Imagine, if you will, a cubicle located in the NJ Department of Banking and Insurance building in Trenton, New Jersey. Picture a man, adorned in a short-sleeve white shirt with a tie and the all-important pocket protector, sitting in this cubicle tapping away at his computer keyboard. He is on the verge on an astonishing breakthrough that will result in the continuous quest to confuse the health insurance industry. This man has invented

“M.O.O.P.”

“MOOP” ladies and gentlemen is not a new household cleaner, nor is it a new children’s toy that they can smear on your new carpet. MOOP is not a disease (although it might turn into one) and it is certainly not the newest slang term that the kids are using in the streets.

“MOOP” or “Maximum Out Of Pocket” is the newest catch-phrase that is understandable to those of us who have finally mastered the meaning of “STOPLOSS.” You can forget “STOPLOSS” because now you have to learn “MOOP.”

If you take the commercial jingle from years back for the toy “Slinky” and apply it to MOOP, it could be an excellent learning tool. MOOP is supposed to be an easier way to identify how much a person will lay out of their pocket towards medical expenses in any given calendar year. I don’t know why they decided to discontinue the term stoploss, I had grown fond of it over the years but I guess it was time for a change.

Like everything else, MOOP has its confusing aspect to it. Does it or doesn’t it include co-pays, prescription co-pays, carry over deductible, plan changes within the same calendar year, etc. Well, it depends on who you ask. Some carriers will tell you, prescription co-pays count towards MOOP, others will tell you no. One carrier has told me that if you make a plan change at renewal within the same calendar year, MOOP rewinds back to 0. How can that be? Why couldn’t the DOBI standardize one set of rules that would apply to every carrier?

Each carrier needs to create a MOOP handbook (with Illustrations of course.) I for one, would find it useful because I gotta tell you, I’m having a hard time explaining it to those of you who ask many of the 25 questions from a previous blog.

In explaining the new rules to a client, there will be many instances where MOOP turns into “OOPS” so I suggest you take the time to study this carefully and don’t just say, “Oh they replaced Stoploss with MOOP.”  You run the risk of MOOP turning into E & O.

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