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Re: Getting Health Insurance in New Jersey (NJ)
Old 04-26-2007, 12:40 PM   #21
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Re: Getting Health Insurance in New Jersey (NJ)

Quote:
Originally Posted by perinova
Tommy
Look at this site. The low income health insurance is now available to children for income levels up to 350% of poverty level. Parents can be included if income doesn;t exceed 115% of poverty level (really low!!!)
tohttp://www.njfamilycare.org/
Unfortunately this solution is for income level too low for us.
Yes the plan is designed for the poor
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Re: Getting Health Insurance in New Jersey (NJ)
Old 04-29-2007, 08:16 PM   #22
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Re: Getting Health Insurance in New Jersey (NJ)

How does insurance in states without community ratings work?

Once you get a private health insurance policy, are you guaranteed renewals at the same or similar rate?

Or can they bump up premiums or drop you if you get seriously sick?

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ww
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Re: Getting Health Insurance in New Jersey (NJ)
Old 04-29-2007, 08:40 PM   #23
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Re: Getting Health Insurance in New Jersey (NJ)

Walkinwood,

We are almost identical to you--same age, state, time to ER--I almost feel when reading your posts they could be mine, except we have children.

I'm not an expert, but I think health insurance in the other states is like car or homeowners insurance, you can be nonrenewed at the sole discretion of the insurer. Some here have suggested moving to another state while you are healthy for the low rates, and coming back to NY or NJ if you get sick for the guaranteed coverage, although planning one's life and domicile around insurance seems such a shame.

NY also has guaranteed insurance and they have some relatively less expensive plans that I have found on ehealthinsurance. PA also has low rates. This would allow you to live relatively close to friends.

Is there any way you can stay on your company's plan, even if you pay the full cost?
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Re: Getting Health Insurance in New Jersey (NJ)
Old 04-30-2007, 01:09 AM   #24
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Re: Getting Health Insurance in New Jersey (NJ)

No, an insurance company cannot just drop you or raise rates only for you. They must identically raise rates on the whole pool of people in the same insurance plan (although this can vary by certain factors like sex, geography, etc., depends on state law). Otherwise, insurance would be mostly useless. This is why short term insurance is much cheaper than regular insurance, because short term insurance does not obligate the insurer to renew for any member of the pool at the end of the time period (in my age bracket, short term insurance is around 40% cheaper than regular insurance for this reason).

In addition to being governed by specific insurance law, many (all?) states have oversight commissions for insurance rates.

When you get into trouble is when an insurance company starts playing games with particular pools, in effect just giving up the business by raising rates above health care inflation for a particular plan over time that was losing money -- it is hard to tell how often this really happens. This was one reason that I didn't want to get a boutique plan, but a very common plan offered by a reputable, growing company that hopefully a large number of other people enroll in, as well.

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Re: Getting Health Insurance in New Jersey (NJ)
Old 04-30-2007, 09:06 AM   #25
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Re: Getting Health Insurance in New Jersey (NJ)

What Kramer said is correct. Insurance carriers cannot drop you or raise your rates individually just because of your personal claims. A lot of people are mistaken about this fact, and you see it all over the boards - people complaining that they personally had their rates raised because of claims, in an effort of the insurance company to personally single them out and force the coverage to be so expensive that the person can no longer afford it.

This is NOT the case. Insurance companies can only raise your rates or cancel your coverage if they do it for the entire large population of other people in your "group" (typically, this is a huge group of people, all who became effective around the same time period as you did, who also live in a similar geographic are as you.)

I often see people complaining that insurance companies purposely try to raise the rates of these groups of people in hopes that the healthier risk will drop out of the group, making it so the insurance company can drive the unhealthy's rates high enough to make it unaffordable for them to keep the coverage. To me, this sounds like a consipiracy theory that I doubt really happens.

