…666) regulating the sale of stop-loss insurance. The legislation, which is currently before the governor, establishes minimum attachment points for stop-loss policies. The minimum specific attachment point – which represents the minimum dollar amount where the stop-loss issuer begins paying for claims incurred by a covered individual and the employer’s liability ends – is set at $20,000 while the minimum…
…benefit from that kind of savings in 2014 and 2015. And, unfortunately, there’s nothing in the newly required notice that will illustrate the cost to the consumer of suspending rate review in a state where regulators had significant authority to stop undesirable insurance rates from being implemented and a track record of using that authority effectively. As stated, it’s baffling….
…recommended medical loss ratio standard, developing the template for insurers to justify premium rate increases, and drafting a consensus recommendation for the summary of benefits and coverage. But that doesn’t mean the NAIC’s work is done when it comes to ACA implementation. Because the law assumes that states will maintain their traditional role as the primary regulators of health insurance,…
…market insurers face sweeping new reforms that require them to guarantee issue policies to applicants, regardless of their health condition, eliminate the use of pre-existing condition exclusions, and stop charging higher rates based on health status and gender. These critical reforms will help make insurance coverage more accessible, adequate, and affordable to people with pre-existing conditions. However, insurers continue to…
…many impose annual or lifetime caps on coverage. Even with these restrictions, these high risk pools have racked up losses of hundreds of millions of dollars, in part because very few people can afford the premiums that would be required for a high risk pool to break even. In order to sustain effective high risk pool coverage for all those…
…able to report the actual number of small employers covered under stop-loss policies or the terms under which those policies are being marketed. Looking ahead, informants believed that health insurers would reconsider selling stop-loss policies to small groups if their competitors start to do so, yet most were hesitant to predict how much or how fast such practices might increase…
…in the utilization of services by newly insured people. The researchers included the caveat that their projections may not account for all of the aspects of the ACA that will affect premiums, including premium subsidies, new benefit designs, taxes and assessments, federal risk mitigation programs, medical loss ratio requirements, and rate review rules. In particular, the analysis assumes that states…
…of paying claims for covered benefits. These employers often minimize their exposure to financial risk through the purchase of a stop-loss policy. Unfortunately, the Congressional requirement directed DOL to use Form 5500 to produce its annual report, and did not require or encourage DOL to expand its data collection to include self-funded small groups. And, in spite of the importance…
…investments in quality improvement activities as reported on their medical loss ratio (MLR) reporting forms. (Refresher: the MLR rule requires insurers to spend at least 80 or 85 percent of premium dollars on medical claims and quality improvement, and requires them to report on these expenditures). The authors found that insurers allocated less than 1 percent of premium dollars –…
…to be seen. Speaking of enforcement… will regulators be able to stop insurers and employers from exploiting loopholes to impede the consumer protections in the law? As Christine Monahan pointed out this week, new loopholes such as an “early renewal” loophole in which carriers begin their next plan or policy years on December 31, 2013 rather than January 1, 2014,…
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