Showing posts with label regulations. Show all posts
Showing posts with label regulations. Show all posts

Thursday, February 10, 2011

New Rule Ensures Students Get Health Insurance Protections of the Affordable Care Act

A new proposed regulation announced today by the Department of Health and Human Services (HHS) would ensure students enrolled in health insurance coverage through their college or university benefit from critical consumer protections created by the Affordable Care Act. Students enrolled in college plans would have the freedom from worrying about losing their insurance, or having it capped unexpectedly if they are in an accident or become sick.

"Thanks to the Affordable Care Act, college students will have more control over their health care," said Secretary Sebelius. "This rule would ensure that these plans remain a viable, affordable option for students while guaranteeing that they are regulated consistently and offer transparent benefits to students."

Student health plans are often purchased when family coverage is not available, or is unaffordable. Approximately 1,500-2,000 institutions of higher education across the country offer some type of health coverage; however, what benefits are covered by these plans, as well as how they're regulated vary widely. The proposed regulation would ensure students enrolled in these plans benefit from important consumer protections created by the Affordable Care Act by clarifying that these plans will be defined as "individual health insurance coverage." Under the proposed rules, some of the new health insurance protections include:
* No Lifetime Limits on Coverage: Insurance companies would no longer be able to impose lifetime dollar limits on the amount they spend on health benefits in student health plans.
* No Arbitrary Rescissions of Insurance Coverage: Insurance companies can no longer drop coverage when student health plan enrollees get sick because of an unintentional mistake on an application.
* No Pre-Existing Condition Exclusions for Students Under Age 19: Insurance companies cannot deny or exclude coverage for students under age 19 because of a pre-existing condition.

Today, some student health plans, only offer limited benefits with low annual dollar limits on health care, or have limited networks of doctors, and other health care providers. For many students, these health plans are their only health insurance option.

The Affordable Care Act allows HHS to take steps to preserve market stability while ensuring student health plans remain affordable until all Americans have new coverage options through the state-based Exchanges that will be established in 2014. Under the proposed rule announced today, student health insurance plans would be allowed to have annual dollar limits on essential health benefits of no less than $100,000 for policy years beginning before September 23, 2012. Student health plans with policy years beginning after that date must fully comply with the Affordable Care Act's annual limit restrictions.

The proposed rules would also require insurance companies to clearly tell students enrolled in student health plans whether or not their plan meets the new requirements laid out under the Affordable Care Act-bringing transparency to this marketplace and enabling students to understand the value and quality of the coverage they have.

As a part of the new proposed rule, HHS also is requesting comments on how other Affordable Care Act protections might apply to student health plans, including the choice of medical provider and application of the new medical loss ratio rules.

To find the new proposed rule, visit www.ofr.gov/inspection.aspx. For a fact sheet on the new proposed rule, visit www.HealthCare.gov/news/factsheets/students02092011a.html . For more information about the new patient protections created under the Affordable Care Act, visit www.HealthCare.gov.

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Saturday, November 27, 2010

New Affordable Care Act rules give consumers better value for insurance premiums

New regulations issued November 22 by the Department of Health and Human Services (HHS) require health insurers to spend 80 to 85 percent of consumers’ premiums on direct care for patients and efforts to improve care quality. This regulation, known as the “medical loss ratio” provision of the Affordable Care Act, will make the insurance marketplace more transparent and make it easier for consumers to purchase plans that provide better value for their money.

“Thanks to the Affordable Care Act, millions of Americans will get better value for their health insurance premium dollar,” said HHS Secretary Kathleen Sebelius. “These new rules are an important step to hold insurance companies accountable and increase value for consumers.”

Today, many insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing. Thanks to the Affordable Care Act, consumers will receive more value for their premium dollar because insurance companies will be required to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement, rather than on administrative costs, starting in 2011. If they don’t, the insurance companies will be required to provide a rebate to their customers starting in 2012.

In 2011, the new rules will protect up to 74.8 million insured Americans and estimates indicate that up to 9 million Americans could be eligible for rebates starting in 2012 worth up to $1.4 billion. Average rebates per person could total $164 in the individual market. Important details regarding the new regulation are included below.

The medical loss ratio regulation outlines disclosure and reporting requirements, how insurance companies will calculate their medical loss ratio and provide rebates, and how adjustments could be made to the medical loss ratio standard to guard against market destabilization.

Beginning in 2011, the law requires that insurance companies publicly report how they spend premium dollars, providing meaningful information to consumers. Also beginning in 2011, insurers are required to spend at least 80 percent of the premium dollars they collect on medical care and quality improvement activities. Insurance companies that are not meeting the medical loss ratio standard will be required to provide rebates to their consumers. Insurers will be required to make the first round of rebates to consumers in 2012.

