Portability of individual BC/BS plans

[newmindfashion]

I know they have Connecticut, New Hampshire, Maine, Georgia, Southern Virginia, Kentucky, Ohio, Indiana, Missouri, Wisconsin along with the three that are in your reciprocation. That's 13 and I think I'm forgetting 1 other WellPoint state.

 

[Dave020]

They also have Empire in New York

 

[newmindfashion]

That's the one I was missing.

 

[TXINSURANCE]

This is a state to state and BLUE issue...

I had a client get BURNED by this BADLY..

Client has BCBS of some other state... On COBRA...

Moves to Texas...

BCBS of other state mails her CONVERSION offer or something? No u/w for $1800/mo

Client declines offer and applies for RISK POOL

RISK POOL declines application because client WAS eligible for another offering and declined it (regardless of price).

There are a lot of little situations like that from time to time... Most are timing issues. I vaguely remember the story - my details might be off a tad.

 

[Dave020]

This is a state to state and BLUE issue...

I had a client get BURNED by this BADLY..

Client has BCBS of some other state... On COBRA...

Moves to Texas...

BCBS of other state mails her CONVERSION offer or something? No u/w for $1800/mo

Client declines offer and applies for RISK POOL

RISK POOL declines application because client WAS eligible for another offering and declined it (regardless of price).

There are a lot of little situations like that from time to time... Most are timing issues. I vaguely remember the story - my details might be off a tad.

TX has a good point here - Blue to Blue. I think that was John's original question. I have been told that All Blue Association members MUST provide a GI coverage option to any Blue members moving to that state. Usually in the form of a conversion plan. I have dug through the Association site and can't find anything in writing that deals with that. According to CA Blues, all Blue must allow Blue to Blue in some form.

On the second point, that situation is a no-win for the client. CA is different, risk pool has a caveat that you must be declined or highly rated with offer of premium in excess of the MRMIP premium to qualify. In her case, since the conversion was $1800 a month and no way she could pay that much for MRMIP, they would have accepted her into the CA risk pool.

 

[TXINSURANCE]

It is my understanding as well that ALL BLUES must offer state to state GI however they do not say at what price.

My client was told "due to your medical conditions of blah blah blah your rate would be... $1800/mo" It was even in a letter she read me mailed to her.

She made the mistake of being honest and telling our risk pool she was offered coverage, they then declined her pool membership.

I agree with CA (on this issue ONLY...lol...)

If your offering is MORE than the pool the pool should be an option.

 

[somarco]

There are two policies available to uninsurables here in GA.

Rape, and Pillage.

Both are indemnity plans (no network). Rates are at least 3x the price for a traditoinal underwritten indemnity plan.

One is a conversion from a Blue group plan. The other is what you get when you go through the DOI and they assign you to Blue.

You can't even say it is great coverage for the price. Just slightly better than having nothing at all.

 

[newmindfashion]

Dave020,
You said "I have been told that All Blue Association members MUST provide a GI coverage option to any Blue members moving to that state. Usually in the form of a conversion plan."

I guess that is the central issue. Where does one find the details if this is true? The Blues in question are saying that there is no such GI conversion. If they are wrong, I'd like to find that out.

The problem is that if the BCBS Association refers back the carriers, I'll get the same info as I'm getting now.

 

[somarco]

I would be curious in seeing this as well. Here is the site for the association. I don't see anything there that speaks to the portability issues.

The problem is the way the original Blues were set up. Each was independent & structured as a non-profit organization. Eventually there were about 70 different plans. Some states (NY, VA, GA) had multiple, competing plans.

The association was formed so each Blue could participate in administering national accounts.

They have several divisions locally, each operating independent of the other. The local BX has individual, Medicare, (soon to have) Medicare HMO, HMO, small group, large group, association plans. They also own Greater Georgia Life to administer their group term life, dental & disability plans.

I have never known of a situation where someone moving from another state is offered a guaranteed conversion that did not go through the DOI. They move here from other states. Call Blue. BX sends out an application that is underwritten. When they are declined sometimes it is too late to apply thru the DOI so they are left out to dry.

I personally think that is the way BX wants it.

 

[bluemarlin08]

Because of these very issues, I ask in my questionaire if they are planning to leave the state and reside in another state, if so I don't recommend BC/BS. Recently went through this issue with a doctor who has been a client that is reaching 65, wife 54, and they will be moving in a couple of years to their ranch in Washington.