[…] In order to attract high-quality health insurance carriers to the exchanges, we have to make sure that the exchanges represent a business environment that is appealing to carriers. We also have to make their appealing and fair to consumers, in order to attract enough people into the exchanges. To work well, the exchanges will need to have a delicate balance between the interests of consumers, providers, and health insurer carriers, with no one group more heavily favored than another.
Individual/Family Health
HHS Guidelines For Women’s Healthcare
HHS today announced new PPACA guidelines pertaining to women’s health, listing several services that must be covered by health insurance plans with no cost sharing by the insured. In scrolling through healthcare news this morning, I saw numerous headlines stating that birth control and breast pumps must be covered by health insurance with no copays. This is true, but the requirements don’t take effect for another year (August 1, 2012) and will apply to new policies that begin on or after that date. […]
A Good Summary Of The HHS Proposed Regulations For Exchanges
[…] The proposed regulations from HHS for the exchanges come to 244 pages, but Timothy notes that they are “practical, sensible, and functional” and that HHS tried to simplify things wherever possible, rather than complicate them. For anyone who wants to get the gist of the proposed regulations without reading the 244 pages that HHS released this month, I highly recommend that you check out Timothy’s article. […]
Employer Funding of Individual Health Insurance – The Rules Are Changing
[…] Because of the new law, employers can now use wage adjustments to reimburse employees for individual policies (as long as they haven’t had a group policy in the past twelve months), which wasn’t allowed at all in the past. But the use of HRAs to fund individual policies can now only be done if the employer hasn’t had a group policy in the past twelve months, and that restriction wasn’t found in the DOI final agency order regarding HRAs. […]
Health Insurance Does Not Always Prevent Medical Debt
[…] Chances are, if you have a claim on your home or auto policy, it will be because of a one-time incident like a fire or a car accident. That can be the case with a health claim too, of course, but many times a large claim on a health insurance policy can be the result of a chronic condition or one that will need extensive long-term treatment. A person might have health insurance at the start of the ordeal, but may lose coverage as time goes on […]
Is High Risk Pool Eligibility Guideline Hampering Enrollment?
[…] In terms of underwriting actions for less serious conditions (those that don’t result in a decline), GettingUsCovered only takes people who have been offered a policy with an exclusion rider… which most carriers don’t do anymore. Perhaps this is resulting in GettingUsCovered being comprised mostly of members who have a condition that would result in a decline in the individual market, while CoverColorado has those members as well as members who have less serious conditions that simply result in a higher-priced policy in the individual market.
Call For Grand Rounds Submissions
We’re honored to be hosting Grand Rounds next week, on June 28th. Please send me your medical/health care posts by 8pm mountain time on Sunday, the 26th. No theme this week – just pick your favorite recent post. Submissions can be emailed to me at louisen78 [at] gmail [dot] com. I look forward to reading your articles!
Biased Language In Employer Health Insurance Survey
[…] Overall, the survey is very thorough, the questions are mostly objective, and the data obtained from 1300 employers is no doubt a useful barometer of current employer attitudes towards health care reform. But I imagine that if the sentence about assuming that exchanges will make individual health insurance easy and affordable had not been included, the number of employers who said that they plan to drop their group plans might not have been so high. Time will tell.
Rate Review Process Does Not Keep Premiums Artificially Low
[…] If the rates are justified, they’ll likely be approved – even if the amount of the increase is distastefully large. The DOI is not trying to keep premiums artificially low or force carriers to cut out legitimate claims expenses. Having rates approved by the DOI does not mean that the people of Colorado get smaller-than-average premium increases. Rather, it means that although our rate increases are sometimes substantial, we know that those rates are justified as a reflection of increasing claims costs.
Expanding Eligibility For Federally Administered High Risk Pool Coverage
[…] The 27 states (including Colorado) that administer their own PCIPs have been notified by HHS that they can modify their programs in a similar manner. As of this morning, the GettingUSCovered website still has the same eligibility guidelines that it has always had: a letter from a private carrier stating that the applicant has been declined, or approved with an exclusion on a pre-existing condition. […]
Handling Income And Job Fluctuations Under The PPACA
[…] There’s no simple answer to all of this. We’re trying to create a somewhat universal health insurance system based on a conglomeration of government-run health insurance, private coverage from hundreds of carriers, eligibility for coverage that is tied to employment and state of residence, and also based on income levels… of course it’s going to get complicated. Hopefully the suggestions raised by this report will help to guide regulations that will ensure health insurance coverage that is as gap-free as possible for most Americans.
DOI Report On Small Group Coverage In Colorado
The Colorado Division of Insurance recently released the 2010 small group market report. The number of employers in Colorado offering small group health insurance dropped by 10% compared with 2009, and the number of Colorado residents with small group health insurance coverage dropped by 7%. The report contains comprehensive data on the availability of coverage, carriers in the small group market, pricing, and how the rating flexibility laws have impacted the market. […]
CHP+ Premiums Will Result In More Uninsured Kids
[…] However, the real world is not always ideal. The Post editorial makes some very good points, and I don’t doubt that if CPH+ moves to a monthly premium system this summer, there will be some kids who lose their coverage, and fewer children will enroll in the future compared with how many would have enrolled if monthly premiums were not part of the deal. […]
Child-Only Plans Returning To Colorado
[…] But presumably if the child is eligible for coverage through a parent’s employer, individual health insurance carriers would not be required to offer the child a child-only policy. As we’ve noted in the past, child-only policies represent a very small fraction of the individual health insurance market, but within the child-only market, it would seem that there are a lot of children who are also eligible for other creditable coverage (albeit more expensive coverage…). It will be interesting to see if this becomes an issue once all the carriers return to the child-only market. […]
Is It Even Possible For Patients To Be Consumers?
