PPFA group insurance?

[Mike LeCompte CPF]

On another thread titled "Headed Home" the writer, Le, is closing shop and moving into his home=based business 'cause his health insurance is now $10K per year.

join the club. Us too.

that said, is PPFA or anyone else doing anyting about group insurance? or are the states too diverse in their requirements and laws so that's an impossibilty>

Or so we raise prices--again--to cover insurance increases.

O and don't think for one New York Minute your insurance won't go up after the claims from katrina. Like it or not, insurance is a BUSINESS not a charity and they will not lose these billions over thenext months or years without increasing across theboard

[Emibub]

I don't think PPFA has anything to offer in the way of group insurance. I think in the long run the biggest damage I did to myself buying this store is losing all hope of ever having health insurance as a self employed person. I have not had any for 4 years. I didn't have a plan for health insurance when I started this venture, I had no idea how hard it would be to get. Talk about a rude awakening.........

[Mike LeCompte CPF]

health insurance is NOT hard to get. It IS often hard to pay for.

[Jay H]

I've never understood how group plans were any cheaper than individual policies.

What happens is that those that never use insurance end up paying for those that use it allot. So those that don't need much drop out and get cheaper individual policies. The rates climb from there.

No matter what the scale is (10 people or 10,000 people) you end up with the same problem. When I was in construction my union FORCED me to participate in our "insurance". It cost me like $7/hour. I used it for about $1000/year, which means I barely met the deductible. The happiest day of my life was when I was able to get my own insurance.

I just don't understand how groups are any cheaper? I guess that’s why I frame.

[Ron Eggers]

Group plans are NOT cheaper than individual insurance.

The reason I'm saving $10,000/year on health insurance is because my employer is paying for a big chunk of it. The old family plan was a group plan through my wifes employer. They didn't pay for any portion of it.

If you have any pre-existing conditions, it can be easier to qualify for coverage with a group because individual members of the group can not be excluded. Claims under some plans can still be denied for pre-existing conditions, however, for a period of time following the effective date.

There are lots of people who could never get a meaningful individual policy, even if they can afford it, because of something in their medical history. If you don't actually need insurance, you should have no trouble getting it.

It's like a bank loan.

Health insurance costs are going to go up because health care costs are going up. We won't be able to blame it on Katrina since most of the big players in health insurance are not involved in property casualty insurance.

[Sherry Gray]

I'm in the process of changing to a Health Savings Account. You must choose a high deductible and pay a lower premium, and pay to fund a health savings account. A debit card is used and when the deductible is met, the coverage is 100%. If you don't use the saved amount in a year, it rolls over to the next. At age 65 you can use the money for things other than medical bills. Many companies are offering this coverage which is different than a Medical Savings Account.

[Mike LeCompte CPF]

Sherry: that's what we have with a $5,000 per year deductible. Even with that it's almost $800 per month. Jay and Ron: think you're wrong, guys, only because it's what's called a "shared risk pool" where the risks are spread among many people thus diluting the cost per individual or per member of that pool. But I could be wrong.

Anyway, the point still remains: why can't PPFA offer a group thing? Not enough members? Too many individual state regulations? Not practical?

By the bye: current provider may be dumped for Blue Cross Blue Shield. Unlike Kathy, only thing I like to gamble on are the dice tables at Vegas. Certainly not health insurance.

[Ron Eggers]

Mike, state insurance mandates are among the most complex and convoluted regulations in the country. In my new job, I deal exclusively with Texas and Arizona for this reason. Then Austin has different regulations than Houston. And so it goes. (My new job is working for one of the largest health insurance companies in the country. We have a large department whose sole function is to keep track of changing state insurance regulations and, yes, influence them when they can.)

For a carrier to deal with a group of a few hundred, spread out over fifty states . . . Well, let's just say they're probably not standing in line for it.

An individual, in excellent health with no risk factors, can probably get "affordable" individual coverage. One with any health history at all will pay more or be refused coverage.

In a group, everyone pays the same for the same coverage and nobody gets excluded. That's where your shared risk pool comes into play.

[Jerry Ervin]

Originally posted by Emibub:
...losing all hope of ever having health insurance as a self employed person. I know every state is different but I have Blue Cross Blue Shield and the rates are $135 per month. In North Carolina we get a special rate for being self employed.

Keep checking around, somebody in your state will have a plan that you can fit into your store budget.

[Pat Murphey]

True Group Insurance premiums are less because the "group" must all participate and therefore share the risk among the old and the young - to over-simplify the issue. "Group" policies, whether imposed by Government regulation or offered by an insurance company, that allow voluntary participation are not true group policies and will therefore have to have higher premiums to be viable - those group members that will likely have lower claims will likely be those that don't participate. True group policies that, for example, require all employees of a large corporation to enroll, normally cost less. Except, even those policies have become more expensive to companies where the demographics of their workforce has aged. There is no free lunch in medical insurance. Small group policies, where participation is voluntary will ultimately have to have premiums similar to individual policies to remain viable.

The nonsense that Government should make us all one large group will only increase the perception that medical care should be "free" creating unlimited demand and unlimited taxpayer cost. The proof of that is in the experience with Medicare and taxpayer subsidized corporate group insurance. As a consumer the choice is to pick where you want to be on the scale between rationing and paying for everything.

My own view is that only "group" catastrophic medical insurance should be universally available. All other care should be paid for by the consumer.

Pat graemlins/kaffeetrinker_2.gif

[Emibub]

Originally posted by Mike LeCompte CPF:
health insurance is NOT hard to get. It IS often hard to pay for. What is your point Mike? I can't afford the premiums as a group of one, so, it is hard for me to get........

