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.

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Who’s Helped?

Marilynn Gray-Raine:

The 64-year-old Danville artist, who survived breast cancer, has purchased health insurance for herself for decades. She watched her Anthem Blue Cross monthly premiums rise from $317 in 2005 to $1,298 in 2013. But she found out last week from the Covered California site that her payments will drop to about $795 a month.

(Reported by San Jose Mercury News, 5 October 2013)