“These rules were carefully developed through a transparent and fair process with significant input from the public, the States, and other key stakeholders,” said Jay Angoff, director of the Office of Consumer Information and Insurance Oversight at HHS. “As we build a bridge to 2014, when better, more affordable options are available to consumers, these rules will help make health insurance fairer for consumers now.”

The Affordable Care Act required the National Association of Insurance Commissioners (NAIC) to develop uniform definitions and methodologies for calculating insurance companies’ medical loss ratios. Insurance commissioners in every State have a responsibility to protect the interests of the general public, policyholders, and enrollees within their respective States. Today’s regulation certifies and adopts the recommendations submitted to the Secretary of HHS on October 27, 2010 by the NAIC. It also incorporates recommendations from a letter sent to the Secretary by the NAIC on October 13, 2010.

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Tuesday, June 15, 2010

U.S. Departments of Health and Human Services, Labor, and Treasury Issue Regulation on "Grandfathered" Health Plans under the Affordable Care Act

Allowing Americans to Keep Current Health Plans or Choose a New Plan While Extending Important New Benefits to All Consumers

The U.S. Departments of Health and Human Services, Labor and Treasury today issued a new regulation that makes good on President Obama's promise that Americans who like their health plan can keep it.

The new regulation protects the ability of individuals and businesses to keep their current plan while providing important consumer protections that give Americans - rather than insurance companies - control over their own health care. The new regulation also provides stability and flexibility to insurers and businesses that offer health insurance coverage as the nation transitions to a more competitive marketplace in 2014 when businesses and consumers will have more affordable choices through exchanges.

"The Affordable Care Act gives American families more control over their health care by providing greater benefits, cost savings and protections," said Secretary of Health and Human Services Kathleen Sebelius. "Today, with the announcement of the new 'grandfather' rule, we're providing the market stability and flexibility to ensure that families and businesses can make the choices that work best for them."

While the Affordable Care Act requires all health plans to provide important new benefits to consumers, under the law, plans that existed on March 23, 2010 are exempt from some new requirements. The "grandfather rule" issued today makes it clear that these plans can continue to innovate and contain costs by allowing insurers and employers to make routine changes without losing grandfather status. Plans will lose their "grandfather" status if they choose to significantly cut benefits or increase out-of-pocket spending for consumers - and consumers in plans that make such changes will gain new consumer protections.

"The rule we are announcing today will allow employers to make routine and modest adjustments to co-payments, deductibles and employer contributions to their employees' premiums without forfeiting grandfather status. This flexibility will encourage employers to continue offering health coverage to their employees and help to ensure coverage for all Americans," said Secretary of Labor Hilda Solis.

All health plans - whether or not they are grandfathered plans - must provide certain benefits to their customers for plan years starting on or after September 23, 2010 including:

* No lifetime limits on coverage for all plans;

* No rescissions of coverage when people get sick and have previously made an unintentional mistake on their application; and

* Extension of parents' coverage to young adults under 26 years old;

For the vast majority of Americans who get their health insurance through employers, additional benefits will be offered, irrespective of whether their plan is grandfathered, including:

* No coverage exclusions for children with pre-existing conditions; and

* No "restricted" annual limits (e.g., annual dollar-amount limits on coverage below standards to be set in future regulations).

"The Affordable Care Act positions consumers, instead of insurance companies, as decision makers when it comes to their health care," said Assistant Treasury Secretary for Tax Policy Michael Mundaca. "The rule we're announcing today preserves individuals' ability to keep their current plan and provides strong consumer protections that give Americans more control over their health insurance choices."

Grandfathered health plans will be able to make routine changes to their policies and maintain their status. These routine changes include cost adjustments to keep pace with medical inflation, adding new benefits, making modest adjustments to existing benefits, voluntarily adopting new consumer protections under the new law, or making changes to comply with State or other Federal laws. Premium changes are not taken into account when determining whether or not a plan is grandfathered.

Plans will lose their grandfathered status if they choose to make significant changes that reduce benefits or increase costs to consumers. If a plan loses its grandfathered status, then consumers in these plans will gain additional new benefits including:

* Coverage of recommended prevention services with no cost sharing; and

* Patient protections such as access to OB-GYNs and pediatricians without a referral by a separate primary care provider.

Details about what routine changes insurers and employers can make without losing their grandfathered status, and the projected impact on large and small employer plans and the individual plan market can be found at http://www.healthreform.gov/newsroom/keeping_the_health_plan_you_have.html.

Most of the 133 million Americans with employer-sponsored health insurance through large employers will maintain the coverage they have today. Additionally, large employer-based plans already offer most of the comprehensive benefits and consumer protections that the Affordable Care Act will provide to all Americans this year - such as preventing rescission of coverage.

