Health Questionnaires still required?

[Benefits 101]

For the 51+ market, it seems that individual health questionnaires can still be required. In fact, many health insurance companies are in fact requiring this.

Now all this seems to me to be in violation of §147.104: Guaranteed availability of coverage: Guaranteed availability of coverage in the individual and group market. Subject to paragraphs (b) through (d) of this section, a health insurance issuer that offers health insurance coverage in the individual, small group, or large group market in a State must offer to any individual or employer in the State all products that are approved for sale in the applicable market, and must accept any individual or employer that applies for any of those products.

Also this: (e) Marketing. A health insurance issuer and its officials, employees, agents and representatives must comply with any applicable state laws

and regulations regarding marketing by health insurance issuers and cannot employ marketing practices or benefit designs that will have the effect

of discouraging the enrollment of individuals with significant health needs in health insurance coverage or discriminate based on an individual's race, color, national origin, present or predicted disability, age, sex, gender identity, sexual orientation, expected length of life, degree of medical

dependency, quality of life, or other health conditions.

I can see the insurance company saying: The health questionnaires are part of our application process. Fair enough, that might fly. But then if they are using the information to jack up the rates, doesn't that qualify as a marketing practice to discourage the enrollment of individuals with health needs?

[GBurns]

I have not seen or heard of this Questionnaire and do not see it on any of the 2014 or 2015 Applications that I have seen.

Is this a separate form?

What insurers and in which states are you seeing this?

[Benefits 101]

Independence Blue Cross & Aetna in PA. Yes, separate form for Blue Cross. Pre-2014 enrollment application for Aetna. Yes, I assure you that I am not lying about this.

[GBurns]

I think that you should check the dates of those forms for currency.

I did not see any such form for IBC, Keystone or QCC.

The IBC Guides state that "* IBC has not used pre-existing conditions as a rating factor in small group before, however now it is a federal law that carriers can no longer deny coverage because of a pre-existing condition or charge a higher rate.".

The Guides then go on to state:

"Beginning January 1, 2014, rating restrictions limit insurance companies to only four factors for adjusting premiums:".

So aside from the Tobacco usage question, it does not seem logical that they would have a Health Questionnaire, which answers they say they did not use and which now under ACA, they cannot use.

I do not see such questions on the Aetna Enrollment Form for Medium or Large Groups, but I do see on the 2014 Small Group (2-50) Enrollment Form a Section G. Case Management (OPTIONAL - This information will be used to help coordinate your care. It will not impact your premium rate or eligibility for coverage........"

http://www.aetna.com/employer-plans/document-library/forms/pa-ee-2-50.pdf

http://www.aetna.com/employer-plans/document-library/enrollment-forms/ppo/68000-20.pdf

[Benefits 101]

I think that you should check the dates of those forms for currency.

I did not see any such form for IBC, Keystone or QCC.

The IBC Guides state that "* IBC has not used pre-existing conditions as a rating factor in small group before, however now it is a federal law that carriers can no longer deny coverage because of a pre-existing condition or charge a higher rate.".

The Guides then go on to state:

"Beginning January 1, 2014, rating restrictions limit insurance companies to only four factors for adjusting premiums:".

So aside from the Tobacco usage question, it does not seem logical that they would have a Health Questionnaire, which answers they say they did not use and which now under ACA, they cannot use.

I do not see such questions on the Aetna Enrollment Form for Medium or Large Groups, but I do see on the 2014 Small Group (2-50) Enrollment Form a Section G. Case Management (OPTIONAL - This information will be used to help coordinate your care. It will not impact your premium rate or eligibility for coverage........"

http://www.aetna.com/employer-plans/document-library/forms/pa-ee-2-50.pdf

http://www.aetna.com/employer-plans/document-library/enrollment-forms/ppo/68000-20.pdf

GBurns... I bet you $10,000 that it is a requirement. My goal here was to analyze this for legality, not for anyone to question what I say is fact. If you do not believe me, please take me up on my wager. Your comments are not helpful and in no way help to answer the question I originally posed in this thread.

