Search Results for: stop-loss

New Rules Protect Navigators and Certified Application Counselors from Over-Reaching State Laws but Also Impose New Requirements

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…are not allowed to receive consideration directly from a health insurance or stop-loss issuer in connection with enrollment. 3) New standards prohibiting certain conduct. The proposed standards regarding providing gifts or promotional items, conducting “cold calling” type solicitation and using “robo” calling (automatic dialers) were finalized with some helpful clarifications. Gifts or promotional items, unless they are of nominal value,…

The Expatriate Health Coverage Act: Like “Using a Bat to Swat a Fly?”

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…as plan sponsors. Expatriate health plans could include lifetime and annual limits, would not have to provide preventive services, and these plans would not have limits on their administrative costs under the medical loss ratio requirements. (EHCCA Sec 2(a)). 2. A much broader group of people than Americans working oversees could be put into expatriate health plans. While the EHCCA…

Back in the Day – Lessons from Pre-reform Days: Death to the Death Spirals

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…claims costs grew and premiums, which are partially based on year-to-year claims experience, gradually increased. Those policyholders who remained healthy and could purchase less expensive coverage elsewhere have moved on, while those, like you, whom no other insurer wants to cover, are stuck. And, your insurer stopped selling your policy when premiums got too high to be marketable, which has…

It’s Raining SEPs: New Administration Guidance on Special Enrollment Periods and What they Mean for Consumers

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…individual mandate penalty. New SEP for COBRA enrollees Federal rules allow individuals eligible for COBRA coverage to gain a special enrollment period when (1) they first become eligible because of a loss of employer coverage and (2) when their COBRA coverage is exhausted. But, as we document in Frequently Asked Question #166 of our Navigator Resource Guide, if you take…

Understanding Special Enrollment Periods, Part 2: Where does COBRA fit in?

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…access to their treating providers. Others might need to use COBRA to maintain coverage through a job-based plan so they can avoid any gap in coverage, even a small one. The opportunity to trigger a SEP 60 days prior to the loss of coverage will help those who know a loss of coverage is coming. But not everyone will have…

Who Gets Extra Time “In Line” and Beyond to Enroll in Health Coverage?

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…the SEP is granted. SEP for Survivors of Domestic Violence – married individuals who have experienced domestic violence may also receive a limited circumstance SEP until May 31st. Qualifying life event SEP – people who have specific changes in circumstances such as the birth of a child or the loss of other minimum essential coverage may qualify for an SEP…

Two States on the Path to the Basic Health Program

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…include essential community providers. Standard health plans that are insurer based (and not health maintenance organization or provider network based), also have to meet an 85 percent medical loss ratio standard. What’s next? We’ll continue to watch Minnesota and New York and report back on how their Basic Health Programs are taking shape. We’ll also be on the lookout for…

Understanding Special Enrollment Periods, Part 1: A Look at Some Who Will be Out of Luck

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…changes: First, they must apply for coverage under Medicaid, knowing they won’t be found eligible. Second, upon receiving their denial from the state Medicaid agency, they must apply for a hardship exemption. Third, once their income changes, they must notify the Marketplace, and apply for a special enrollment period based on the loss of their hardship exemption. Needless to say,…

New Tools to Help Consumers Compare Health Plans

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…so consumers can benefit from a real one-stop-shopping experience and don’t need to click back and forth between different websites. It’s also important to remember that the effectiveness of any of these tools is only as good as their inputs. As we discussed in our December 2013 report for the Commonwealth Fund, a number of state-based marketplaces have taken steps…

Shifting into Post-Enrollment Issues: Fielding New Questions from Consumers

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…after September 24, 2014. I pay more for my plan because I’m a smoker. If I stop smoking after I sign up, will my rates go down? Your insurer doesn’t have to lower your rates to reflect your new non-smoker status until you renew your coverage. I got a letter saying my employer plan didn’t meet the medical loss ratio…

The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.