Search Results for: stop-loss

Major New Rule Seeks to Modernize & Improve Quality of Medicaid Managed Care

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…we are pleased to see that the final rule better incorporates pediatric providers. For example, the final rule requires states to develop pediatric network adequacy standards for the following classes of providers: primary care, behavioral health (including mental health and substance use disorder), specialists, and dental. Accountability and Transparency: The final rule maintains the minimum medical loss ratio of 85%…

NAIC Roundup: Catching Up on the Spring Meeting and Looking Ahead

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…the different SEPs that are available (for example, due to a permanent move rather than loss of other coverage). However, that data is not available in the report, nor is there data to show reasons enrollees allow coverage to lapse (for example, because an enrollee obtained other coverage). My fellow consumer representative, Sarah Lueck, offered a consumer perspective on SEPs,…

One Way Insurers Could Improve Marketplace Risk Pools? Stop Cannibalizing Their Own Business

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…sell ACA-compliant plans through 23 marketplaces, citing financial losses. What is short-term health insurance and why do insurers like selling these policies? We’ve written about short-term health insurance on CHIRblog before, noting that these policies are not regulated by the ACA, and thus don’t need to comply with federal prohibitions on pre-existing condition discrimination, out-of-pocket cost protections, or requirements to…

Report Provides (Some) Insight on Network Adequacy as New Regulations Promise More

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…give states time to incorporate the National Association of Insurance Commissioners (NAIC) model act on network adequacy. But while CMS stopped short of establishing quantitative measures of network adequacy via regulation, the federal government will incorporate maximum time and distance standards in its certification process for QHPs, as outlined in its 2017 letter to QHP issuers in the FFM. However,…

As Self-Funding Increases in Popularity, Two States Step up to Address Potential Stop-Loss Policy Concerns

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…Association of Insurance Commissioners (NAIC) released a white paper draft, titled “Stop Loss Insurance, Self-Funding and the ACA,” which explores the various regulatory issues that state insurance departments must be aware of when regulating stop-loss insurance policies. Specifically, the NAIC sought to provide state officials with options for regulating stop-loss coverage in situations in which mere disclosure of the policy’s…

Not a Pretty Picture for Obamacare CO-OPs: 2015 Financial Losses Spike

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A recent review by PoliticoPro of insurers’ financial filings has found that the remaining 11 companies in the Affordable Care Act’s CO-OP program sustained substantial losses in 2015 – collectively close to $400 million, with the bulk of the losses coming in the fourth quarter. Perhaps even more distressing, CO-OPs that appeared to do reasonably well in 2014 were hit…

Healthcare.gov Changing Approach to Special Enrollment Periods, May be Bumpy Road for Consumers

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…process is forthcoming, the administration will require consumers to upload or to mail documents verifying the following life events: Loss of minimum essential coverage or loss of another type of health insurance, Permanently moving to an area where an individual will have access to new health plans, Birth, Adoption or child support or court order, Marriage. The administration is making…

Recent Guidance About Marketplace Residency Requirement and Special Enrollment Period When Moving

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…COBRA and not sufficiently informed about their coverage options Consumers who were previously enrolled in the Pre-Existing Condition Health Insurance Program The administration announced two additional measures related to special enrollment periods. First, it will review the most frequently used special enrollments – loss of minimum essential coverage and permanent moves – and try to determine whether people are using…

The Failure of the ACA’s Health CO-OPs: Lessons for Policymakers

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…rivals. Price too low, and it might gain members but risk significant losses if premium revenue isn’t sufficient to cover enrollees’ costs. It is little surprise then that most health insurance markets have long been highly concentrated and are dominated by just one or two insurers. The largest insurer in the individual market has 50 percent or more market share…

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