…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…
…numbers and effect on premiums and health care costs in states where they are competitive, but what regulators really wanted to hear was how the CO-OPs were dealing with financial challenges. CHIRblog readers will be familiar with the challenges most CO-OPs are facing; an analysis found all but one of the 23 CO-OPs are running at a loss based on…
By Sabrina Corlette, Kevin Lucia, Justin Giovannelli and Sean Miskell The failure of the health insurance CO-OP operating in Iowa and Nebraska and recent analysis documenting significant losses among all but one CO-OP have caught the attention of policymakers and raised questions about the long-term viability of the Affordable Care Act’s Consumer Operated and Oriented Plan (CO-OP) program. The nonprofit,…
…placed his total trust and confidence in us. He had a great policy mind and deep intellectual curiosity. More fundamentally, he was a good, thoughtful and kind person. For the health policy community that knew him and loved him his loss is a giant void that will be deeply felt for a long time. Thank you Andy. We miss you….
…definition of full time work and the Obama administration recently opted to delay implementation of rules regarding insurance standards for the coverage that businesses provide their employees. But the ACA’s Small Business Health Options Program (SHOP), the marketplace for small businesses and their employees, has received less attention from lawmakers and employers alike. SHOP marketplaces were envisioned as online, one-stop-shopping…
…stronger chance than ever that your employer wants to help you with that resolution. More employers are offering workplace wellness programs. An annual survey of employer-provided health benefits found 3 out of 4 firms that offer health benefits offer some kind of wellness program, such as weight loss programs, biometric screening, nutrition counseling, or lifestyle coaching. Linking that program to…
…check. Back in the early 1990s, New York required insurers to sell to all comers, regardless of health status, but they didn’t require healthy people to maintain health coverage. As a result, premiums went through the roof, insurance companies stopped selling, healthy people dropped out, and the individual market all but collapsed. It was the proverbial insurance “death spiral.” Although…
…purchased a policy has stopped taking new patients by the time the enrollee attempts to schedule an appointment. Another regulatory option is to require prominently displayed announcements both online and on all narrow network plan print materials that state the network is limited and urge shoppers to review the provider directory before choosing a policy. There are all sorts of…
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