In my experience, most carriers renewal rates are similar to new business rates WITH THE EXCEPTION OF ASSURANT HEALTH. Assurant health tends to take rate increases more often (approx. every 9 months), and their renewal rates are almost always higher than new business rates for everyone.
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Re: Getting Health Insurance in New Jersey (NJ)
Old 04-30-2007, 10:55 AM   #26
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Re: Getting Health Insurance in New Jersey (NJ)

I often sound like a broken record on these issues, but insurance regulation is a mix of federal and state law. Federal law doesn't regulate pricing at all. Federal law does require insurance policies be guaranteed renewable, even policies sold on the individual market. There are exceptions. Temporary insurance isn't guaranteed renewable. Insurance obtained through fraud can be canceled (you lied about your health history for example). If you leave the service area, the insurance company can drop you. The insurance company can also drop the particular plan, which it may very well do if it determines that the people in the plan are costing them too much money. They can then invite everyone to reapply for a new plan and decline coverage to the less healthy. Or they can raise rates for everyone in the plan and the healthier will abandon the plan for a cheaper plan.

MyKids speaks too broadly about the ability of insurance companies to raise your rates due to your health status. This is a matter of state law. A number of states do not prohibit insurers in the individual market from increasing rates based on claims or age of covered individuals. Some states require community rating of health insurance premiums. No policyholder can be charged more than any other based on health status, health history, or other risk factors. (NJ for example) Other states require modified community rating with adjustments permitted for age, but not health status. Yet other states impose rating bands that limit how much premiums can vary based on health status, age, and other factors.


This is a good summary of state restrictions: http://www.healthinsuranceinfo.net/n...ion_limits.pdf
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Re: Getting Health Insurance in New Jersey (NJ)
Old 04-30-2007, 06:06 PM   #27
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Re: Getting Health Insurance in New Jersey (NJ)

Martha,

Quote:
Originally Posted by Martha
MyKids speaks too broadly about the ability of insurance companies to raise your rates due to your health status. This is a matter of state law. A number of states do not prohibit insurers in the individual market from increasing rates based on claims or age of covered individuals.
I believe you are incorrect about insurance companies being able to SINGLE people out for rate increases based on personal claims alone. I don't know of a single state that allows this. Yes, they can raise rates based on age band (usually in increments of 1-5 years), but I have never seen any insurance carriers single anyone out for a rate increase based on their personal claims alone. Rate increases can only be based on the overall claims history of large groups of members. They can't give one person a rate increase for claims without raising everyone else's rates who are in the same group by the same percentage.

The other factors you mentioned above are all correct and make sense. OF COURSE temporary insurance is not renewable. That's why it's called TEMPORARY insurance. OF COURSE insurance companies can rescind coverage if you lie on your application. That information is explicitly stated in every contract. Portabililty, as has been discussed in great length on these boards, is also an issue that needs to be considered BEFORE purchasing your policy. There are many carriers that have nationwide networks and that have portability to a majority of the different states.

BUT, in my 10 years experience, I still have yet to see any of the carriers that I work with drop a plan just to get the unhealthy people out of the pool or raise rates to a point where the healthy start opting out for cheaper coverage. I'm sure it happens, but I can't say enough, that people need to really check into the companies that they do business with. Your reputable carriers, like Humana and Blue Cross, typically offer the same, or similar, rates at renewal as they do for new business.

Yes, it pays to be cautious, because there are some less than reputable private carriers out there, but that doesn't mean that the individual health insurance industry is failing everyone, which is the picture that I see being painted in many of the posts on this board.
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Re: Getting Health Insurance in New Jersey (NJ)
Old 04-30-2007, 06:37 PM   #28
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Re: Getting Health Insurance in New Jersey (NJ)

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Originally Posted by mykidslovedogs
Martha,

I believe you are incorrect about insurance companies being able to SINGLE people out for rate increases based on personal claims alone. I don't know of a single state that allows this. Yes, they can raise rates based on age band (usually in increments of 1-5 years), but I have never seen any insurance carriers single anyone out for a rate increase based on their personal claims alone. Rate increases can only be based on the overall claims history of large groups of members. They can't give one person a rate increase for claims without raising everyone else's rates who are in the same group by the same percentage.