Originally posted by Mike LeCompte CPF:
Unlike Kathy, only thing I like to gamble on are the dice tables at Vegas. Certainly not health insurance. Yikes, Mike, I think you are picking on me. When I became self employed I was very ignorant as to how expensive health care would be for an individual. I didn't expect to be without it this long. Believe me, being 50 years old without health care is not where I expected to be. In the beginning, I assumed I could add it on and unfortunatley, it has not come to be yet.

It is all a big racket, medical costs are set by what the insurance companies will pay out. Most individuals cannot afford to pay the ridiculous prices especially since those prices are set by the insurance companies. At this rate the only ones who can afford to be self employed are the very wealthy........

[wpfay]

Mike, I think the reasoning behind PPFA not being in the group coverage business is a combination of all of the factors. Certainly not least is the varying state to state regulations. The health insurance companies are compartmentalized into each state as well. BCBS/FL is a different business from BCBS/NC, even though there is a parent organization. There are small group policies available in Fl through BCBS for groups of 1-50 (my wife works for BCBS in that department). The insurance in the group is more expensive than individually underwritten policies because not only do all employees in each business have to accept the insurance unless exempt by other coverage (bringing down the average cost), the insurer cannot refuse any applicant that qualifies as a small business (skyrocketing the cost). There is no medical underwriting, and no pre-existing condition clause.
As you can imagine the interest in "qualifying" has spread to many individuals with serious illness, and there is much bad business being written. My wife is an auditor and her specialty is ferreting out fraudulent information given by individuals on their applications. It is truly amazing what ends folks will go to to get coverage. Her unofficial title is "Head of Business Prevention".
But that makes Florida different from all the other BCBS states, and is another reason a national organization will be hard put to offer group insurance to the members.

Part of Ellen's compensation package is a partially funded health insurance program. It's done cafeteria style, and we tailor it to our needs as those needs change (no longer need to carry maternity insurance, so we boost the coverage for eye exams). It's worth a lot of money, and we probably wouldn't be able to have as nice a policy if she didn't work for the company.

As to Katrina's effects on insurance...If what happened after Andrew is any indicator, we will have a lot fewer companies in the game, and the states are going to have to step in to see that people that choose to stay in the higher risk zones are able to get some kind of catastrophic coverage. Florida currently has a state mandated wind storm policy managed by Citizens Insurance. It has to be purchased separately, and if you ever let it lapse, you cannot get it started again. The cost of the state mandated policy is roughly 20 times the cost for the same coverage when it was included in you basic homeowners or business owners policy (and it's not as good of a coverage...10% deductable...for each occurance. The folks that got hit more than once during last season's hurricanes had to pay multiple deductables).
Allstate recently discontinued covering coastal residences, and State Farm is no longer writing new business along the coast (not sure where the line of demarcation is, only that I'm on the wrong side to feel comfortable). Alabama, Mississippi, and Louisianna will probably be following suit in the immediate future. The cost of doing business is only going to go up because of Katrina, and the cost of insurance is only going to be one of many increases.

I don't know about any answers to the delima of health insurance. I do know that whatever it is it will be very complex and far from perfect.

[Mike LeCompte CPF]

Kathy: my point exactly. You can get insurance. You just have to afford it. Which is the problem.

Wally: I'm checking now into other carriers and my agent tells me more and more companies are getting out of the health insurance field. Altho he doesn't tell me why I can only suppose and surmise it's because of spurious litigations and lawsuits and from a corporate standpoint I guess thefeeling is why bother?

And please, folks, lets not forget, that insurance is a business, not a charity.

Finally: the only people who HAVEN"T posted here are PPFA heads. Wonder why???????

[Bob Carter]

Mike-I'll take a stab at the PPFA issue, although I am certainly no expert on insurance

But, I am certain that we are too small a group. Look at your Who's Who in PPFA (and please,I'm doing this from home so the numbers may or may not be accurate)and take a quick inventory of membership of smaller states. Wyoming may only have 50 members and some of them may not be interested or have insurance elsewhere or who knows. So, that leaves 25 people, maybe?

And, it might be no different in New Mexico or Rhode Island or Maine. It's a tough issue. Like Ron, probably the only one of us that really knows much about what we are talking about (and he is stillpretty new to the job),insurance has to be done on a state by state arrangement.

So, does PPFA get it done for California and New York and Florida and states that have enough to get a workable number? And blow off the smaller states?

We all think it is so easily done-it ain't

So, let me make a suggestion. NASE has a great medical program (National Association for Self-Employeed). They have numbers to make it work and each person can tailor a plan to meet their needs. Check the web for local contacts

Or,we could increase our membership by about 500%

Not trying to be a smartalec, but does your franchisor offer a medical plan for it's franchisees?

[Mike LeCompte CPF]

Bob: no and probably for the same reasons PPFA doesn't either. I really think it's a logistical nightmare fraught with legalities. And I used to--years ago--sell for NASE when they used the medical program as a ploy to sell outrageous term life. They were scumbags, altho I AM going back about 20 years.

Might check them out since you suggested them.

[Bob Carter]

Mike-I cannot vouch for them; just that theyseem to have a large presence in our market.

You are savvy enough to smell a bad deal.

I always thought it seemed like they used the medical program to get you to join the association

[Baer Charlton]

Bob, I think this is where PMA could do some amazing good. Their membership roles are huge, and effectively in the same 'small businessperson' shape.

Maybe if PMA looks into a worthwhile HMO or PPO there could be some relief for us PPFA members...

If they do, that old question of "what's in it for me" can go sailing right out the door. Just that alone could make membership all worth while.

And why stop there: Auto insurance discounts, business insurance, or even L&I/work comp.