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E & Ooops

Much like doctors and lawyers carry malpractice insurance, licensed insurance agents carry Errors and Omissions (E&O) coverage. This type of liability policy protects policyholders (clients) if/when the agent screws up, causing financial loss.

Now come the Navigators. In addition to having to pass no background checks or graduate high school, these folks will also not be required to carry any kind of E&O coverage. Which is actually a good thing (from their perspective) because it's not clear that such coverage would actually be available to them even if they wanted it.

Professional liability insurance (including E&O) requires certain things to be true. In the case of E&O, one must be licensed to sell insurance. Okay, Henry, what about someone who isn't licensed, but needs this kind of coverage, such as an IT professional? There's no Ohio Bureau of Geek Licensing, but these folks would be eligible to purchase
Professional Liability insurance due to training and expertise.

Navigators may be neither licensed nor certified, heck, they don't even need a high school education to qualify; they'll simply attend 20 to 30 hours of instruction and be sent out the door, where they'll spread their, um, "expertise" to unsuspecting victims "clients." But what happens if/when they screw up? What financial recourse will their "clients" have? Their homeowner's policy (if any) won't cover them because it's business, and it's unlikely that they're independently wealthy (deep pockets).

Where's the consumer's protection?

Co-blogger Patrick pointed me to this article, which reports that Navigators in the Hawkeye State will be required to purchase surety bonds. The problem is that a surety bond is not the same as professional liability; it essentially covers theft of money.

For example, a Navigator tells a "client" that coverage will definitely be in force the next day. Three days later, the "client" has a heart attack and runs up tens of thousands of dollars in hospital bills, only to find out that coverage was not, in fact, in force. The most that "client" can recover from the Navigator is whatever he paid the Navigator for his services, not the huge hospital bills he now owes.

This would be where professional liability (E&O) insurance would come into play had a licensed agent been involved. From the article, it appears that Iowa Navigators must be licensed, so they may, in fact, be eligible for E&O coverage. But this is not the case in all 58 states; and therein lies the rub. Having spoken with two actual experts in this area, neither could think of a carrier that would write this coverage.

Which is not to say that it couldn't be developed, should the marketplace demand it. The problems inherent in underwriting such a plan, though, seem pretty insurmountable. And how would one price this in a competitive way? It's unlikely that most of the Navigators are going to be clearing $96-large; more likely, this will be another part-time job to help ends meet. So how do they afford even a minimum premium (generally hundreds - if not thousands -  of dollars a year)?

Yeah, that's what I thought, too.

[Huge IB Thanks to P&C Gurus Teresa S and Bill M for helping me noodle through this post]
 

Coming Soon - Obamacare Wait Times


 

ObamaTax Compliance heads' up

Received a sample notice that will (when finalized) have to be sent from employers to their employees later this summer. If you're interested, click here to download it. It's 3 pages, and pretty scary.

Scary, Henry?

Well, here's the thing. The employer will need to complete this form, and attest that, for example, his group plan meets the "minimum value standard." That is, that "the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs."

One presumes that the carrier will notify employers whether their group does, in fact, meet that criteria, but it's not entirely clear that this will be so for all carriers in all markets.

There's a related issue that so far seems to be flying under the radar: Exchanges and participation requirements. All carriers require that a minimum percentage of eligible employees sign up for coverage. This is to help reduce the chance of adverse selection, where only the least healthy enroll. The term "eligible" is somewhat flexible, but in general it's full-time employees who don't have "valid waivers." A valid waiver might be, for example, coverage through a spouse, or Medicare. Oddly, an individual medical plan does not qualify as a valid waiver, so that employee must be accounted for in the grand total.

So here's a question: if an employee opts off the group plan in favor of a (subsidized) individual plan from his state's Exchange, is that a "valid waiver?" This matters - a lot - because if enough folks opt off the group plan, it's going to go away, whether or not this is what the employer (and the other employees) want.

But remember: if you like your current plan, you can keep your current plan.

Or not.

[Hat Tip: FoIB Beth D]
 

Obamacare | GSU Prof. Bill Custer Whiffs It

According to Georgia Health News citizens of the Peach State will have 7 (but in reality only 6) carriers to pick from when the 2014 Obamacare exchange, uh, marketplace rolls out this fall.