[…] Dr. Perednia makes some excellent points about the inability of patients to be true “consumers”, even in cases where they have their own money on the line. He notes that if you call your doctor’s office to find out the price of a procedure, they won’t be able to tell you because there are too many complexities in the health insurance system for the doctor to give you an accurate idea of what the cost will be. And if you call your health insurance carrier directly […]
Colorado House Approves Child-Only Health Insurance Bill
The language of the law was modified to include open-enrollment periods during which children could apply for coverage, and last September the Colorado Division of Insurance officially designated those open-enrollment periods as January and July each year. The idea was that with open-enrollment periods rather than constant access to new policies, parents would be less likely to wait until a child was sick to seek coverage. But even with the open-enrollment periods, only two carriers – Rocky Mountain Health Plans and […]
MLRs – One Size Does Not Fit All
[…] A state with two functional insurance carriers offering individual policies is obviously going to have a very different marketplace than a state with ten major carriers competing for business. It will be interesting to see how things play out in the states that are granted temporary MLR waivers by CMS. Three years from now, will their insurance markets be able to provide adequate coverage and also comply with the 80/85% MLR guidelines? Or will the waivers morph into something that allows the impacted states to set their own guidelines? Time will tell.
HHS To Stop Accepting Early Retiree Reinsurance Applications After May 5, 2011
[…] Although the program has proven quite popular – as of last month, HHS had approved approximately 5850 applications – one of the concerns from the beginning was that the $5 billion allocated to the ERRP might not be sufficient to last until 2014. HHS said from the start that they would only accept applications as long as they had enough available funding. They have now announced that they will not accept any new applications after May 5, 2011. […]
Spending Caps Will Help Individual Families But Won’t Reduce Overall Costs
[…] But although the spending caps will be beneficial to families that have large medical expenses, they do nothing to actually address the rising cost of health care, and the over-utilization that is also driving costs. This has been a recurring theme with a lot of the provisions created by health care reform: we’re finding ways to spread the costs in a more equitable fashion, but we’re not really addressing the fact that the total cost burden of health care in this country isn’t sustainable on its current trajectory, no matter how much we spread it out across the population.
Senate Bill 200 Begins The Process Of Creating Colorado Exchange
[…] Senate Bill 200 (the Colorado Health Benefit Exchange Act), co-sponsored by Senator Betty Boyd (D – Lakewood) gets the ball rolling on the health insurance exchange that the state will have to have in place by 2014. Specifically, the bill would create a “nonprofit unincorporated public entity known as the Health Benefit Exchange”. It includes guidelines for the appointment of a 12-member board of directors (9 of whom will be voting members) who will oversee the exchange, and lays out their responsibilities. […]
New CoverColorado Provider Fee Schedule
As of April 1, 2011, CoverColorado will be switching to a new fee schedule for reimbursing providers. In the past, CoverColorado has used the Rocky Mountain Health Plans provider network, and doctors were paid according to the RMHP network-negotiated rates when they treated CoverColorado members. The new CoverColorado-specific fee schedule applies to any provider who treats a CoverColorado member, regardless of whether that provider is part of the RMHP network or not. […]
Does Colorado’s New Maternity Law Impact Underwriting?
[…] The language in the Division of Insurance FAQ page does seem to create some confusion on the issue. Stating that “A person who is already pregnant may obtain insurance at this time” could be interpreted in various ways… some might see it as saying that the person may obtain insurance if the carrier allows it (which none of them currently do), while others might see it as stating that the DOI interpretation of the law requires carriers to treat a current pregnancy as a specific exclusion rather than cause for an outright decline. […]
Maternity Coverage On Renewing Individual Policies
Since January 1, 2011, all new individual health insurance policies issued in Colorado have included maternity coverage as required by a new state law. The text of the bill was quite clear in stating that its provisions would apply to all “policies issued or renewed on or after the applicable effective date of this act.” (see the top of page 3 of the text). But until now, there was still some confusion around maternity coverage and policy renewals, and inconsistencies in how the law was being applied. […]
Using HRA Funds To Purchase Individual Health Insurance
[…] However, it appears that the Colorado Division of Insurance has repealed its 2009 order regarding the use of HRA funds to purchase individual health insurance. Final Agency Order O-11-064 details the questions involved (including issues regarding eligibility for CoverColorado) and concludes that “Self-funded employee benefit plans sponsored by a private company such as an HRA, are employee benefit plans under ERISA and are not subject to the jurisdiction of the Commissioner.” […]
Mandatory Health Insurance Does Not Prevent Medical Bankruptcies
[…] The study’s authors note that implementing mandatory health insurance rules is not likely to result in a significant decline in the number of medical bankruptcies nationwide unless we also focus on improving the level of coverage that people have (to reduce out of pocket exposure), and on expanding access to disability insurance that can help provide income to people who are unable to work because of a major illness or injury. […]