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mini-medical/ limited-benefit plan is Ins. industry innovation to lower $

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papau Donating Member (1000+ posts) Send PM | Profile | Ignore Wed May-31-06 10:16 AM
Original message
mini-medical/ limited-benefit plan is Ins. industry innovation to lower $
Mini Med is a smoke-and-mirror concept that looks good, but are designed to not pay claims(the design of course varies - how else to hide cost from cost comparisons - but the employee's $60 per month premium usually covers a $15 co-pay for in-network physician office visits benefit with a maximum annual benefit of $450, and with maximum annual limits on outpatient diagnostic coverage of $300, an outpatient surgery surgery annual maximum benefit of $1,000, a hospitalization is usually not covered but if covered it might have a maximum of $1000 per day with a few days as the maximum, and if drugs are covered there would be a co-pay and annual maximum also). These plans are being promoted by companies that bill themselves as mini-medical insurers, but that are really just marketing organizations, resulting in a breakdown of the quality and frequency of health care in the US - but then again the private sector is meeting the request of the Bush administration for a low cost non-governmental innovative response to the high cost of health care.

Now that Aetna Inc.(which acquired Strategic Resource Corp) and and United Health Group Inc. have joined little guys like Star HRG in offering these plans, can we ever again trust being a large operation to mean you have any more credibility than someone running a marketing scam?

The Bush/Reagan/GOP corporate greed is good world already has about 10% of US companies using these plans, including around 70% of companies with more than 5,000 employees, and they are coming soon to the part-time, hourly, and contract worker jobs and to the retailers, hotels, restaurants, nursing homes, trucking companies, and employment agencies businesses. GOP approval was earned by the fact the cost "sharing between employer and employee' is overwhelmingly 100% out-of-pocket for employees - less than 5% of employers contribute anything. But the selling pitch suggests mini-med is an employee retention tool because the company can start paying a small percentage of the small premium after say the first six months of employment, and the workers will know they are better off than they would be with a union.

Of course this fits into the high-deductible plans the Bush administration has been trying to sell as the national health crisis cure that doesn't involve single payer national health. The Bush folks want you to takes some of that pay increase you received during the Bush years, and build up some savings in the MSA savings account so that you start to cover that high deductible. But since pay has actually gone down for the average worker under Bush, few MSA's have been started, so these mini-med policies are now GOP approved to fill that hole. While this is an inefficient expensive way to deliver health care, it preserve those high salaries for health industry paid management, the high returns for the health industry shareholders, and the high PAC contributions to the GOP.

Hey, it is better than nothing - right?

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CountAllVotes Donating Member (1000+ posts) Send PM | Profile | Ignore Wed May-31-06 10:36 AM
Response to Original message
1. yeah I noted something like that I got yesterday
It came from one of the Unions I belong to. They frankly piss me off. They are against offering Long term care to employees that have been disability retired which is simply not right. Those are the very people that might need this important benefit.

Now they are "unveiling" some new PPO plan that sounds like a piece of crap BUT it will cost 7% less (big attraction there).

The cost of the health insurance for my husband and I is $10,000.00 a year at present. And to think they want to tweak it and make it worse than it already is!

I had to wait for a whole month to be "eligible" to get an appt. for a potential knee injury I have that may require surgery. And to think, $10,000.00 a year is being paid out for this type of "service". :grr:

More to come I am sure ... these thieves never stop.

:(

:kick:

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papau Donating Member (1000+ posts) Send PM | Profile | Ignore Wed May-31-06 11:40 AM
Response to Reply #1
5. This is worse than any PPO plan I've ever seen. As to long term
care - at the moment it is an "experimental coverage" - meaning the many plans out there, the massive amount of money on deposit/in reserves, and the profits being reported by the companies that issue it, are all based on some very soft reasoning and numbers, which are backed up by claim underwriting.

Claim underwriting means that in 2007 if the ins company is having a veru good year with long term care, the a rather weak claim might be approved, while in 2008, if the insurance company is burried in claims and losing money, not only will the weak claim not get through, but the average claim will not get paid - some small print will be found, or there will be a need for documentation that never ends, so that the insurance company can report that it is making money.

And in addition, long term care is expensive - in effect, you are doing the saving for the nursing home over 10 years that you should have been saving for over the last 20 years . After paying someone a commission to bug you to pay the premiums in the future, and paying someone to make sure you are really in need of a long term care benefit before you see a dime of the money, you get a bit more "interest" on your money (your premiums) from the fact that some folks will die without ever going into a need for a long term benefit mode - and their account will be spread over the ones still in force - but only after the insurance company takes its share - increase the rate of return allowed on your account (accumulated premiums).

Now where the numbers are predictible, as in life or disability claims, the insurance company cut is a small price to pay for the protection against financial ruin. But in Long Term Care you really do not know what you are paying for because of that "claims underwriting" procedure.
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Epiphany4z Donating Member (1000+ posts) Send PM | Profile | Ignore Wed May-31-06 10:36 AM
Response to Original message
2. sounds like it
is good enough to get you to the doc to find out what wrong but wont cover treatment once you find out..other than maybe strep and the flu type stuff.
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papau Donating Member (1000+ posts) Send PM | Profile | Ignore Wed May-31-06 11:25 AM
Response to Reply #2
3. Exactly - sadly
:-(
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OneBlueSky Donating Member (1000+ posts) Send PM | Profile | Ignore Wed May-31-06 11:39 AM
Response to Original message
4. health "insurance" in this country has become nothing but . . .
one giant consumer rip-off . . . the industry's objective is certainly not to improve healthcare access; it's solely to improve their bottom lines . . .

just one more example of the haves stealing from the have-nots -- who have little choice but to play along if we want ANY kind of coverage at all . . .
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papau Donating Member (1000+ posts) Send PM | Profile | Ignore Wed May-31-06 11:41 AM
Response to Reply #4
6. true :-(
:-(
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benEzra Donating Member (1000+ posts) Send PM | Profile | Ignore Wed May-31-06 06:57 PM
Response to Original message
7. What a scam...I'd call that UNINSURED...
"mini-med" may be fine if your employer will guarantee that you will never, ever be subject to anything but "mini-diseases" and "mini-injuries."

What a crock...
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oscar111 Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Jun-01-06 01:17 AM
Response to Original message
8. = to "INDUSTRIAL" health ins of years back, i suspect. Right?
just a little fatter in the areas of what your pay monthly,

and a little fatter in benefits.. maybe.

so it seems to this casual observer. Am i right? BTW, super well written papau.

=============================

As industrial insurance was once summed up, "marketed to the ignorant poor, to milk them, and then pay shabby benefits".

I once was in a GP MD's office when he spoke to the lady sitting next to me, saying

"this insurance wont get you into a regular hospital. I can however put you into the hospital here for the poor." I figure she had industrial insurance. And did not realize how worthless it is. Just a drain on the monthly budget.
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