The roughly 42 million people insured through small businesses will likely transition from their current plan to one with the new Affordable Care Act protections over the next few years. Small plans tend to make substantial changes to cost sharing, employer contributions, and health insurance issuers more frequently than large plans. To help small businesses afford employee coverage, the Affordable Care Act includes a tax credit for up to 35% of their premium contributions.

The 17 million people who are covered in the individual health insurance market, where switching of plans and substantial changes in coverage are common, will receive the new protections of the Affordable Care Act sooner rather than later. Roughly 40 percent to two-thirds of people in individual market policies normally change plans within a year. In the short run, individuals whose plan changes and is no longer grandfathered will gain access to free preventive services, protections against restricted annual limits, and patient protections such as improved access to emergency rooms.

In 2014, small businesses and individuals who purchase insurance on their own will gain access to the competitive market Exchanges. These Exchanges will offer individuals and workers in small businesses with a much greater choice of plans at more affordable rates - the same choice as members of Congress. In fact, the Congressional Budget Office (CBO) has estimated that, on an apples-to-apples basis, premiums will be 14- 20 percent lower than they would be under current law in 2016 due to competition, lower insurance overhead, and increased pooling and purchasing power. Small businesses also will have more affordable options. CBO has estimated that a family policy for small businesses would be available in the Exchanges at a premium that is $4,000 lower than under current law in 2016.

These reduced premiums do not take into account the tax credits available to small businesses and middle class families to help make insurance affordable. These additional new choices and cost savings may further lower the likelihood that small businesses workers will remain in grandfathered health plans. Consumers insured through large employers are more likely to remain in grandfathered plans in 2014 and beyond.

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Monday, December 14, 2009

Insurance Now Subject to Federal Jurisdiction

/PRNewswire/ -- On December 9, 2009, the United States Court of Appeals, Tenth Circuit, affirmed the federal government's position that private insurance companies are "plans" and therefore subject to federal jurisdiction. (US vs. Frost)

Although other federal courts have held that contracts issued by insurance companies may be subject to federal jurisdiction under Title 18 Section 1347, US vs. Frost is the first case an insurance company itself has been held to be a "plan," because, as the government claimed in this case, all insurance companies are "plans." At trial and initially on appeal in this case, the government maintained the position that insurance contracts are "plans," but to avoid a constructive amendment, changed their theory claiming that all insurance companies are "plans" as a "matter of law" and the 10th Circuit agreed.

Ironically, the term "plan" was first adopted by ERISA in 1974. Although ERISA generally excluded insurance companies as "plans," the federal government now claims that health insurance companies are the private equivalent of Medicare and Medicaid which are "plans." Therefore, all insurance companies that make payments for the cost of medical services are "plans" under federal law. The 10th Circuit agreed and upheld the district court's finding that simply paying a medical claim qualifies an insurance company as a "plan."

Not only does this ruling open the door for the federal government to hold all insurance companies subject to ERISA, but it automatically and retroactively subjects all insurance companies to federal jurisdiction under Title 18, 669, 1035 and 1347 by qualifying them as "Health Care Benefit Programs" under 24(b).

If upheld by the Supreme Court, a quantum leap toward federal regulation of health insurance companies will be complete. Redcorn and Frost, the defendants in the case, stated they would ask the Tenth Circuit to reconsider the matter 'en banc' before they appeal to the Supreme Court.

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Wednesday, June 10, 2009

New Single Source Location for HIPAA & HIT Information

/PRNewswire/ -- Several nationally recognized healthcare experts have joined forces to create HIPAA.com, a single-source resource site where visitors will find access to HIPAA regulations, American Recovery and Reinvestment Act (ARRA) updates, and practical guidance on what to do to meet new regulations.

"Most of our readers are seeking help on ARRA's requirement that Business Associates become covered entities, effective February 20, 2010," says Edward D. Jones, III, founding partner of HIPAA.com and leading authority on healthcare, insurance, electronic remittance/payments, and electronic health record (EHR) issues. Jones also was a founding commissioner of the Electronic Healthcare Network Accreditation Commission (EHNAC) and served as the Chair of the Workgroup for Electronic Data Interchange (WEDI).

While HIPAA.com serves as a single-source search site, the founders are clear about not offering legal advice. "We refer these inquiries to our health law partners, many of whom will soon be listed on our site," says David Cargile, co-founder of HIPAA.com. Cargile is CEO of Cargile Consulting, Inc. and previously served as the CEO of the Centris Group, U.S. Benefits, and USF Reinsurance Company and Reinsurance Facilities Corporation.

"HIPAA.com is the go-to resource for all information and services related to privacy laws and policies. [HIPAA.com] has expanded to guide health systems and providers in benefiting from the new Health Information Technology stimulus dollars. HIPAA.com is now a great source for both privacy and HIT," says Joseph E. Scherger, MD, MPH, Vice President of Primary Care at the Eisenhower Medical Center in Rancho Mirage, CA.

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