Search Results for: stop-loss

Checking in on the NAIC: Work in Progress to Update Model State Laws to Comply with the Affordable Care Act

Posted by

…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,…

Helping Consumers Understand their New Health Insurance Options: CCIIO Releases Model Renewal Notice

Posted by

…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…

A Surprising Source of an Intra-Party Fight: The PCIPs

Posted by

…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…

Factors Affecting Self-Funding by Small Employers: Views from the Market

Posted by

…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…

Diving Deep on Two New Rate Studies

Posted by

…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…

Missing the Point: Department of Labor’s Annual Report on Self-Insurance

Posted by

…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…

Paying for Value, By the Numbers

Posted by

…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 –…

Ready for Reform?

Posted by

…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,…

Consumer Representatives Issue Recommendations for Sweeping Insurance Reforms Under the Affordable Care Act

Posted by

…been largely ignored so far, such as the potential that the sale of stop-loss insurance to small groups or of unregulated indemnity insurance plans could undermine the consumer and market protection provisions of the Affordable Care Act,” said Timothy Jost, professor of law at Washington and Lee University. Contributing to the report were NAIC consumer representatives Elizabeth Abbott, Health Access;…

Putting the “Quality” in “Quality, Affordable Health Care”

Posted by

…or other incentives”, to improve health outcomes, reduce hospital readmissions, improve patient safety, implement wellness and health promotion activities, and reduce health disparities. Medical loss ratio (Section 2718 of the Public Health Service Act): Health insurers are now being held to higher quality standards through the ACA’s medical loss ratio rule, which requires plans to spend at least 80 percent…

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.