Search Results for: stop-loss

On its 10th Anniversary, during a Public Health Crisis, the Affordable Care Act is More Important Than Ever

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…stop insurers from charging higher premiums to sick people. We know that people with underlying conditions are at a higher risk of contracting a severe illness from the novel coronavirus than healthy ones. We’re grateful those discriminatory practices that, 10 years ago, would have barred them from coverage are no longer permitted. Providing Comprehensive Coverage Before the ACA, even people…

December Research Round Up: What We’re Reading

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…to be a successful stopgap, And for the December Research Round Up, that’s a wrap! Goldin J, McCubbin J, Lurie I. Health Insurance and Mortality: Experimental Evidence from Taxpayer Outreach. National Bureau of Economic Research (NBER), December 6, 2019. Researchers have long considered the question of how access to health insurance impacts mortality rates. Since the famous 2012 Oregon Health…

Updates from the MEWA Files: The Good, the Bad, and the Ugly of Federal Enforcement Efforts

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…and one of the later cases involving Ray Palombo’s Contractors & Merchants Associations, Case No. 50-027125. There are also a multitude of examples of where federal intervention resulted in the plans fixing problems before they appear to have resulted in significant, if any, harm. These changes frequently involved steps like securing stop-loss insurance or fidelity bonds, moving plan assets into…

FAQ of the Week: Who Qualifies for a Special Enrollment Period?

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…opportunity. Some events that trigger a special enrollment opportunity are: Loss of minimum essential coverage or other qualifying coverage. For example, if you lose your employer-sponsored coverage because you quit your job, were laid off, or if your hours were reduced. This also includes “aging off” a parent’s plan when you turn 26 or if you lose student health coverage…

Updates from the MEWA Files: Self-Dealing, Derelict Administration, and Repeat Players, Oh My!

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…Association Employee Benefit Plan) As these and other cases show, absent proper actuarial guidance, a plan can become insolvent and face millions of dollars in unpaid claims very quickly. Self-insured MEWAs are required to disclose whether they have stop-loss insurance on their Form M-1, and, when noticed, the absence of stop-loss insurance can trigger an investigation by DOL. See, e.g.,…

November Research Round Up: What We’re Reading

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…Policy examined how insurer marketplace exits affected consumers’ re-enrollment decisions between 2015 and 2018. What it Finds Over the study period, consumers were 7.1 to 12.9 percent more likely to forego marketplace coverage after their insurer stopped offering marketplace plans. Insurer exits affected unsubsidized consumers significantly more than subsidized consumers, with unsubsidized consumers facing disenrollment increases of 18.3 percentage points,…

October Research Round Up: What We’re Reading

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…the national trend. What it Finds In response to federal efforts to undermine the ACA, California implemented a number of policies to stabilize the state’s health care market, including increasing the length of the open enrollment period, increasing funding for in-person assistance, offsetting the loss of federal cost-sharing reduction payments to insurers, and expanding Medi-Cal coverage to undocumented children and…

The MEWA Files: Lifting the Curtain on DOL’s Investigation into AHPs and Other Fraudulent Health Plans

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…enforcement cases involving MEWAs since 1985, it admits that its “enforcement efforts often were too late to prevent or fully recover major financial losses,” and that it fails to consistently collect information about the “associated unpaid claims or their financial impacts on patients and healthcare providers.” DOL’s final rule has since been blocked by a federal district court, an order…

Here are the Facts About Anti-Immigrant Policies Pushed by the Administration and Their Impact on Children and Families

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…in states that fully embraced the Act by expanding Medicaid. If this Administration truly cared about increasing coverage and decreasing uncompensated care, it would stop sabotaging the ACA, stop approving waivers requiring Medicaid beneficiaries to report work hours to stay covered, and start paying attention the troubling decline in Medicaid and CHIP enrollment. Instead, this Administration has overseen two years…

Trump Administration Launches New Program that Could Undermine ACA Protections

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…than an enrollee who meets the weight loss threshold. Or, a diabetic who has trouble controlling his or her blood sugar level could face a higher deductible than one who controls it well. States would be required to design these programs so they do not result in a decrease in coverage or increase the cost to the federal government. However,…

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