an unelected board might run Georgia's new risk pool..

[flaminbats]

there will be debate on HB320 in a state House subcommittee today!

"33-29A-10.
(a) The pool shall offer pool coverage consistent with major medical expense coverage to each eligible person who is not eligible for medicare. The board, with the approval of the Commissioner, shall establish:
(1) The coverages to be provided by the pool;
(2) At least two health benefit products to be offered by the pool;
(3) The applicable schedules of benefits; and
(4) Any exclusions to coverage and other limitations.
(b) The benefits provisions of the pooĺs health benefits coverages shall include the following:
(1) All required or applicable definitions;
(2) A list of any exclusions or limitations to coverage;
(3) A description of covered services required under the pool; and
(4) The deductibles, coinsurance options, and copayment options that are required or permitted under the pool.
(c) The board may adjust deductibles, the amounts of stop-loss coverage, and the time periods governing preexisting conditions to preserve the financial integrity of the pool. If the board makes such an adjustment, it shall report in writing that adjustment together with its reasons for the adjustment to the Commissioner. The report shall be submitted not later than the thirtieth day after the date the adjustment is made.
(d) Benefits otherwise payable under pool coverage shall be reduced by amounts paid or payable through any other health insurance or insurance arrangement and by all hospital and medical expense benefits paid or payable under any workerś compensation coverage, automobile insurance whether provided on the basis of fault or no-fault, and by any hospital or medical benefits paid or payable under or provided pursuant to any state or federal law or program.
(e) The pool shall have a cause of action against an eligible person for the recovery of the amount of benefits paid that are not for covered expenses. Benefits due from the pool may be reduced or refused as an offset against any amount recoverable under this subsection."

Board members will be appointed by the Insurance Commission to serve six-year terms.

"(c) The board shall be composed of:
(1) Three persons affiliated with different insurers admitted and authorized to write health insurance in this state, two of whom must represent domestic insurers;
(2) One person affiliated with a third party administrator or other case management organization having, as a line of business or specialty, disease state management, case management, patient safety management, or other risk reduction methodologies;
(3) Two persons licensed to sell health insurance in the state;
(4) One representative of the general public who is not employed by or affiliated with an insurance company or plan, group hospital, or other health care provider, and can reasonably be expected to qualify for coverage in the pool. Representatives of the general public include persons whose only affiliation with an insurance company or plan, group hospital service corporation, or health maintenance organization is as an insured or person who has coverage through a plan provided by the corporation or organization;"

for more on this wonderful bill.. http://www.legis.state.ga.us/legis/2005_06/fulltext/hb320.htm
contact the Georgia legislature to raise hell.. http://www.legis.state.ga.us/legis/2005_06/house/05district.htm

[punpirate]

1. So...

... the foxes run the henhouse. Who appoints the Insurance Commission? The governor?

[flaminbats]

2. correct me if I am wrong..

but Georgia only has one Insurance Commissioner..why not let the elected Insurance Commissioner represent all interests?

Perhaps Oxendine just never liked performing his duty. :smoke:

[punpirate]

3. I'm just curious, since the bill refers to...

... an "Insurance Commission," appointing members of the pool board, rather than a commissioner. Guess that might mean that the head of the commission, the commissioner, would be doing the appointing.

Cheers.

[flaminbats]

4. Why doesn't the Insurance Commissioner sit on this board?

wouldn't it be better to have seven members..one to represent consumers, one representing insurance companies, one representing doctors, one representing the patients, one representing employers, one representing labor, and the Insurance Commissioner to represent all of the voters?

Why require that two are licensed to sell insurance? Three to represent insurers, two representing insurance salesmen, one representing employers, and another representing the providers. This leaves one to represent the general public and another to promote disease management..or possibly patients? The pirates will be guarding the cargo ships!

or..instead of appointing them to represent certain groups, just elect them all, as done with the PSC.