…a sicker risk pool – and the higher claims costs for insurers. Because it’s too late in the year for insurers to recalculate and re-file their premium rates for review, they could be exposed to significant losses and it could even threaten their solvency. The bottom line? An attempt to delay the individual mandate is tantamount to an attempt to…
…job. Her doctor told her she should stop working permanently because of the severity of her symptoms. But Karen was hoping to put off that day, and worked as long as she could before taking a second short-term disability leave. It was during that time that she came to terms with the difficult reality of her condition. MS is a…
…for Improving Maternal and Infant Health Outcomes to “identify specific opportunities and strategies to provide better care, while reducing the cost of care for mothers and infants covered by Medicaid/CHIP.” States are beginning to alter their Medicaid payment policies to discourage elective deliveries: Texas stopped paying for them altogether, while Washington State began paying a bonus to hospitals that met…
…workers to get the care they need. Yet we don’t have evidence that financial incentives delivered as higher health plan costs really work. It’s one of the areas a recent Rand report notes needs more research, noting, “Employers overwhelmingly expressed confidence that workplace wellness programs reduced medical costs, absenteeism, and health related productivity losses. But at the same time, only…
…of who operates the Marketplace, CMS is working to ensure streamlined and secure access to a variety of information sources that are essential for operation.” He continued that the exchanges will be on track to fulfill the one of the key aims of the law: to provide a one-stop shop for public or private coverage. Mr. Cohen further noted that…
…in every state by October 1, 2013. Exchanges are intended to address the current barriers to affordable and adequate health coverage in the individual and small-group markets by providing a seamless, one-stop experience for individuals to apply for financial assistance, compare health plans, and enroll in public or private coverage. Similarly, Small Business Health Options Program (SHOP) exchanges are designed…
…rate review processes and medical loss ratio requirements, as well as participate in state reinsurance and risk adjustment programs. However, the NAIC went on to identify 10 areas of continued concern, including essential health benefits, appeals, and the proposed process for dispute resolution, among others. Essential health benefits. Citing concerns about the risk of adverse selection, the NAIC objected to…
People, stop wringing your hands and roll up your sleeves. On Sunday, we’ll be just 100 days from the first day of open enrollment in new, high quality and affordable health insurance coverage options. As we barrel towards the finish line, pundits and policymakers have been quick to question whether we can actually pull it off. There’s not enough time,…
…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….
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