[GBurns]

Why not just post the Questionnaire?

The question that you originally posed in this thread, can only be answered by seeing the Questionnaire. If I looked and did not see such a form, it is only logical that i ask you questions. Are you above being questioned?

[Benefits 101]

The question I asked can only be answered by seeing the quesionnaire!?! Ummm.. Ok, if you say so, Please explain why seeing the the individual health questionnaire is required to answer the question. If you really thought that, why not just ask "can you post the questionnaire" from the beginning then?

Its very rude considering that I assured you that it is factually correct and insurance companies are requesting this information. Now most of this thread has been trying to satisfy your demand that what I am saying is true (so you've basically hi-jacked my attempt to get some quality input). I would have preferred you not hi-jack the thread, maybe I would have been able to get some real input towards the question I asked.

Anyway, to get this moving in the event you actually have something to contribute, here you go... your proof you so insistently demanded: https://www.dropbox.com/s/i6qcn4j1qpis9qy/Virgin%20Group%20Questionnaire.pdf?dl=0

[GBurns]

Thank you.

People make assurances that things are factually correct etc, all the time, but that does mean that they are correct. People make mistakes all the time. There are many reasons why this happens, To err is human,

I am sorry that you think that questioning you about a Form that does not appear in the IBC Forms listing and which information, IBC says that it does not use, is rude. But, bear in mind that you said that Aetna was also using such a Questionnaire. While this is true, this is explained on the Aetna Application, showing the purpose of their medical questions,

I was faced with your word against what is published by IBC and you apparently not seeing the Aetna explanation. It would have been foolish of me to not ask you questions,

When I posted that I had not seen or heard of such a Questionnaire, then told you that i had looked and suggested that you check the date of the forms, most people would have provided a copy or a link. I did not think that I needed to ask. I also do not think that asking you about the forms means that I think that you are lying.

You are fairly new to these forums, but you have been on enough threads to know that I have in no way hijacked. Some posts get little or no response..

,

[Flyboyjohn]

Similar questionnaires are still legal in the large group market (and widely used in Virginia) so the insurer can underwrite the group and set the composite rate.

The insurer meets the ACA guaranteed issue requirement by not denying coverage to the individuals who indicate medical issues.

Small groups (currently up to 50 but going to 100 in 2016 or 2017) are community rated so the questionnaires are irrelevant and essentially "illegal".

[Benefits 101]

Similar questionnaires are still legal in the large group market (and widely used in Virginia) so the insurer can underwrite the group and set the composite rate.

The insurer meets the ACA guaranteed issue requirement by not denying coverage to the individuals who indicate medical issues.

Small groups (currently up to 50 but going to 100 in 2016 or 2017) are community rated so the questionnaires are irrelevant and essentially "illegal".

Thanks for staying on point John. You know if anyone's tried to extend §147.104(e) to challenge this practice... or if HHS has commented on this by issuing guidance?

The argument being:

1. I have cancer

2. I complete a health application as part of my employer's plan

3. insurance company increases rates to the point where the insurance is unaffordable

4. therefore the insurance company has constructively discouraged me to enroll / apply for the coverage.

I understand that (e) was created to make insurers cover things like diabetic supplies, but does the force of that section merely end there? Is "rating up" a "marketing practice", and if so, does it discourage people with health needs from applying? Two insurers in my area might think so, because they won't even issue rates without the questionnaires, therefore eliminating step 3 of my argument. United Health Care will, but required questionnaires after the fact.

A judge could strike this practice down with one ruling and then have that ruling survive a few appeals, then this medical questionnaire non-sense goes away.

I'm thinking informal guidance might have been given by HHS to the insurers (i.e. HHS told insurers: "we won't regulate that practice if you do it")... because its such wide spread practice. But it seems worthy of impact litigation... in a plaintiff friendly anti insurance kind of court.

If public guidance was given, I'm wrong and that argument probably doesn't have a shot and these insurers can go on doing this obtrusive practice.