Healthcare_Reform_Overview

Healthcare_Reform_Overview - PRIVATE INSURANCE REFORM...

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Unformatted text preview: PRIVATE INSURANCE REFORM CHANGES TAKING EFFECT IN 2010 f f Establishesfafprocessfforfreviewingfincreasesfinfhealthfplanf premiumsfinfwhichfadequatefjustificationsfforfincreasesfmustf befgiven.fStatesfwillfbefrequiredftofreportfonftrendsfinfpremiumf increasesfandfrecommendfwhetherfcertainfplansfshouldfbef excludedffromfthefExchangef(seefbelowfforfmorefonfExchanges)f basedfonfunjustifiedfpremiumfincreases.f New York State enacted a law in 2010 that requires the Department of Insurance to give prior approval for premium rate increases by health insurance companies. f f Healthfinsurersfwillfnoflongerfbefableftofrescindfexistingf healthfinsurancefpoliciesfwhenfafpersonfgetsfsickfasfafwayfoff avoidingfhigherfcostsfoffenrolleesfhealthcarefneeds. f f Healthfplansfcannotfplaceflifetimeflimitsfonfcoverageforfusef restrictivefannualflimitsfinfallfemployerfplansfandfnewfplansfinf thefindividualfmarket. f f Allfnewfplansfmustfcoverfspecificfpreventivefservicesfatfnof chargefbyfexemptingfthesefbenefitsffromfdeductiblesfandfotherf cost-sharingfrequirements. f f Requiresfnewfplansftofimplementfanfeffective,fexternalfap- pealsfprocessfforfcoveragefdeterminationsfandfclaims. CHANGES TAKING EFFECT IN 2011 f f Insurersfwillfbefrequiredftofreportfthefproportionfoffpremi- umsfspentfonfclinicalfservices,fquality,fandfotherfhealthcaref costs.fIfflessfthanf80%foffpremiumsfforfindividual/smallfgroupf markets,forf85%fforflargefgroupfmarkets,fisfspentfonfhealthcaref orfimprovingfquality,fthenfinsurersfwillfbefrequiredftofofferf rebatesftofconsumers.fThisfwillfcontrolfhealthfinsurersfspend- ingfonfadvertising,fdividendsfandfexecutivefpayouts,fwhichf oftenfleadsftofincreasesfinfconsumersfpremiums. CHANGES TAKING EFFECT IN 2013 f f Simplifiesfthefadministrativefprocessfoffhealthfinsurersfbyf adoptingfafsinglefsetfoffoperatingfrulesfforfeligibilityfverifica- tionfandfclaimsfstatus.fInsurersfmustfadoptfandfimplementf uniformfstandardsfandfbusinessfrulesfforfthefelectronicf exchangefoffhealthfinformationftofreducefpaperwork,fadmin- istrativefburdensfandfcosts. CHANGES TAKING EFFECT IN 2014 f f Requiresfthefadoptionfoffafsinglefsetfoffoperatingfrulesfforf methodsfoffhealthcarefpaymentfandfelectronicffundftransfers. f f Healthfplansfcanfnoflongerfdenyfcoveragefforftreatmentsfbasedf onfpre-existingfhealthfconditions. f f Limitsfthefabilityfoffinsurancefcompaniesftofchargefhigherfratesf dueftofheathfstatusfandfgender.fPremiumsfcanfonlyfvaryfbasedfonf agef(nofmorefthanf3:1),fgeography,ffamilyfsize,fandftobaccofuse. f f Prohibitsfallfemployerfplans,fandfnewfplansfinfthefindividualf market,ffromfimposingfannualflimitsfonfthefamountfoffcover- agefanfindividualfmayfreceive. f f Prohibitsfinsurersffromfdroppingfcoverageforfdenyingf coveragefforfroutinefcarefbecausefanfindividualfchoosesf tofparticipatefinfafclinicalftrial.fThisfappliesftofallfclinicalf trialsfthatftreatfcancerforfotherflife-threateningfdiseases....
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This note was uploaded on 04/19/2011 for the course LS 2 taught by Professor Pires during the Spring '08 term at UCLA.

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Healthcare_Reform_Overview - PRIVATE INSURANCE REFORM...

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