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Biotech / Medical : Oxford Health Plan (OXHP) -- Ignore unavailable to you. Want to Upgrade?

To: Christopher White who wrote (342)	12/5/1997 7:16:00 PM
From: Thomas Haegin	Read Replies (1) \| Respond to of 2068

Chris, so sorry to bother you: What is a VUL? -Thx, Thomas

To: Christopher White who wrote (342)	12/6/1997 7:19:00 PM
From: David Rosenberg	Read Replies (1) \| Respond to of 2068

OXHP has highly paid actuaries who should be able to determine a proper premium for these older Americans based on the morbitity of the group...It seem to me that if OXHP can't make money off the gov't cash cow Medicare, their case managers aren't doing their job. OXHP doesn't have to accept assignment of a claim...if the care is more expensive than Medicare's approved amount, than the excess charge will paid by the patient. Christopher, in Medicare HMO's (Senior Plans) the premium is the Federal Medicare premium and continues to be paid by the patient to the Federal Government. The patient does not pay the plan any premiums. There is only a surrender by the patient of the choice of using any provider. In return for this surrender the government, namely HCFA, begins monthly payments to the HMO say $400 per month regardless of whether any medical care is received by the patient. I believe the figure is 95% of the average monthly Medicare cost that the the government incurs for a fee-for-service (non-plan) senior. These payments are all that the HMO gets and must provide for all the hospitalization and office care that the member may need. There are minimal "token payments" that the patient pays say "$5 doctor visits" or "$6 per prescription" but these are probably just to curb indiscriminate use of these services. The Senior Plans may not "underwrite" and must accept all patients sick or well. (Else it would be self selection). Plans that get healthy patients who use few services make a profit. Plans with sick patients will lose money. It really does not depend that much on actuaries. In general sicker patients tend to avoid HMO's anyway as getting specialists becomes more difficult. Thus the strategy of shifting patients out of fee-for-service has generally worked for the HMO's and backfired for the government!!