…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,…
…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…
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…
…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…
…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…
…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…
…unable to stop the old tactics of avoiding risk that made them so much money in the past. To wit, the admission of at least one insurer – CIGNA – that they have stopped paying commissions to brokers for enrolling people in gold level health plans. What does this have to do with discriminating against sick people? There are two…
…Act’s Medical Loss Ratio requirement. First, the big news: The network adequacy model act – revised to reflect substantial changes in the health plan market since the model was first developed in 1996 – was formally adopted by the Executive Committee. The newly adopted model act includes key consumer-friendly provisions, such as protections against surprise out-of-network charges (sometimes called “balance…
…premium rate increases when required to shift to the small group market. They further argued that these employers would have strong incentives to leave the fully insured market altogether. Specifically, Commissioner Lindeen remarked that these employers would likely self-insure, particularly because they can protect themselves from undue risk with stop-loss insurance. Commissioner Lindeen and Mr. Giesa predict that, as larger…
…more mid-sized businesses would have an incentive to self-fund if the definition of the small group market is expanded to 100. Ms. Corlette also noted the availability of self-funding + stop-loss insurance packages designed to mimic traditional health insurance. She called for the federal government to clarify that plans in which the insurer bears most of the claims risk are…
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