A new state mandate could kill a thriving market in one type of
health insurance in New York state, warn health maintenance
organization (HMO) officials.
- A guideline issues earlier this year by the New York
insurance department would require health insurers selling
point-of-service health plans to adhere to community
rating -- insurance pricing that doesn't charge employers
higher or lower premiums based on the health claims
experience of their workers.
- "Point-of-service" plans are managed care plans that offer
greater flexibility than HMOs because they allow people to
use health providers outside the plan's network.
- About two million New Yorkers belong to point-of-service
plans, and some health plans have been using experience
rating to offer employers better rates.
- If community rating is imposed, insurance brokers say
there will be a shift to more expensive "preferred-
provider organizations."
Health plans are challenging state regulators' authority to
impose community rating without a change in state law. The
regulation is set to take effect in February 2000.
Source: Nancy Ann Jeffrey and Ron Winslow, "New York Plan Draws
Criticism from HMOs," Wall Street Journal, July 13, 1999.
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