…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,…
…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;…
…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…
…if stop-loss coverage is available with $0 attachment points nationally. By comparison, they find that if stop-loss coverage were only available with specific attachment points of $60,000 (and similarly high aggregate attachment points), “the fully insured small group market would be roughly 1.5 times as large and the average fully insured small-group premium would be at least 20 percent lower”…
…loss regulation. The ERISA (B) Working Group heard lively debate during a discussion on the regulation of stop-loss coverage. In response to concerns raised by small businesses as well as some insurers and brokers, the Working Group released a memorandum answering questions about its process and the study used to support the NAIC’s actions. Although the NAIC has deferred the…
…Waxman of California criticized Republicans for their tactics in attempting to stall implementation, first through the Supreme Court lawsuit, then by dragging out implementation until after the presidential election. He noted they are now complaining about the lack of guidance from HHS. “Stop the political grandstanding,” Waxman urged. “We have a law that is doing good already; it is going…
…reforms, many states have amended or passed new laws in response to the ACA’s new requirements for enhanced rate review as well as internal and external appeals processes. States have also amended their medical loss ratio standards, and a handful have begun implementing the ACA’s broader 2014 market reforms. These states include the District of Columbia, Maine, Maryland, New York,…
Earlier this week, the Commonwealth Fund released a study evaluating insurers’ responses to the medical loss ratio (MLR) rules under the Affordable Care Act. The study’s authors found that the MLR has resulted in a total of $1.5 billion in savings from reducing insurers’ administrative costs and rebates for consumers. The MLR, often called the “80/20 Rule,” measures how much…
…health plan, as long as they pay the full premium. So with money from their savings and lots of help from family, Beth and Aaron scraped enough together to pay the high-cost COBRA premiums to continue their coverage. Unfortunately, their bad luck did not end there. Shortly after delivery, their newborn son Henry began seizing and stopped breathing. His doctors…
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