Blog Entries With Tag: reform


Posted: Aug 23, 2009

I have been taking the time to 1) listen and 2) read about the details of the Health Care Reform Act - distortions and fact alike.  So, with the Legislature still on vacation and battling out fact from fiction in Town Hall Meetings, I thought I would take some time to share some of the good, bad and ugly of this bill which is very, very similar to the one Massachusetts enacted a few years ago.

 

I will address a few of the easy, straight-forward facts first. 

 

  • Similar to Massachusetts reform, the House version of the bill eliminates the ability of insurance companies to exclude potential customers or cancel customer policies due to pre-existing conditions UNLESS you lie to them.  They may only cancel your policy for lack of payment and even that has a restriction with a grace period of about 30 days.
  • In addition, the bill disallows inordinate premium increases to customers because of history or onset of a new condition.  They may not increase the premiums of one person in a group; they must increase premiums for the entire risk group.

 

  • They may of course charge based on plan benefits which for the public option will be classified in three categories, essentially:  basic, enhanced, and premium. 

 

  • The public option, like the Massachusetts will calculate rates based on zip-code which is part of how private insurers currently calculate rates.  For example, at one point when I was a benefits administrator, Greenwich, CT had the highest "reasonable and customary" allowable charges in the country.  This was in the days of major medical plans - when we all paid low deductibles and were reimbursed at rates described as 80/20 or 90/10 (they paid 80%, we paid 20% up to an annual maximum).  These days, providers negotiate contract reimbursement rates and we pay a copayment or coinsurance either with or without a deductible.  I have not found these details yet but I am still reading the document.

 

  • There will be a phase in period much like there has been in Massachusetts.  I have read a 3-5 year phase in proces in different parts of the document so far.  This allows for grandfathering of some non-compliant plans for a  period of time - also much like the Massachusetts bill. 

 

  • Annual and lifetime maximums will be banned.

 

  • Methods of coinsurance will also be banned, leaving only customer-friendly, easy to understand methods copayment methos.

 

I will keep reading and come back with some more basics soon.

Comments | Reddit | del.icio.us | Digg | Stumble | MySpace |
Tags: reform (2) Care (2) care_health (1) health_care (1)
Add tags:   

Related posts:


Vlog: Gene Kelly on Insulin to Carb Ratio
Vlog: Gene Kelly on Insulin to Carb Ratio
Gene discusses factors that go into every diabetic's unique insulin-to-carb ...
more more Featured Videos
Cost Savings Tool
Do you know the annual cost of managing your diabetes? Would you like to find ways to reduce your costs? Calculate your total budget and identify ways to save money. You can do this in just a few minutes by entering facts about the products you use. This quick analysis will provide you with a comprehensive overview of both spending and potential savings.

Cost Savings Tool
Monitor Comparison Tools
Blood glucose monitors offer an easy way to test your blood sugar at home or on the go. Use this comparison tool as a guide to learn more about the features and benefits of your current monitor or to find a new one.
Handheld Monitor Comparison
Continuous Glucose Monitor Comparison
Advanced BMI Calculator
Ever wonder if you are at a healthy weight? Then enter your height and weight in our advanced Body Mass Index (BMI) calculator. This tool provides you with two important numbers reflecting the estimated impact of your present body weight and shape upon your overall health.
Advanced BMI Calculator
more Care Tools
Home | About Us | Press | Make a Suggestion | Content Syndication | Terms of Service | Editorial Policy | Privacy Policy
Last updated: Dec 3, 2020  © 2020 Body1 All rights reserved.