Insurance jargon question

Just a quick question about insurance jargon…I am looking at signing up for a new group plan and found this in the marketing info:

“The Select Plan is medically underwritten (all size firms).”

What specifically does this mean WRT diabetes?

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I am no expert and there’s not a whole lot of context there to analyze but at a glance I would think it might be referring to a plan being self funded by the employer? Just speculating?

Medical underwriting means there are medical criteria that determine who is eligible to join the plan, or what the plan costs. More generally, insurance underwriters are the folks who decide whether a risk is worth covering at a given premium (or at all).

So yes, it would be good for you to look into this further; contact this plan and see whether you can get it and what it would cost you.

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Also if it’s a group plan, and you’re part of the group, you can get coverage with no additional headaches than anyone else has. All the noise about health insurance in the media lately has only been about individual plans wrt preexisting conditions etc. group plans essentially haven’t changed in decades in that regard… members of the group can’t be excluded for any reason. (With minimal exceptions in certain states that can allow a temporary PEC exclusion for a few months only if going from completely uninsured to on the group plan… not an issue with contiguous coverage)

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Yes that is what I’ve always thought too. But this new plan I’m looking at is a large group plan, an association health trust. Not sure how they are allowed to use medical underwriting if it means excluding people based on medical history.

I’ll be talking with one of their sales people and will get clarification.

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If it’s a group plan, it cannot mean that and never could. Rest assured. And currently no matter what type of plan it is, it cannot mean that…

@John58, I would love to find out what they tell you.

I was reading a number of articles specifically regarding Washington State as related to association health trust medical plans. Very confusing and almost all of the articles are talking about Washington State which makes me wonder if something different is going on there as opposed to anywhere else in the USA.

I had a nice conversation with the sales person and learned a few things. This is an association health plan “partially self funded”, run by a national trust (through ACEC, consulting engineers). A small business will be accepted for coverage if they are (1) ACEC member firm (I am) and (2) 2 or more employees. Covered employees have to work minimum 20 hours per week. They use the medical underwriting to set your premium. The “partial self funding” part of the equation is over my head but basically a portion of the companies annual premium is refunded if your claims are below the estimate they use to set your premium. The insurance works like an normal PPO through Aetna and has all the usual options of copays/deductibles.

For me, not a good solution because I thought I wanted to be a sole proprietor. The expense/hassle of getting an employee would not be worth the potential savings of money/hassle if this turned out to be better insurance than I currently have (which I’m not sure it would be).

What I’m tinkering with right now (any ideas would be appreciated):
I am retired but I still have coverage through my old company. I am “on call” for consulting assignments in order to maintain this coverage. Coverage and premium is a good deal for me, coverage is through a WA/OR association health plan trust that has been around for over 50 years. I used to be a trustee of the health trust so I have some loyalty to them.

I could keep this going for a few more years (I am 60) but want to switch before I hang it up and go on Cobra. Only downside to my current setup and only reason to switch would be the health insurance company the trust contracts with seems incompetent and I am tired of dealing with them. One example: between Edgepark and insurance co., CGM sensor and transmitter billing has been screwed up so the “final numbers” for this year are still totally up in the air. This has been going on since May. Planning to start on pump in 2018 and looking for an insurance company that can handle the approval/billing/administrative part of the coverage with fewer hassles. Trying to minimize the hassle factor even if it costs me a few bucks in the end.

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Isn’t COBRA only good for 18 months though? Or have the regulations changed?

Yes Cobra is good for 18 months…I am planning ahead! I figure (unless I can find something better) start Cobra at age 63 1/2.