Catching Up With Health Care Reform
I’ve taken a few weeks off from blogging, but health care reform sure hasn’t taken a break. There’s a lot going on, so let’s catch up with some interesting tidbits: In April the Internal Revenue...
View ArticleMLR Rules Still in Play
The Patient Protection and Affordable Care Act requires carriers to spend a specified proportion of the premium dollars they take in on medical care and health quality efforts. That’s the law. As I’ve...
View ArticleCommission Exemption Not in NAIC’s MLR Rules, But Issue is Still Open
The National Association of Insurance Commissioners approved rules defining how carriers will calculate their medical loss ratios as is required by the Patient Protection and Affordable Care Act. The...
View ArticleNAIC Submits Standardized Benefit Summary Recommendations to HHS
Before I worked for a carrier I’d often wonder if the folks who write health plan benefit descriptions go to a special school that teaches them how to write these documents in as confusing and obtuse a...
View ArticleRequirement that Carriers Justify Double-Digit Rate Increases a Teachable...
Reasonableness, like a host of other things, can be in the eye of the beholder. Regulating reasonableness, consequently, is nothing like a science. Yet the Patient Protection and Affordable Care Act...
View ArticleGovernors and HHS in Violent Agreement Concerning Exchange Flexibility?
While the Patient Protection and Affordable Care Act is federal law, much of its implementation is in the hands of the states. Near the top of the list on the state’s to-do list is the creation,...
View ArticleRate Regulation Grants Announced by HHS
Carriers set health insurance premiums based on several criteria. The single biggest component is the expected cost and utilization of medical services. Then there’s the need to cover overhead (such as...
View ArticleThe Open Enrollment Convergence: Scope and Resources
To state the obvious, there are 12 months in the year. Unfortunately for health insurance companies, brokers, exchanges and those they serve, various health care coverage open enrollments for most...
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