Search Results for: stop-loss

Affordable Care Act Reforms Not Fully Realized for Small Businesses: New Study Documents a Market in Transition

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…“grandfathered” plans, plans that predated the ACA and do not have to comply with many of the law’s reforms. “Level funded” products marketed to healthier groups. Insurers have ramped up the marketing of level-funded products that combine self-funding, a stop-loss policy, and administrative services. These products are targeted to small employers that have relatively young and healthy workers. They are…

No Rest for the Weary: Unexpected Defeat of ACA Repeal Effort Doesn’t Mean End of Threats to Law

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…out people with pre-existing conditions and do not have to cover EHB. These plans would then become more attractive to healthy people, and they could charge significantly lower premiums than ACA-compliant plans. This would, in turn, given insurers an incentive to stop offering ACA-compliant plans and leave consumers with pre-existing conditions or who need more comprehensive coverage with fewer options…

Insurer Q2 Earnings Reports Begin—How Will Companies React to Federal Uncertainty?

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On July 18, Unitedhealthcare reported its second quarter (Q2) financial earnings, kicking off the Q2 cycle in which health insurers will announce their quarterly results, detail major financial gains and losses, and provide insight into how they expect to perform over the following quarter. While the audience for these reports is mainly financial analysts, and calls are carefully scripted to…

Amid Market Uncertainty, Trump Administration Retreats from Health Plan Oversight

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…enforcement of the law’s individual mandate, recent regulatory actions reduce federal oversight of marketplace health plans, passing responsibility to the states for ensuring compliance with federal consumer protections. In mid-April, the Trump administration announced it would stop monitoring marketplace plans for compliance with several important federal protections and instead defer to state oversight. The administration’s hands-off approach effectively: Rolls back…

Signs of Marketplace Stability May Be Undercut by Federal Policy Uncertainty

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By Emily Curran, Justin Giovannelli, Kevin Lucia and Sabrina Corlette Health insurers suffered early financial losses on their Affordable Care Act (ACA) marketplace business last year, leading many to scale back participation and increase premiums for 2017. Though analysts saw evidence of stability after these adjustments, recent federal efforts to repeal and replace the ACA have sparked growing concerns about…

Lots of Changes for 2018 Marketplace Enrollment Mean Confusion for Consumers

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…Marketplace enrollees stop paying health plan premiums and drop their coverage. Many do so either because they cannot afford the premiums or because they obtain other coverage but neglect to notify the marketplace or insurer of that fact. This year, if these individuals come back and try to enroll during OE, their insurer can require them to pay any past-due…

The Ins and Outs of the New Approach to Special Enrollment Periods: Pre-enrollment Verification (SEPV)

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…will apply to new Marketplace applicants experiencing any of the following four events: loss of qualifying coverage or minimum essential coverage (MEC); a permanent move; marriage; gaining a dependent (i.e., adoption, foster care or court order of child support/other court order); and a Medicaid or CHIP denial. The SEPV process will be implemented in phases: applying to consumers losing MEC…

We Read Actuarial Memoranda so You Don’t Have to: Trends from Early Health Plan Rate Filings

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…and insurers. We took a dive into the actuarial memoranda that support each premium rate proposal, and learned the following: Cost-sharing reductions are a big deal Insurers are estimating that the loss of cost-sharing reduction (CSR) payments will drive between 14 and 20 percent of premium increases going into 2018. Blue Cross Blue Shield of North Carolina’s filing calls it…

Relaxing the Affordable Care Act’s Guaranteed Issue Protection: Issues for Consumers and State Options

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…insurer so no consumer is shut out of coverage for non-payment of premium for prior coverage. Require insurers to provide exemptions to this policy for extenuating circumstances like temporary job loss, unexpected financial loss, or if a consumer simply transitioned to another form of coverage. Require insurers to establish installment plans for individuals with past-due premiums and only apply the…

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