You have clients ??

This is free enterprise at its best.

Why should any insurance carrier care how the deductible if funded. They are paid on premium, not deductible (unless these plans were meant for under-utilization due to upfront costs). It is none of their business. It is legal and there are TPA’s that will administer these types of scenarios.

Business men/women have found a way to increase benefits while reducing costs and the insurance company now wants a piece of that lower premium back. I have noticed that HSA prices have risen at the same time people are suggesting a better usage of medical dollars.

So why are premiums going up?

Notice to Greg: Don’t get cancer on the 16th of the month because you will have to wait 6 weeks for your new EFFECTIVE DATE on your pre-existing insurance. 6 weeks of cancer care could cost a bundle, say $100,000 or more.

Greg thought he was going to enroll into the pre-existing plan on the way to the hospital and have an EFFECTIVE DATE that day like private insurance companies do today. Greg is wrong.

10 days in the hospital can cost $100,000 today. 6 weeks in the hospital would cause major pain on semi-retired Greg’s checking account.

I may be wrong, but I don’t see why carriers would try to “prevent HRAs from gaining a foothold.” Brokers have told me that they do not like to sell consumer-driven plans because their commissions are a percentage of premium. So, they only sell CDHP when groups are at the end of their ropes and threaten to drop benefits because of cost. The choice is CDHP or nothing. In that case, I don’t see why the carrier would try to sabotage it.

The only credible reason to quash commissions is that the broker has wrapped the CDHP in a HRA/HSA/FSA that actually indemnifies the patient from out-of-pocket costs, thereby retaining the incentives of a traditional PPO, IMHO.

Here’s why: I have a QHDHP and an HSA and am enrolled in a plan in the California small-group market. Until this year, I paid all medical costs up to the deductible. In 2010, the rates increased significantly and the carrier started covering more preventive care. I went for an annual physical (which I amd convinced I do not need) and did not pay one penny out-of-pocket. However, I am in the same “consumer-driven health plan” as I was in 2009.

Because I have a contact at the carrier, I called him and asked why they had done this, well in advance of ObamaCare’s requiring coverage of preventive care. (Indeed, they changed it half a year before ObamaCare passed!)

He said that the carrier was having trouble with brokers who were promoting benefits that coupled a high-deductible plan with an HSA/FSA/HRA but the employer did not deposit a fixed sum in the employees’ accounts. Instead, when an employee incurs a medical cost, he submits the claim to corporate accounting, which deposits that sum into the HSA/FSA/HRA and then the employee pays.

Economically, this is a traditional PPO disguised as a consumer-driven plan. Employer gets a lower premium but claims experience is no different that traditional PPO. When carriers identified this, they tried to stop it by not paying commissions to brokers who promoted these arrangements, but they were difficult to identify and it was perhaps illegal not to pay commissions.

So, this carrier (at least) threw in the towel and started covering preventive car and jacked up premiums. I cannot estimate how widespread this experience is, but I suspect it is a significant malformation of consumer-driven health care.

These are all valid points for health policy wonks. However, the studies by left-of-center policy groups never seem to appreciate how empowering it is to control some of my own funds. They would rather have a third-party bureaucracy control all funds since third parties can be regulated and told what to do.