Wednesday, February 21, 2007

Notice to all small employers in Georgia:

Are you ready for Georgia State Senate Bill 150?

You have to read past the innocuous start that says "To amend Chapter 4 of Title 26 of the Official Code of Georgia Annotated, relating to pharmacists and pharmacies, so as to require pharmacies to submit certain performance and cost data to the Department of Community Health" to find out that...

A pair of “Republican” state senators have decided that if you wish to offer medical insurance benefits, that you should have it administered by the state government and pay the government additional fees over your taxes and insurance premiums for the privilege.

In order to do this the state government will set up the “Georgia Health Insurance Exchange”as follows (check out 3 & 4 below):
The exchange shall have the power to:
(1) Contract with vendors to perform one or more of the functions specified in Code Section 33-62-4;
(2) Contract with private or public social service agencies to administer application, eligibility verification, enrollment, and premium payments for specified groups or populations of eligible individuals or participating individuals;
(3) Contract with employers to act as the plan administrator for participating employer plans, subject to the provisions of Code Section 33-62-11, and to undertake the obligations required by federal law of a plan administrator;
(4) Set and collect fees from participating individuals, participating employer plans, and participating insurance plans sufficient to fund the cost of administering the exchange;
(5) Seek and directly receive grant funding from the United States government, departments or agencies of this state, county or municipal governments, or private philanthropic organizations to defray the costs of operating the exchange;
(6) Establish and administer rules and procedures governing the operations of the exchange;
(7) Establish one or more service centers within this state to facilitate enrollment;
(8) Sue and be sued or otherwise take any necessary or proper legal action; and
(9) Establish bank accounts and borrow money.

So you say “I don’t need the government to administer my health plan.” They have an answer for that:

(a) A carrier shall not issue or renew an individual health benefit plan, other than through the exchange established under Code Section 33-62-2, after the first day of the plan year following the first regular open season conducted by the exchange in accordance with Code Section 33-62-6.
(b) A carrier shall not issue or renew a group health benefit plan to a small employer with 50 or fewer employees, other than through the exchange established under Code Section 33-62-2, after the first day of the plan year following the first regular open season conducted by the exchange in accordance with Code Section 33-62-6.

“Okay. Fine.” You say,”It’s too much trouble. I’ll just not offer medical insurance” They still have requirements (pay particular attention to (a)1):

(a) Each employer in the State of Georgia shall annually file with the Commissioner a form for each employee employed within this state indicating the health insurance coverage status of the employee and the employee´s dependents, including the source of coverage and the name of the insurer or plan sponsor, and, if no coverage is indicated:
(1) The employee´s election, in lieu of insurance coverage, to post a bond or establish an account in accordance with Code Section 33-66-15;
(2) The employee´s election to apply or not apply for coverage through the exchange; and
(3) The employee´s election to be considered or not to be considered for any publicly financed health insurance program or premium subsidy program administered by this state.
(b) Each form shall be signed by the individual to whom it pertains.
(c) Each self-employed individual in this state shall annually file the same form with the Commissioner.

So everyone will need a bond or an account or insurance. I wonder if this applies to illegal immigrants?

Meanwhile for the big boys, something that would lower everyone’s costs will be available:

The General Assembly recognizes the need for individuals, employers, and other purchasers of health insurance coverage in this state to have the opportunity to choose health insurance plans that are more affordable and flexible than existing market policies offering accident and sickness insurance coverage. Therefore, the General Assembly seeks to increase the availability of health insurance coverage by allowing insurers authorized to engage in the business of insurance in selected states to issue accident and sickness policies in Georgia.

The selected out-of-state insurers shall not be required to offer or provide state mandated health benefits required by Georgia law or regulations in health insurance policies sold to Georgia residents.

So the relief of the mandates is only allowed if the government takes over. When the government was busily installing those mandates, they were necessary, why aren’t they now?

And not only are unlicensed companies invited to the government’s all-you-can-stand porkfest but they are carving out other exceptions to the insurance law on the books:

(a) In cases when a producer licensed in this state enrolls an eligible individual or group in the exchange, the plan chosen by each individual shall pay the producer a commission on premium either in an amount determined by the board of directors of the exchange or in the amount or amounts voluntarily agreed to by the various carriers and producers.
(b) In cases when a membership organization enrolls its eligible members, or the eligible members of its member entities, in the exchange, the plan chosen by each individual shall pay the organization a fee equal to the commission specified in subsection (a) of this Code section. Nothing in this Code section shall be deemed either to require a membership organization that enrolls persons in the exchange to be licensed by this state as an insurance producer.

It seems that the next great business opportunity in the state is to set up a Small Business Insurance Membership Organization and offer to refund 50% of commissions fees because commissions can not, by law be “rebated” even to the extent of buying a customer lunch.

I have to wonder if the "mergers and acquisitions" lawyer that sponsored this bill was involved in the Wellpoint buyout of Blue Cross Blue Shield of Georgia (this really sounds as though it was designed with considerable input from them)or if some insurance agent p*ssed in his Wheaties.

Senator Hill's Campaign Finance Data
Wellpoint's Plan Similarities