Come for the politics, stay for the snark.

I really should read my own blog.

Never give a known liar the benefit of the doubt.

If a good thing happens for a bad reason, it’s still a good thing.

They love authoritarianism, but only when they get to be the authoritarians.

Celebrate the fucking wins.

JFC, are there no editors left at that goddamn rag?

Conservatism: there are people the law protects but does not bind and others who the law binds but does not protect.

Authoritarian republicans are opposed to freedom for the rest of us.

Anyone who bans teaching American history has no right to shape America’s future.

The republican speaker is a slippery little devil.

And now I have baud making fun of me. this day can’t get worse.

There are more Russians standing up to Putin than Republicans.

There is no right way to do the wrong thing.

with the Kraken taking a plea, the Cheese stands alone.

People really shouldn’t expect the government to help after they watched the GOP drown it in a bathtub.

Nothing worth doing is easy.

Sadly, there is no cure for stupid.

After dobbs, women are no longer free.

Everybody saw this coming.

Let’s show the world that autocracy can be defeated.

“Until such time as the world ends, we will act as though it intends to spin on.”

T R E 4 5 O N

That’s my take and I am available for criticism at this time.

We will not go quietly into the night; we will not vanish without a fight.

You are here: Home / Anderson On Health Insurance / Process flows for QHP’s

Process flows for QHP’s

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Just a couple of things that I’ve thrown together on how to think about the decision points for Exchange strategy. The first is the universe of Qualified Health Plans. All On-Exchange plans are a subset of the QHP universe. Not all QHP’s have to be offered on Exchange. This gives some flexibility to insurers that want to offer off-exchange plans that are unique.

QHP

This second is a super high level flow of the plan designs from creation to final sales. Each step sees options shrink.

Plan design flow

Right now almost all carriers are waiting for the second stage to conclude. We are waiting for the relevant regulators to come back and approve, request more information or deny plan design and rate decisions. From there, carriers can make a decision as to what they actually will offer. The major regulatory constraint at that point is that anything that is offered On-Exchange has to be offered Off-Exchange. The converse is not true; Off-Exchange plans can be special snowflakes.

By early August, carriers will know what has been approved from their potential offerings and at what price. More importantly, they’ll roughly know what has been approved and at what price for their regional competitors. This knowledge can feed strategy changes.

Carriers that think they might be able to dominate the #1 Silver ranking but used an isomorphic Silver spamming strategy for 2016 still have some time to change strategy this summer once their dozen isomorphic Silvers are approved. They can move most of their mirror-image Silvers to Off-Exchange only while embracing a Silver Gap strategy On-Exchange.

That decision point for carriers will vary but it is late Summer/early Fall for everyone.

Reader Interactions

4Comments

  1. 1.

    MomSense

    I’m anxiously watching my insurance co-op, Maine Community Health Options. They are really wonderful but last year they stopped taking new customers. I’m concerned that the Republican shenanigans with risk corridors are screwing up a good thing.

  2. 2.

    Richard Mayhew

    @MomSense: not having seen their financials I would not worry too much if they have survived. The asskicker on risk corridors was that a 13% payout was unexpected. That forced big write downs and reserves becoming insufficient. Now no one expects more than a few percentage points of total risk corridor payments to be quickly made. The write down already happened before the plan year started so most insurers should be able to handle shenanigans

  3. 3.

    Barney

    Hey Richard, just to put on your refereeing hat for a moment – have you seen this?

    Referee banned for stealing female referees’ identities on Tinder

    A male referee has been banned from all football-related activities until 2019 after posing as female officials on a dating app.

    Connor Mayes set up fake accounts on Tinder, pretending to be Women’s FA Cup final referee Lucy Oliver, Amy Robinson and Paula Wyatt.
    …
    Mayes knew Oliver – wife of Premier League referee Michael Oliver – working with her at county-level matches.

    He had also been one of her students when she worked at South Downs College near Portsmouth.

    Mayes’ fake accounts led to social media users mistakenly believing the women were acting flirtatiously. They received unwanted comments and unsolicited approaches while they were refereeing and socialising.

    http://www.bbc.co.uk/sport/football/36517506

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