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April 08, 2010


As long as the American people continue to support 30% for the insurance companies to manage their health care, this will continue to be the way of the land. I have not been happy with Democrats all the time but it's clear that November and voting will still have to be about party and if we vote Republican, we can see more profits for insurance companies, less controls over their policies and more people priced out of insurance even as they are legally required to get it with a fine taken out of their tax refund or charged through IRS if they don't. We have to make this work for all our sakes. What irks me is those who think it's about the poor. It's not about the poor but about the working and retired middle class. And it's about putting corporate interests ahead of individuals as we saw the Supreme Court do with their decision that made corporations a person for donating purposes.

If you would use a little logic, if you force the insurance to set no max limits on coverage, accept anyone regardless of condition, guess what you have to pay more. If the insured now have to pay for the uninsured, it will cost you more. Or are you on of the bright one, just want som Obama money. You have now entered Brian's great world pay more and get less, the church of praise Obama.
Get rid of most state mandates, allow insurance across state lines, stop covering aliens for free, have you been to an emerengcy room. They can have emerengcy care and deported.
State mandates require you to pay for coverage that you will never need or want, which is in part why it cost so much.

I also have this same policy. With the new one you don't get to see the doctor more then four times a year then you have to pay the 1000 dollars deductable. It's awful. I'm afraid. we don't have that kind of money.

Good news - these annual maximums should all go away at your policy renewal date after the health reform act goes into effect on 9/23/2010. Bad news - You'll probably see a significant rate hike associated with this change.

About your lifetime max. The health care bill does not go into effect until 9/23/2010. No insurance companies will remove lifetime maximum limits until this law goes into place, so it will be removed at your renewal FOLLOWING implementation of the law. Regence isn't ignoring or circumventing the law, they're abiding by it. The law applies to all plans (your old Selections plan and your new Evolve plan), so this doesn't have anything to do with switching you to a different plan. Either way, it doesn't take effect until 9/23/2010.

In addition, those types of benefit changes have to be filed and approved by the state. Currently, health insurance companies have new plans with the new provisions filed with the state and are waiting for approval before they can offer them in the market. By law, they have to do this. On that note, when these new Evolve plans were filed (public information) with the state, the Federal reform act hadn't even gone through the House, so there were no upcoming provisions for Regence to even consider including at that point in time.

The reality of a billbeing passed and a health insurance policy changing immediately is completely roadblocked by government entities. At a minimum, there is a 60 day review period AFTER the health insurance company files a new plan with the state. Generally, in Oregon, the Department of Insurance stretches this review time.

The bill was passed on 3/23/2010. The bill is very ambiguous in defining most provisions. The Federal government just started releasing (as of the last 2 weeks) guidance to health insurance companies on the details of the provisions and how this translates to coverage changes.

Take preventive care as an example. To simply say "preventive care must be covered in full with no cost share to the consumer" is not something that a health insurance company can act on without additional guidance. Physicians bill hundreds of thousands of different billing codes for various services. Without a defitinion of "preventive care," noone can move forward. Each of the services that fall under preventive care need to be listed. The Federal Government has been very slow to issue this guidance.

Given the state filing and review requirements, most insurance companies will not be able to implement changes in time for 9/23/2010.

As a side note, less than 10 people hit the lifetime max annually and they are all reinstated. Essentially, it serves no purpose as it is never enforced.

To reaffirm, your lifetime max would not have been removed on your Blue Selections plan in July 2010. It would not have been removed until your renewal following 9/23/2010. Unfortunately the reform act is complex and often misinterpreted/misquoted.

In reference to profit margin, I would check out the Department of Insurance posted information on insurance carrier financials. Regence has a average profit margin of 0.1% (yes, one tenth of one percent). Most industries range from 10%-50%. Each year, there's about a 50/50 chance that the company will have losses vs. gains. The last 3 years, it had losses.

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