Friday, November 17, 2017

Some Thoughts on ObamaComp

Although I'm no longer actively working in this market, I do get the various carrier updates and contractual changes. Yesterday's mail brought this from Evolent (to which I'm connected via what used to be Premier Health Insurance):

"On behalf of Premier Health Plan, Evolent Health would like to thank you for your relationship ... it is necessary to amend [your contract]."

Regular readers already know where this is heading, but I think this may be instructive as to why I received a particular phone call yesterday:

[click to embiggen]

I would estimate that it takes at least a good hour (likely more, plus service time after the sale) to do a decent job for a client, even when there are so few choices still left. And of course, there's overhead and the like, so that $5 is quickly eaten up.

And once again I would ask: will their rates be lowered to reflect the decreased comp?

(Spoiler Alert: Not likely)

Oh, about that phone call?

Well, I was the third or fourth agent she'd contacted about health insurance for her son and daughter-in-law. They're currently with CareSource (which is primarily a Medicaid carrier, but has branched out into the "commercial" arena, as well). The county in which they live currently has these health insurance choices: CareSource. Since they don't use agents, there's no incentive for anyone to sell them. Which is why the poor lady was so frustrated.

And who can blame her?

Oh, did I mention the almost 100% rate decrease increase?

Insult and injury, ObamaCare is thy name.

Thursday, November 16, 2017

This Picture: What's Wrong With It?

NAILBA - the National Association of Independent Life Brokerage Agencies - is currently in the midst of its 36th annual convention, and by all accounts a fine time is being had by all. Which is, of course, great, but also provides an excellent illustration of the disconnect between trade groups such as this (and of course, they're far from unique in this regard) and how the public perceives those of us in the field.

Several years ago, I noted the irony inherent in a continuing education course on ethics:

"My fellow participants couldn't understand why I was giggling about an "Ethics" course given - for free! - to agents who'd received a "goody bag" full of tschochkes (chip clips, staplers, etc)."

Well, apparently the folks sponsoring that class were pikers:

ExamOne is a vendor agents and carriers use for medical exams for insurance applicants.

So much for those Ethics CE requirements....

Wednesday, November 15, 2017

Another Government-run Health Care Success Story

Words fail:

"A veteran committed suicide by setting himself on fire in front of a New Jersey VA clinic after staff at the clinic repeatedly failed to ensure he received adequate mental health care"

Charles Ingram, a 51 year old Gulf War vet, was actually cleared for treatment at a non-VA facility, but the bureauweenies in charge failed to follow through.

But sure, let's go all-in on state-run health "care."

[Hat Tip: FoIB NARNfan]

Tuesday, November 14, 2017

Sad news

We've just learned of the passing of Dr Uwe Reinhardt earlier today. His was a voice of reason and thoughtfulness, and he had a unique talent for making complex health care policy understandable.

We first noted the great work of Dr Reinhardt in this post by co-blogger Bob back in 2009:

"The insurance industry is congenitally weak in bargaining with supply side of the American health sector,” explained Princeton University health economist Uwe Reinhardt on a recent NPR Money Planet segment. Reinhardt believes that insurers largely dance to the fiscal tune whistled by hospitals and physicians."

A little over a year later, co-blogger Mike quoted another great example of Dr Reinhardt's insight:

"Thus, after blushing over miserly fee updates, taxpayers might go on to ask physicians why an average annual compound increase of 5.4 percent in spending per Medicare beneficiary was not enough to give the nation’s elderly good medical care."


He will be missed.

Monday, November 13, 2017

From the P&C Files: Foreign General Liability

Regular readers know our friends at Global Underwriters for their wide array of travel medical options, but they also work the other side of the insurance fence: since a lot of their business comes from employers with substantial international exposure, GU has an interesting product called Foreign General Liability (FGL) coverage. I'll let GU's Peter Schulteis explain:

"Today, thriving companies aren't just operating globally. They're sourcing, producing, recruiting, and genuinely "thinking" in global terms. However, most domestic General liability policies only cover lawsuits brought within US borders. This leaves US companies, schools, churches, non-profits, etc. and their international operations without a legal or financial safety net if taken to court abroad."

Okay, so what is Foreign General Liability coverage?

"FGL primarily consists of 3 main benefits:

International Commercial General Liability: The first line of defense against costly legal actions arising from events occurring outside US borders.

Typical Coverages: Bodily Injury and Property Damage, Employee Benefits Liability, Personal and Advertising Injury Liability, and Medical Payments.

