reform law that blocks the sale of fixed-indemnity insurance plans.

Fixed-indemnity insurance plans pay a fixed rate for certain injuries and illnesses, rather than the varied rate more traditional plans pay depending on the severity of an injury.

Companies faced up to $100 per day in penalties for selling plans to people without other health insurance coverage that meets the Affordable Care Act's minimum requirements.

Source: Courthouse News Service

ac
 
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