Unfortunately, I believe that I am right. I know Colorado does not allow re-underwriting or rate bands based on health status, but some states do. Some states have no laws regarding rate increases in the individual market. The link I pointed to above shows which states currently allow health status rate bands. You may also want to read this: http://www.familiesusa.org/issues/pr...n-41-rate.html

Unfortunately, in the individual market, many states do not prohibit insurers from reexamining health status (re-underwriting) or increasing premiums based on the duration of coverage. So, even if consumers enroll in reasonably priced policies, they can find themselves unable to afford renewing their policies if they have become ill or have other health problems

I have a paper version of the footnoted article but not an online version. From the article:

It is hard to pin down how many insurers use changes in medical status, claims history, or other factors in re-underwriting at renewal. The factors used by insurers in the underwriting process are reported to be closely guarded trade secrets. Some experts contend that that practice of medical re-underwriting is limited to only a few small, for-profit insurers and that recent media reports have brought undue attention to the issue. Other recent events suggest this might not be the case. At the annual meeting of the National Conference of State Legislatures in July 2002, a workshop on re-underwriting at renewal briefed state legislators on the "resurrection of re-underwriting." The Health Insurance Association of America has said it opposes high annual rate increases but not modest rate increases based on medical condition or claims history. The Wisconsin Physicain Services Insurance Corporation, a not-for-profit insurer with more that 220,000 custormers in the state, has publicly stated that it has begun to charge some policyholders more at renewal based on their claims in the prior 12 months. These examples suggest that medical re-underwriting at renewal is a growing trend. Protecting Consumers from Unfair Rate Hikes: The Need for Regulation of Health Insurance Renewal Premium Increases. Published in 2003 by FamiliesUSA.
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Re: Getting Health Insurance in New Jersey (NJ)
Old 05-01-2007, 06:58 AM   #29
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Re: Getting Health Insurance in New Jersey (NJ)

Once again, MKLD proves that she does not know her rectum from a hole in the ground. What a big surprise... :
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Re: Getting Health Insurance in New Jersey (NJ)
Old 05-01-2007, 07:53 AM   #30
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Re: Getting Health Insurance in New Jersey (NJ)

To give MKLD credit, I have learned a good amount from her experience as to what insurers look at when underwriting and variability among insurance companies. She has specific experience with insurers that is of real practical value here.

In contrast, for a couple of years now I have been gathering information on nationwide health insurance issues and what the federal government regulates in contrast to what is left to the states.
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Re: Getting Health Insurance in New Jersey (NJ)
Old 05-01-2007, 08:36 AM   #31
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Re: Getting Health Insurance in New Jersey (NJ)

Quote:
Originally Posted by Martha
To give MKLD credit, I have learned a good amount from her experience as to what insurers look at when underwriting and variability among insurance companies. She has specific experience with insurers that is of real practical value here.
Agreed. The problems are that she endlessly pounds the table over irrelevant political garbage that ranges from silly to insulting to offensive, and that she tends to assume that everyone lives in CO for the purposes of insurance regulations.
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Re: Getting Health Insurance in New Jersey (NJ)
Old 05-01-2007, 08:47 AM   #32
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Re: Getting Health Insurance in New Jersey (NJ)

I won't disagree that "re-underwriting" could potentially occur, and perhaps even be gotten away with, especially with the smaller, less reputable carriers.

But let's take a closer look at the "conspiracy theory" that this is happening on a widescale basis. For something like that to occur, and I'm talking about with a Humana or a Blue Cross, large carriers would have to hire a whole slew of underwriters to specifically review renewals on a case by case basis just so that they could nab a few people with heavy claims history.

First of all, do you realize how expensive it would be for a large carrier to do that? They could drive themselves out of business just on the cost of having to pay "renewal" underwriters alone. Most carriers have a difficult enough time keeping enough underwriters on hand to review new business alone. It makes a lot more sense that the renewal system is computerized, using a "basis rate" to compare loss ratios to on a large scale basis. The system then spits out an automated letter at renewal, plugging in a renewal rate that is computed based on a percentage of basis that is assigned to a group of members based on that group's loss ratios.

I'd be willing to bet that anyone who brings a renewal to me that has been generated by a carrier such as Humana or Blue Cross will find that their renewal rate, 95% percent of the time is going to be within 10-15% of new business rates.

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Re: Getting Health Insurance in New Jersey (NJ)
Old 05-01-2007, 10:55 AM   #33
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Re: Getting Health Insurance in New Jersey (NJ)

It isn't so hard. If the pre-renewal claims were over a certain dollar amount, raise the rates.

