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Walgreen Co. Message Board

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  • robbsbeach robbsbeach Oct 14, 2010 8:08 PM Flag

    Abracadabra:Walmart and Humana

    You forgot to mention a reinsurance company, Perhaps you heard of AIG or you missed that one.
    As for Humana they have a HMO that is at Risk with there insured, I don't disagree with what you said about risk management an ERISA,(Self Funded plans)however unless you have set one of these programs up, you are presenting Medical Insurance Contracts in Black and White, so sorry thats not how these contracts are put together and won, Very large Contracts deal in issues of gray all the time.
    Did you ever think medical Technology is a part of the gray.
    Besides being clue-less you are also pompus..
    Being that you are so knowledgeable tell how a insurance company calculates recidivism.

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    • <<”As for Humana they have a HMO that is at Risk with there insured, I don't disagree with what you said about risk management an ERISA,(Self Funded plans)however unless you have set one of these programs up, you are presenting Medical Insurance Contracts in Black and White, so sorry thats not how these contracts are put together and won, Very large Contracts deal in issues of gray all the time.
      Did you ever think medical Technology is a part of the gray.”>>


      There is very little if any “gray area” with respect to whether a plan is “full risk” or “no risk.” In the first place members of an ERISA Trust plan do not have insurance. Premiums are paid to the plan and NOT the insurance company. The insurance company does NOT pay for the healthcare expenses of these members….period….The insurance company is strictly a fiduciary providing ASO (administrative services only) to the mandates of the plan. Members of a “full risk” plan DO have insurance…The premiums are paid to the insurance company and the insurance company pays the medical expenses of the insured. “Full risk” plans have to follow the state mandates of the state in which the contract is signed (not where the insured resides). ERISA Trust plans are exempt from all state insurance mandates and instead follow Federal ERISA mandates. For ERISA Trust plans, the insurance company is paid a flat per head administrative fee regardless of the healthcare expenses of the member (the insurance company does not pay these cost). HMO’s can be set up under both models as can PPO’s…..The gov’t has HMO’s through UNH, HUM, AET and others and still picks up the tab for the healthcare expenses of these members. Med-D is a “no risk” plan. The healthcare expenses are paid by the gov’t. The premiums paid to the insurance company basically defray administrative cost. Medical Technology is independent of whether a plan is “full risk insured” or “no risk.” The SG&A of an insurance company reflects the administrative cost of BOTH “full risk plans” and “no risk” plans. The med-loss ratio pertains ONLY to “full risk” plans since by definition the 2 variables used to calculate the med-loss ratio, premiums paid and healthcare expenses paid, pertain ONLY to full risk plans…..Each ERISA Trust plan would have their own med-loss ratio since they both collect the premiums and pay the healthcare expenses of their members independent of the insurance company used as the fiduciary……You are the one that referenced the med-loss ratio with respect to Med-D….you were incorrect in your posting…..

 
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