A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Archive: August 2010

HHS announces nearly 2,000 employers and unions approved for early retiree coverage

Posted on August 31, 2010

The Department of Health and Human Services has announced that nearly 2,000 employers and unions have been accepted into the Early Retiree Reinsurance Program created by the health reform law. The program provides five billion dollars to assist employers and unions cover retirees over age 55 who are not yet eligible for Medicare.

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Editor’s Comment: Un-Stacking the Deck Against Patients Insured through ERISA Health Plans

Posted on August 30, 2010

The Affordable Care Act is a complete game changer. Under its terms, as implemented by the US Labor Department, when a patient appeals a claims denial to an external reviewer, the review now is to be completely independent and binding on the plan. If the plan should refuse to go along with the decision, the patient can go to court and seek an order enforcing the decision against the plan.

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Appeals of Claims for Benefits

Posted on August 29, 2010

The right to a fair and impartial appeal when a group health plan or health insurer denies a claim would seem to be a basic matter of fairness. Historically, however, this has not been the case. Patient protections vary tremendously depending on the type of health insurance and federal and state legal requirements.

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Editor’s Comment: Medical Loss Ratio and Rebates in Private Health Insurance

Posted on August 25, 2010

A key issue for insurers, businesses and consumers in health reform is working its way through the regulatory process. Beginning January 1, 2011, insurers will be required to spend a minimum percentage of insurance premiums on medical expenses, as opposed to administrative and marketing costs or profits. Insurers that fail to meet these minimum percentages, called medical loss ratios, will be required to rebate the difference in premiums. Group policies will be required to spend 85 percent on medical expenses and individual policies must spend 80 percent on medical expenses.

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HHS unveils Insurance Finder widget

Posted on August 25, 2010

The Department of Health and Human Services has unveiled a new widget, which can be embedded in any website, that takes users to HealthCare.gov resources for finding insurance options.

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Center for Health Care Strategies releases report, “Covering Low-Income Childless Adults in Medicaid”

Posted on August 25, 2010

Based on the experience of ten states that currently run programs covering low-income childless adults, the Center for Health Care Strategies has released a report with lessons for the health reform law’s Medicaid expansion. It highlights the fact that much of the expansion population is likely to have complex health needs—including mental illness and substance abuse—and have higher average costs than adults currently enrolled in Medicaid.

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Labor issues technical release on appeal review

Posted on August 23, 2010

The Department of Labor has issued a technical release on the rules concerning review of appeals for denied claims.

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AHIP and NFIB comment on ‘Grandfathered Plans’ rule

Posted on August 19, 2010

The health reform law classified health insurance plans in place before its enactment as “grandfathered plans,” exempting them from many new regulations. As Sara Rosenbaum points out in her Implementation Brief, “Health Insurance Reforms and ‘Grandfathered Plans,’” the statute could be interpreted to mean that the kinds of changes often made by health plans year-to-year—increases to premiums and cost sharing as well as benefit reductions—could cause the loss of grandfathered status. More broadly, the statute left open the question of whether grandfathered plans ease the transition to a marketplace in which all plans meet the requirements of the health reform law or are conceived of as permanent entities.

On June 14, the Department of Health and Human Services Office of Consumer Information and Insurance Oversight, the Department of Labor’s Employee Benefits Security Administration, and the Internal Revenue Service jointly issued an interim final rule regulating these policies and opened a comment period that closed on August 16. In their letters commenting on the rule, both America’s Health Insurance Plans and the National Federation of Independent Businesses argue that the regulations squeeze grandfathered plans out of existence.

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NAIC approves MLR reporting form

Posted on August 18, 2010

The National Association of Insurance Commissioners has approved the final Medical Loss Ratio Blanks Proposal, the form to be used by insurance plans for reporting financial information to state regulators to calculate medical loss ratios and any rebate due under the health reform law.

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Employer Wellness Programs

Posted on August 16, 2010

One objective of the insurance reform provisions of the health reform law was to continue the policy begun under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to encourage individuals and their families to be more engaged in their health care and to adopt healthier lifestyles.

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