I am not spouting conspiracy theories. Don't blow what I say out of proportion. I am just saying what is or is not barred by state law and the variation among the states as to what they allow regarding rate variation based on age or claims experience. If a state law does not forbid a practice than a practice can occur. The extent that practice does occur is difficult to determine. All of which I have said before.


You said:

Quote:
Originally Posted by mykidslovedogs

Insurance companies can only raise your rates or cancel your coverage if they do it for the entire large population of other people in your "group" (typically, this is a huge group of people, all who became effective around the same time period as you did, who also live in a similar geographic are as you.)

What you said was wrong. I felt I needed to point that out. Because you are in the insurance business people may believe that you have special knowledge on these issues. I don't want readers to be mislead.
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Re: Getting Health Insurance in New Jersey (NJ)
Old 05-01-2007, 12:02 PM   #34
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Re: Getting Health Insurance in New Jersey (NJ)

Quote:
Originally Posted by Martha
It isn't so hard. If the pre-renewal claims were over a certain dollar amount, raise the rates.

...
The Wisconsin Physicain Services Insurance Corporation, a not-for-profit insurer with more that 220,000 custormers in the state, has publicly stated that it has begun to charge some policyholders more at renewal based on their claims in the prior 12 months. These examples suggest that medical re-underwriting at renewal is a growing trend.
I understand your point and apologize for my lack of "off the top of my head" knowlegde of all of the laws of every single state in the union. Let me rephrase...

In my 10 years of experience, I have never seen a carrier yet that is charging exhorbitant renewal rates based on personal claims history. In fact, every carrier representative that I have ever spoken with has always explained that renewal rates are based on a combination of the following factors:

1.) Current Age of the member
2.) The overall claims experience of the member's group
3.) Trends and inflation in the industry

Whenever someone tries to tell me that they've gotten a rate increase based on their claims, I have, 100% of the time, been able to show them that their current rates are almost identical or within 10-15% of new business rates.

The statement you quoted above, "These examples suggest that medical re-underwriting at renewal is a growing trend" gives the impression that the problem of re-underwriting is becoming common practice, and IMO, it is statements like the above that are misleading.

I disagree that re-underwriting is a common practice among the largest and most reputable carriers, and although I haven't been researching like you have for several years, I haven't found a single example of re-underwriting based on personal claims yet. Since I process renewals on a daily basis, I feel that my experience does count for something.

Each day, I have several renewals that I have to process. I look at the person's current rates. Then, I run a new business quote to see if we can offer the client a better rate in the marketplace. Sometimes I can, sometimes I can't. I have almost NEVER seen anyone that is rated more than 10-15% higher than new business rates available from the same carrier, except for ONE case, and that was with Assurant Health. Fortunately, the member did not have any pre-existing conditions and had almost no claim history (which means her rate-up couldn't have been based on personal claims) so we were able to write her with a different carrier offering better rates.

When I called Assurant Health to complain, they explained to me that that particular person's entire group had been subject to a 20% rate factor that year. I do not like the way Assurant Health processes renewals. I feel that they take rate increases more often than other carriers (every 9 months, instead of every 12), generally leaving thier entire membership with higher rates than what is available on the marketplace for healthy individuals. I haven't seen this practice with any of the other larger and more reputable carriers.
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Re: Getting Health Insurance in New Jersey (NJ)
Old 05-01-2007, 12:13 PM   #35
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Re: Getting Health Insurance in New Jersey (NJ)

MKLD,

I am curious as to the nature of your client base. If you yourself are on the younger side, is it possible your general clientele are also generally young and healthy? I know it's hard to quantify, but just curious. I've come to wonder if perhaps your situation doesn't accurately mirror much of the population at large.
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As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
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Re: Getting Health Insurance in New Jersey (NJ)
Old 05-01-2007, 12:20 PM   #36
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Re: Getting Health Insurance in New Jersey (NJ)

Actually no. We work in a large agency and are specialists for all of the agents in the agency. They bring their clients to us and we work on a partnership basis with those agents, so we have a huge variety of different ages and classes of people that we work with.
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