Aetna, Alliant, Blue Cross and Blue Shield of Georgia, Coventry, Humana, Kaiser Foundation Health Plan, and Peach State will offer a range of plans for individuals in Georgia as part of the Affordable Care Act’s exchange, or “marketplace,” which will debut in 2014.

Aetna is/will be buying Coventry so really only 6 players.

But that isn't where Custer made his last stand. It was this comment that raised an eyebrow.

“On average, these plans are coming in slightly less than premiums of employer plans,’’ said Custer.
He said he based that assessment on premiums for a single person in employer plans in the 2012 Kaiser Family Foundation/HRET benefits survey, where an HMO plan for an individual in the South averaged $456 per month.
“A lot of the fears about premium shock are unfounded, at least in these preliminary filings,’’ Custer said.
For starters, averages are mostly meaningless unless the buyer is . . . average.
But where Prof. Custer really blows it is in comparing individual rates (and apparently nothing else) with group rates.

Small group starting rates are roughly 2x individual rates for similar plans.

It would appear Mr. Custer also failed to consider the tiny networks that will be used by carriers participating in HIX and the even skinnier drug formulary.

Custer believers will be sadly disappointed when 2014 rolls around. I wonder if we should grade his advice on a curve?
 

Excessive Hospital Profits

These days it seems like everyone is a financial expert and wants to cast stones at people or companies they believe are "excessively wealthy" or "unjustly profitable".

The latest group is, of all people, a nurses association, that claims that hospitals are now the villains raking in obscene profits.

The nurses' research found what appear to be staggering statistics: U.S. hospitals charge on average $331 dollars for every $100 of their total costs, a 331 percent charge-to-cost ratio. From 2009 to 2011 (the most recent year for which the data is available), hospital charges lunged upward by 16 percent, while hospital costs only increased by 2 percent.
“There is no other word for this than price gouging,” said Deborah Burger, co-president of NNU whose research arm, the Institute of Health and Socio Economic Policy produced the findings based on an analysis of publicly available Medicare Cost Reports.
I realize most of these nurses probably never took a business course, but let's hope they know how to balance a checkbook. I will go out on a limb here and assume some of them have filed a health insurance claim at one point in their life, and then took the time to review the EOB.
If they did it would be obvious that the amount collected by the hospital bares no relationship to the actual billed charges.
Hospitals are like any other business in that, they report earnings based on collected revenue less expenses.
Almost no one pays sticker price for a car, or full fare for airline tickets. I wonder if these nurses believe car companies and airlines report earnings based on the full price?
If hospitals really were guilty of making a 331% profit EVERYONE would want to get in that game. I don't know about where these nurses live, but here in Atlanta hospitals are closing their ER and L&D departments because . . . they are losing money.
I guess they want to just hang on to the surgical and critical care parts that are the money makers.
So while the nurses believe the word of the day is price gouging, I would say there is a different word. I would describe the nurses as part of the low information crowd.

 

Outstanding Carrier Trick

As we reported almost 8 years ago, in our exclusive interview with its Medical Director Dr Dexter Campinha-Bacote, Aetna has long been in the forefront of health care transparency.

Now, our good friend David Williams blogs that the carrier has "won an Award of Distinction  for its short videos designed to help members comprehend and use their benefits."

David offers some great reasons why he approves of this development, and singles out Aetna's terrific payment estimator in particular:

Kudos, Aetna!
 

About that Union Label

Nice to see the legacy media catching up with us:
"[S]ome unions leaders have grown frustrated and angry about what they say are unexpected consequences of the [ObamaTax] ... The problem lies in the unique multiemployer health plans that cover unionized workers ... union plans were already more costly to run than traditional single-employer health plans. The [ObamaTax] has added to that cost"
Gee, who could have seen that coming?

Oh, yeah.

And it's not just the unions, either. A large majority of Americans (56%) believe it would be "[b]etter to go back to previous system" (pre-ObamaTax).

And this is before the Exchanges and (Evil) Mandate kick in.
 
 
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