What is needed in order to start a health insurance company in NJ/NY? What are the state rules and regulatory standards? I want to start an insurance company competing with Aetna etc... not an agency.

Contact the State Insurance Dept for each state. They can give you the regulatory requirements you have to complete. They are extensive. The most important issue is capitalization. You will need to have a lot of capital to fund potential obligations before you will be granted a license to sell coverages.

Another issue here is that most health insurance providers work by creating a network of health care providers who will agree to accept a schedule of payments to provide care for your customers. So you will first have to line up those providers.

I'm wondering whether you have any experience in the insurance industry? Why did you decide to try this as a venture?

No experience here. Just sold my tech company so have cash to start-up. How about the pooling of funds to serve all? What I want to know is a basic picture of how the process works from a insurance compacts back-end? Thanks for your help!

Well the first thing I would do is hire a consultant who has experience with either starting or running a health insurance company. Again this is a complex business with HEAVY regulatory requirements.

Re your question about pooling funds. That's how insurance works. Policyholders pay premiums. Those premiums go into a pool of assets that is used to pay claims. There are specific requirements on how much must be kept in that pool relative to potential obligations.

Hello k:

Sounds to me like you had a bad experience with Aetna and you want to put 'em out of business... If you're going to be successful, however, you have to act just like them. After all, there isn't money to pay for EVERYTHING. If there was, insurance companies would go broke. So, you're going have to DENY life giving care to SOME of your customers/members, just like Aetna does... Sort of like your very own death panel.

If you can do that stuff, and you sold your tech company for BILLIONS, go for it.

excon

Sucks to know it's a highly fragmented market. Thanks for all your support.

What about basic insurance for office visits medications and lab orders

Sucks to know it's a highly fragmented market. Thanks for all your support.

Not sure what you mean by a fragmented market?


What about basic insurance for office visits medications and lab orders

What about it? ANY form of insurance will require regulatory oversight.

There are so called discount plans. Basically, you line up a network of care-givers who will offer discounts to members. Members then pay a fee. I'm not sure whether this comes under insurance or not.
The patient is responsible for payment, but at a discounted rate.

After you prove you have millions of dollars to show ability to pay claims.