‘Substandard plans’ Mr. President? Here is proof that you are lying once again

C. Steven Tucker

After President Obama was forced to finally admit that he was not telling the truth when he promised repeatedly “if you like your plan, you can keep your plan. No one will take it away from you, period.” The latest ‘spin’ from the president  is “mostpeople can keep their plans and those who lose them will be getting a better plan for a lower price to replace the substandard plan they have now” from the ‘old market‘. A market that HHS secretary Kathleen Sebelius referred to as ‘The Wild West‘. As if the current individual and family market is some wild unregulated market where consumers can be abused by unscrupulous carriers offering ‘skinny‘ or ‘shoddy‘ plans. Nothing could be further from the truth. The evidence below will prove that the president is lying to the American people once again.

Below I will link actual policy termination letters from four of my existing clients who hold individual health insurance policies from Blue Cross Blue Shield of Illinois. The last names and policy numbers have been redacted in order to protect the privacy of these clients per 1996 HIPAA law.

Click here to download Stephen’s Obamacare termination letter.
Click here to download Robert’s Obamacare termination letter.
Click here to download Kathleen’s Obamacare termination letter.
Click here to download Michael’s Obamacare termination letter.

When you review their current health insurance policy outlines of coverage. Tell me, do these plans look like ‘unregulated plans‘ from a market similar to the ‘Wild West‘? Are these ‘skinny’ plans or ‘substandard plans’?

Please note that each of these policies offer 100% coverage for in network covered charges after an aggregate ‘common family’ deductible has been satisfied. The size of each of their family deductibles is listed in their current outlines of coverage, also included in each PDF document.

Please also note that each of these policies already include 9 out of the 10 “Essential Health Benefits” that are scheduled to be added to every individual and family major medical policy in the country as of 1/1/14. Blue Cross even offered maternity coverage. All other individual and family major medical health insurance plans already included 8 out of the 10 ‘Essential Health Benefits” since 9/23/2010 when the following additional federally mandated charges were added to every policy offered by every carrier in America per the PPACA (Obamacare).

Coverage of Children
If a policy makes available dependent coverage of children, the policy will make such coverage
available for your children who have not attained age 26 regardless of the presence or absence of the
child’s financial dependency, residency, student status, employment, or any combination of those
factors. In addition, the policy will not deny or restrict coverage of such children based on eligibility
for other coverage.

Rescissions
Coverage under the policy, with respect to an individual, will be canceled retroactive to the effective
date of coverage if the individual (or a person seeking coverage on behalf of the individual) performs
an act, practice or omission that constitutes fraud, or makes an intentional misrepresentation of a
material fact, as prohibited by the terms of coverage. At least 30 days advance written notice will be
provided before any such cancellation.

Lifetime Maximums
Benefits that are considered essential benefits (as that term is defined in the Affordable Care Act and
applicable regulations) will not be subject to any lifetime limit on the dollar value of such benefits
for any individual.

Preexisting Condition Waiting Period
A preexisting condition waiting period will not apply to enrollees who are under 19 years of age.

Preventive Services
The policy will provide coverage for those preventive items and services required to be covered by
the Affordable Care Act and applicable regulations and will not impose any cost sharing
requirements (for example, coinsurance, deductible, copayment) with respect to those items and
services, when delivered by a participating/network provider. These preventative services are listed below:

Annual Benefit Maximums
Although under the Affordable Care Act a restricted annual limit on the dollar value of essential health benefits (as that term is defined in the Affordable Care Act and applicable regulations) may be applied prior to 2014, benefits under this policy that are considered essential health benefits will not be subject to any annual limit on the dollar value of such benefits for any individual.

Please also note that in every case, the PPACA compliant ‘replacement plans’ offered to these clients are priced higher and in most cases much higher than what they are paying now. However, they’re not just priced higher, they expose these clients to a much higher out of pocket risk each year. Up to $12,700 for a couple and a family. Below are the outlines of coverage for each PPACA compliant alternative plan offered to these clients:

The Blue PPO Bronze 005. Click here to view the outline of coverage.
The Blue Bronze PPO 006. Click here to view the outline of coverage.
The Blue Choice Silver PPO 003. Click here to view the outline of coverage.
The Blue Choice Bronze PPO 006. Click here to view the outline of coverage.

Lastly, regarding president Obama’s other statement that the ‘old market’ was a largely “unregulated market” where consumers could be taken advantage of by the ‘big insurance companies‘. Whilst there were a few bad players in the market before the PPACA was passed, the health insurance market was highly regulated. In fact, you can click here to see how Blue Cross’s HSA qualified plan (the same plan the aforementioned clients hold today) was designed long before the PPACA was signed into law. Tell me does that policy, designed in 2009 look like a ‘skinny’, ‘substandard’ plan? Once again, the president’s rhetoric does not match the facts. Then again, has it ever?

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