Tuesday, July 14, 2015

Obama lied, Grandpa died

Remember this?

Well, just like that storied 3000% rate decrease, not so much:

"Reminder: Non-Grandfathered Plans Must Implement Embedded Out-of-Pocket Maximums"

The article points out that this rule applies not only to individual medical and fully insured group plans, but self-funded groups, as well.

But what does it mean?

There are essentially two ways to apply deductibles in policies covering more than one person (aka "family" coverage): embedded and aggregate:

"An embedded deductible is when the plan begins to make payments as soon as one member of the family has reached the individual deductible limit."

That is, each person has his own deductible to meet before any co-insurance is applied. So if John meets his deductible the plan will immediately shift to co-insurance (or 100% if there is none). Under an aggregate plan, the total family deductible must be met before co-insurance kicks on. So even though John meets his deductible, nothing gets paid out until Sue meets hers.

Whether one method is superior is debatable, but the point here is that once again, we are not allowed to keep the plan design we prefer.

Just one more ObamaCare lie.
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