Although there are differences by regions throughout the country, there are common threads of focus among all carriers and health plans. Of course, the developing look of healthcare reform is currently on everyone’s minds and is an over-arching consideration for long-term strategic planning. And whatever the outcome of healthcare reform, most carriers are recognizing that change, resiliency, and response can bring new and exciting opportunities.

The most common subject we hear today is about the Individual Market:

1) Individual Marketplace - New Entry and Expansion:

With the reduction in employer-sponsored coverage, and increase in lay-offs during this economic downturn, the individual market is already expanding; a trend that will occur, with or without healthcare reform. Carriers are focused on this new opportunity to convert group coverage and particularly COBRA eligibles to individual coverage, as opposed to losing membership completely.

The uncertainties around healthcare reform, (in whatever shape it may take) has many carriers looking at the individual marketplace to strengthen their competitive position. They want to be prepared with a product portfolio, marketing plan, and efficient operations to be ready for significant growth in this market segment. As such, many carriers are now evaluating their current processes, with expectations of receiving and handling large volumes of applications in a very short period of time.

Healthcare reform may bring the additional possibility of a mandate to purchase some type of health insurance coverage, whether through a cooperative, employer, or an individual health plan. Thus these are additional incentives for carriers to be prepared for explosive expansion and new opportunities in the individual marketplace.

Carriers who do not currently offer individual products are concentrating on the following:

• Conducting market needs analysis and defining the target market
• Analyzing the competitors’ product designs and price points in order to competitively build a new product with attractive benefits and premiums
• Designing and filing new product designs
• Investing in underwriting risk selection tools customized to the carrier and marketplace, along with the design and implementation of efficient, automated workflow processes, including partnership with expert outsource underwriting partners, and
• Establishing risk and rating guidelines which meet financial targets for long-term sustainability.

If you are contemplating expansion to the individual market, let the team at Medwise assist you.