The way it was

There has been a lot of media attention focused on various technical difficulties related to signing up for insurance under the ACA.  There is also a lot of attention being paid to the fact that individuals who had insurance on non-grandfathered plans are now receiving termination notices — though this is hardly “news”.  (A “grandfathered” plan is one that was in existence before passage of the ACA in March 2010; a “non-grandfathered” plan is a plan that an individual or employer group purchased or set up after that time. In order to be “grandfathered”, plans had to also be upgraded to meet certain specified requirements as to coverage).

I’ve recently discovered a document that was created by an insurance company (Anthem Blue Cross) to assist its agents in understanding the standards for coverage and setting rates. This 64-page Booklet, called The California Agent Guide: Policies and Procedures Sales and Underwriting for Authorized Agentss, is quite recent, published in May, 2013. But it’s worth reading as a very detailed reminder of the hurdles that everyone had to pass in order to purchase insurance.

The list of disqualifying conditions or medications is staggering.  Kid taking medication for ADHD? that’s a 25%-75% increase in premium.  Taking prescription meds for acne? Decline.   In fact there’s a whole page listing dozens of prescription medications that would preclude a person from getting insurance.

Single man with a pregnant girlfriend, applying to insure himself only? Decline.

A bout of asthma within six months? Decline.  Deviated septum? Decline.

Taking prescription medications for migraine?  That’s a 50% increase in premium level.

Has your kid had four or more ear infections in the past year? That’s also worth a  50% increase in premium.

If you are under 30 and suffer from anxiety, that’s a 50% increase in premium. Ditto for mild depression up to age 49.

And you better not have sought treatment for infertility — that also puts you in automatic decline territory.

Keep in mind that this insurance manual was written in May, when any policy sold would be due to expire with the advent of Obamacare. In other words, Anthem (and probably other insurers as well), knowing full well that come January they would have to accept all comers, was still shutting the door on anybody with the potential to actually use their insurance to pay for medical treatment as of this past spring.

Read this document. That is the problem that the ACA was created to fix.

The next time you hear someone griping about their non-grandfathered policy being cancelled, think of all of the people who couldn’t get any insurance at all, at any price.

The next time you hear someone griping about a rate increase, think about all of the extra premium dollars that people who were lucky enough to get insurance paid because their kid was prescribed Ritalin or needed allergy shots.

And the next time you hear someone complaining about the poorly designed and glitchy exchange web sites, remember that the old system was to fill out a detailed medical history for everyone in your family, then submit that to strangers to go over with a fine tooth comb.

The new system isn’t perfect, but it has one thing going for it that the old system didn’t:  guaranteed eligibility for coverage.   That’s a relief for the many who were denied insurance or forced to pay exorbitant premiums in the past even because of minor ailments reflected in their medical history.  And it also means that for the future, no one will have to worry that a new diagnosis will render them uninsurable for the future.





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