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  #41  
Old 05-20-2015, 11:08 AM
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Originally Posted by Dismal Science View Post
Filling out gummint bid forms? Maybe the compliance work is involved for the actuarial group - but it certainly doesn't impact other parts of the organization as much as the other types of business on the list.
Are you involved in Medicare Advantage in an insurance company? Or have you been?

customer service
provider contracting
compliance
underwriting (depending on how EGWPs are handled)
data warehouse
EDI
risk adjustment
provider coding reviewers
network
pharmacy

All those areas are affected, and I am certain I missed some.
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  #42  
Old 05-20-2015, 11:09 AM
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Man, there are a lot of FI groups over the 1,000 sub line.

Plenty of city and county gov't groups in that range that you'd think would be ASO, but aren't.
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  #43  
Old 05-20-2015, 11:10 AM
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Why would any large group go fully insured? It either doesn't exist or the company is extremely dumb for doing it
You didn't specify it as self-insured in this post.
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  #44  
Old 05-20-2015, 11:11 AM
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You didn't specify it as self-insured in this post.
It was clearly a follow-up to the post where I clearly wrote "Large Group (ASO)"
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  #45  
Old 05-20-2015, 11:11 AM
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Probably as low as 1K subscribers
In that case, I've personally underwritten dozens of those, even without the government or union contracts I referred to in earlier posting.
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  #46  
Old 05-20-2015, 11:13 AM
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So is ASO seriously a money maker where you are DS? It would surprise me, but wouldn't be the strangest thing I've heard today.

Edit: and I mean after real admin cost allocation.
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  #47  
Old 05-20-2015, 11:20 AM
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What is the definition of large group that you are each using?
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Most health carriers define the term "large group" as having 100+ members. Now I think in your list you meant "large" as "jumbo" (which is usually 2k, or 5k), but that's a guess.

I pass all your posts through my "doesn't know much about health insurance" filter, so it can lead to miscommunication.
When he said Large, I was thinking Jumbo. My most recent employer was an insurer owned by GE. Definitely jumbo, definitely ASO. I'm not even sure whether there was stop-loss involved. And I already disclosed that I don't know much about health insurers.
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  #48  
Old 05-20-2015, 11:46 AM
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So is ASO seriously a money maker where you are DS? It would surprise me, but wouldn't be the strangest thing I've heard today.

Edit: and I mean after real admin cost allocation.
ASO fees aren't the only source of revenue for these groups.

They are often sold additional programs and services or make money off less transparent fees charged through the claim wire (ex. taking a portion of negoatied shared savings for out of network contracts (50% or more) and subrogation recoveries). Not to mention all the wellness programs that can be sold or customer service and care management buy-up programs.
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  #49  
Old 05-20-2015, 12:04 PM
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Defining "large" as 100+...


Ahem, 42 U.S. Code 18024 (b) (1)
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  #50  
Old 05-20-2015, 12:15 PM
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In the context of that title they chose to define group size that way.

The goals and motivations for the definitions obviously vary. Those definitions are mostly concerned with exchange eligibility and loss ratio calculations.

For other purposes I'm struggling to think of how a 25K life group would be treated similarly to a 100 life group.
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