Employer's Responsibility/Worker's Compensation: Outside the US, nothing quite compares to our nation's own worker's compensation system for comprehensive coverage [ed: as we've seen before].

Typical Coverages: Foreign Voluntary Worker's Compensation (Statutory worker's comp benefits for US and Non-US employee's), Employer's Liability - Bodily injury coverage to employee's for accident or endemic illness contracted outside the US.

Foreign Auto Liability: Each country and jurisdiction around the world has its own rules and regulations concerning automobile liability - from who would be at fault if an accident were to occur to how an automobile liability claim should be handled.

Typical Coverages: Applies to any auto of the insured, including owned, hired, and non-owned vehicles, Auto Bodily Injury/Property Damage Liability

Nice. What are typical coverage amounts?

"FGL limits are typically $1 - $2 Million, with the possibility of increasing benefit limits to $5 Million, if desired."

Thanks, Peter!

If you (or someone you know) would like additional details (or even a quote), be sure to stop by Global Underwriters'

Friday, November 10, 2017

It's a Holly Jolly Friday LinkFest

(All links courtesy FoIB Holly R)

Britain's Much Vaunted National Health System© continues to prove that gummint-run health "care" #Fails at reining in costs:

"[T]hree highly influential health think-tanks - the King's Fund, the Nuffield Trust and the Health Foundation - published a joint report calling for an extra £4bn to be given to health next year."


"Every Hour, Prostate Cancer Kills 45 Men. This Foundation Has Raised $769 Million to Fight it"

And yet, unlike mammograms, prostate exams aren't considered Essential Health Benefits (so they aren't first dollar).

Men's Health Matters (but not to ACA proponents).

And now for some good news:

"In world first, Israeli hospital employs MRI designed for infants"

MRI's have become almost as ubiquitous as X-Ray machines and EKG's, but one of the challenges is that patients need to stay very still while being scanned, which is a problem when dealing with infants. The generally accepted solution seems to have been anesthesia, but that poses its own set of risks in ones so small and vulnerable. This device seems to have solved the problem.

Yasher koach (that's Hebrew for "Kudos")!

Thursday, November 09, 2017

The ACA is Working - and Better than Expected!

Given that the explicit goal has always been single-payer:

[click to embiggen]

Health Wonk Review - Notable Quotables edition

Our good friend (and favorite health care economist) Jason Shafrin hosts this week's fun, uniquely designed roundup of health care fun and policy.

Wednesday, November 08, 2017

LifeAid: An Accelerated Benefits story

Back in the 80's and early 90's, when the AIDS "epidemic" was just taking off, a lot of folks - especially singles and the elderly - began looking for ways to leverage their life insurance policies. For those with no dependents, keeping a policy in force made little sense, and by selling their plans they could raise quick cash to pay for alternative treatments, or even just take a cruise.

Unfortunately, this lead to a lot of questionable practices, and even more questionable tax implications.  And so, as part of HIPAA, a new word entered the popular lexicon: viatical. Basically, one can sell one's plan to a 3rd party with little (or no) tax consequence.

Naturally, insurance companies weren't too keen on any of this, but the cat was already out of the metaphorical bag. Eventually, the industry settled on  the old "if you can't beat 'em, join 'em" strategy, and thus was born the Accelerated Benefit Rider. These enable the policyholder to "access" the face amount as a living benefit. Naturally, there are some caveats and potential tax implications, but it's a reasonably effective answer to the viatical issue.

Illinois Mutual has provided a helpful primer ion how they work:

Thanks, IM!

Another few words on Open Enrollment

Building on yesterday morning's post, it bears repeating that even though I'm no longer active in the individual market, I still get calls, emails and referrals seeking my assistance. Since I'm loathe to just leave folks hanging, here's a brief recap of what we usually discuss:

First, going bare is not necessarily an irrational decision. When one is facing thousands (often tens of thousands) of dollars in out-of-pocket before a plan kicks in, well, it's difficult not to at least consider this route.

Second, of course, is an ObamaPlan (although these have become increasingly difficult to find, since so many areas have only one or two available). These satisfy the ObamaTax, and cover pre-existing conditions.

Third would be Short Term Medical plans, which don't satisfy the mandate, but offer lower premiums and out-of-pockets.

Fourth would be Health Care Sharing Ministries, which are ACA-compliant, but pose their own challenges.

And finally, there's what I call "Dave's Plan," which is not ACA-compliant, but can offer a valuable bridge at a reasonable price.

And yes, I know: DPC is also an option,but I'm not going there until there's a cat plan available to wrap it.

Did I miss any?

