Consultant: Rate this without specialty drugs. We plan to exclude all specialty drugs.
Underwriter: You can’t do that! What will plan members do if they can’t get their specialty drugs?
Consultant: What does it matter to you? Just shut up and evaluate this risk by excluding specialty drugs!
Underwriter: This is bad! You can’t take these drugs away from those that need them!
Consultant: You are obviously a liberal socialist. Are you going to evaluate this risk or not?
Underwriter: No! This should be unlawful! I will not participate in a scheme to take life saving drugs away from those that need them!
Consultant: Well, the alternative is discontinuing health coverage for all the employees because the employer can’t afford to pay any more than they are paying now. Are you sure you want that to happen?
Underwriter: Of course not. That would be criminal. Employees are entitled to health insurance!
Consultant: Then how will all of this be paid for?
Underwriter: Don’t give out any more raises! Increase the deductible, co-pays, and co-insurance! Put on a hiring freeze! Get the employer, the rich bastard that he is, to spend more of his lucrative, record breaking profits for the benefit of his hard working employees!
Consultant: No, we don’t want to do that. We want to improve benefits, reduce costs and give out raises to every employee that deserves one. And we are going to exactly that plus we are going to make sure employees who need specialty drugs get them without paying for them!
Underwriter: What!!!! That’s impossible. What have you been smoking recently?
Consultant: Are you going to underwrite this case or not?
Underwriter: I lied to you. I’ve already done that. The agg factor is reduced by 22%.
Consultant: Damn you’re high maintenance!
AND THEY LIVED HAPPILY EVER AFTER (and plan members who need specialty drugs continue to get them through other people’s money as opposed to the plan sponsor’s money – risk transfer on steroids)
