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.

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