Tuesday, November 07, 2017

Oy Canada: CanuckCare© Strikes Again

Previously on CanuckCare© Today:

"[A] doctor can not only deny life-saving treatment for a person in their right mind who wants it, but actually have that patient, against the patient’s will and with their full mental faculties, outright executed by lethal injection."

And that's if the patient is "fortunate" enough to even get an appointment.

For many, that's quite the luxury:

"I actually thought I misread it’: Doctor ‘stunned’ over years-long wait for specialist appointment"

What the heck's she talking about?


The joys of government-run health "care."

But hey: it's free!

[Hat Tip: FoIB Dr Gerard G]

Back in the (MMO) Saddle Again

As regular readers know, I've basically called a moratorium on new individual health insurance sales. At least part of that is driven by the fact that my immediate service area offers exactly 3 carrier options, none of which I'm interested in representing (let alone selling).

But just a few miles north of here, Medical Mutual of Ohio still maintains a footprint, and I received a call from a young lady who was interested in climbing aboard the MMO bandwagon.

She's currently with Anthem, which is going away at the end of December (so much for that explicit promise). Fortunately for her, MMO offers a plan that fits her needs and budget, and is available off-Exchange (she's not subsidy-eligible, so no reason to venture into that dark cavern). I popped over the the MMO agent portal, ran the quote, and about 15 minutes later had her all signed up.

So why did I agree to write this case?

Well, for one, thing, it killed me to leave this poor lady hanging: she knew enough to avoid the online marketing sharks, and had educated herself on what she really needed. In short, exactly the kind of client I prefer.

So, sometimes the exception makes the rule.

Monday, November 06, 2017

Workers' Comp and The Mandalay

In the comments section at the link to the most recent Health Wonk Review, IB regular BernieFlatters wrote:

I found this to be particularly intriguing, so I reached out to FoIB (and Workers' Comp guru) Julie Ferguson for her thoughts, which she graciously agreed to share with us:

That’s pretty interesting, but there are no easy answers there.

Workers comp is for injuries that occur in the course & scope of the job. Every state has a slightly different law, but that is fairly common wording. In a case like this, there is a lot of gray.

They call that issue compensability. Was the injury compensable? With any claim, that is the first thing the insurer does is determine compensability. Did the injury happen at work? Probably 90% or more of the cases, that is clear cut, but there are cases like the ones you describe that end up in court.

The cops who were working, if injured, that is a clear case of workers comp.

The off-duty cops who spring into action? Not so clear.  Most laws are clear that it is “in the course and scope of work” and many edge cases wind up in court.   “Never off duty” is not a very precise phrase when it comes to legalities. It would be  nice to think that an employer would just say “gee, that guy did the right thing, let’s cover him” but you have to be consistent and precise about compensability legalities or you can find yourself in quicksand.  Your insurer, lawyer, taxpayers or board of directors  are not likely to accept sentiment as valid legal basis.

Some of these issues came up in a big way in 9/11.  For example, generally people are not covered by workers comp when they are “going to and fro” – traveling to or from work. You’re on your own health insurance plan if you get hit by a car or fall down. But if you are going to & fro and you fall in the employer’s parking lot, you would be covered. On 9/11, so many people were killed on their way to work or on their way fleeing from work that it got to be a big issue.  Were they on the property or weren’t they? Were they working on weren’t they? It was pretty hard to sort out.

Thanks so much, Julie!

Friday, November 03, 2017

DisHartening News

(BTW: That's not a typo - wait for it...)

So FoIB The Political Hat reports that:

"More Millennials Are Turning to Witchcraft for Activism & Self-Care"

I replied that since the alternative was ObamaCare, perhaps that wasn't the poorest choice available.

To which our other good friend, Allison Bell, responded:

"But, really: What do we know about medical witchcraft economics? Maybe there's a lot of inflation in the care to goat ratio."

Which is a fair point, and one that has actually been previously addressed (now):

Shopping Medicare: The Movie

Co-blogger Bob V is trying something new, and we're pleased as punch to introduce his first video on shopping for Medicare supplements. Pretty timely, too, seeing as how it's Open Enrollment season.


Thursday, November 02, 2017

More Life Insurance Horribles

That's not how this works:

"Natalie Finn’s parents took out two life insurance policies on their adopted daughter before the 16-year-old died from starvation and abuse in the family's West Des Moines home"

The fiends "parents" had allegedly purchased a $10,000 Hartford Life policy, as well as one from Modern Woodsman for $25,000.

So this poor girl was starved to death for (a measly) $35,000.

Words fail.

[Hat Tip: FoIB Joe K]