…an official demand from ranking majority members of the House Energy and Commerce Committee to produce reams of paper documents associated with their grants, as well as all related communication with state and federal officials, and even Enroll America. Many recipients didn’t even see the request until after their return from the long weekend on September 3rd, giving them a…
…3 years ago, she noticed that every time she got up from her desk, her legs were really tight. Karen was working a lot of overtime during a busy season as a mortgage loan processor, so she chalked up the problem to getting old and not enough exercise. But it wasn’t that. She was experiencing one of the more common…
…Arkansas’ health insurance marketplace. And the plans sold on the marketplace will be more comprehensive and provide greater financial protection. Unfortunately, if Blue Cross Blue Shield in Arkansas sees short-term policies as a way to get around the ACA, it’s likely other companies in other states do, too. Especially if state regulators allow them to advertise these plans as “comprehensive”…
…as medical inflation and new taxes and fees. Three other states have banned early renewals in only certain markets. New York passed new legislation prohibiting early renewals in the small-group market. Washington outlawed early renewals by association health plans, while soliciting public comment on action in its traditional individual and small-group markets. California has made terminating all non-ACA compliant individual…
…us expected that navigators would largely be non-profit community-based organizations who work with vulnerable populations to deliver services. At a minimum, I assumed they would be trusted ambassadors in their communities for the new marketplaces. And to be sure, there are many, many navigator grantees that appear to be just that – such as local United Way organizations, Planned Parenthood…
…and attracting a healthy number of insurers. Last Friday, the Robert Wood Johnson Foundation’s State Health Reform Assistance Network released a brief prepared by researchers at CHIR that compares several state network adequacy requirements to the ACA’s network standards applicable to QHPs. The paper focuses on network adequacy standards in place in California, Colorado, Delaware, Hawaii, Maryland, Minnesota, Montana, Texas,…
…limited to the large group market, employers and insurers should voluntarily comply with the out-of-pocket limitations beginning in 2014 for self-funded and fully insured small employer group plans. Additionally, many insurers use a separate pharmacy benefits manager (“PBM”) to administer pharmacy benefits for all plans and policies and across all markets. Beginning 2014, insurers that use a separate PBM are…
…to a single combined out-of-pocket maximum up to the statutory limits set forth in the Affordable Care Act and as described above. However, under the FAQ, group health plans may impose a separate or unlimited out-of-pocket maximum on pharmacy benefits. Since many group health plans use separate pharmacy benefit managers to administer these benefits, consumers with serious illnesses may continue…
…Island, and Virginia. Our most recent report, released this morning, examines how insurers are coming into compliance with the ACA’s new essential health benefits standard. In our report we find that: Technical glitches and tight deadlines posed challenges for insurers and regulators alike, but an “all hands on deck” mentality has kept the product development and review process moving forward….
…poking around www.healthcare.gov for what the law could do for him. And that’s when he learned about the Pre-existing Condition Insurance Plan (PCIP), the temporary program for uninsured individuals who are turned down for coverage because of a pre-existing condition. He applied for PCIP in California and his coverage began April 1, 2012. His final four rounds of chemo were…
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