Search Results for: stop-loss

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…

What About “Don’t Discriminate Against Sick People” Do You Not Understand?

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…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…

NAIC Fall Meeting: As One Issue Winds Down, Another Rears Its Head

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…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…

Affordable Care Act Legislation Affecting Small Employers Sparks Rare Bipartisanship

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…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…

CHIR Expert Sabrina Corlette Testifies before U.S. Senate Roundtable on Small Business Health Care

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…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…

While All Eyes Are On Upcoming SCOTUS Decision, NAIC Work Continues

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…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…

The Affordable Care Act CO-OP Program: Facing Both Barriers and Opportunities for More Competitive Health Insurance Markets

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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,…

We Say Goodbye to a Visionary, Fighter and Friend

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…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….

After a Slow Start, Federal Small Business Health Insurance Marketplace Offers New and Improved Functions

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…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…

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