1 Reinsurance and its Role in Increasing Access to Health Insurance for Workers with Disabilities The rising cost of health care premiums affects the ability of small businesses and selfemployed workers to provide or obtain health care coverage. Individuals with pre-existing conditions find it difficult to get coverage in the private market without high price tags and a lot of exceptions in coverage requirements. One possible solution to this problem is emerging: state-sponsored reinsurance programs that target the health insurance markets for small groups and individuals, making insurance more affordable and accessible. Table of Contents Disability, Employment & Health Insurance... 2 The Basics of Reinsurance... 3 Reinsurance Programs: Key State Examples... 4 Publicly Subsidized Programs... 4 New York... 4 Idaho... 6 Commercially Funded Programs... 7 Connecticut... 7 Arizona... 8 New Mexico... 9 Critical Questions for Reinsurance Programs Related Research Reinsurance and its Role in Increasing Access to Health Insurance for Workers with Disabilities.1.
2 Disability, Employment & Health Insurance With average annual health insurance premiums of nearly $12,700 i for a family of four and single coverage at $4,700, employed people with disabilities, whose average income is approximately two-thirds of the average income of workers without disabilities, are unlikely to be able to afford employer-based health insurance coverage. Twenty-five million working-age people in the United States with a sensory, physical, mental, or self-care disability could gain coverage from reinsurance initiatives. i Reinsurance programs and their positive effects on health care coverage also may help attract more workers with disabilities to the labor force. Currently, less than 40% of working-age people with disabilities are employed, compared with 84% of people without disabilities. ii Often, the fear of losing public benefits, including public health insurance coverage, deters individuals iii iv v vi vii with disabilities who wish to enter or re-enter the workforce. Reinsurance and its Role in Increasing Access to Health Insurance for Workers with Disabilities.2.
3 The Basics of Reinsurance Simply put, reinsurance is insurance for insurance companies. In other words, insurance carriers purchase coverage to insure against the financial risk posed by high-cost cases. Reinsurance programs work by spreading the costs of high-cost cases across insurance carriers. Because employees with high expected health care costs drive costs for coverage in small businesses higher, reinsurance programs are designed to minimize the impact of highcost cases on carriers and increase affordability of insurance for small businesses and individuals. Potential Impact of Public Reinsurance Programs Premium Costs to Members and Employers Reductions in premiums Reduces the impact of high-cost cases on small employers premiums, encouraging small groups to offer coverage Coverage and Employment Larger number of people with disabilities and chronic conditions insured More people with disabilities can rely on small group or private coverage to enter or remain in the workforce Market Competition Provides incentives for small insurance carriers to enter the small group and/or individual markets, increasing market competition Reinsurance and its Role in Increasing Access to Health Insurance for Workers with Disabilities.3.
4 Reinsurance Programs: Key State Examples Several states have implemented reinsurance programs to fix problems in the small group and private health insurance markets. The goal: more accessible and affordable health insurance coverage in the small group and/or private health insurance market. Challenges in the small group and private health insurance markets include viii High and rising premium costs Policy underwriting for individuals with pre-existing conditions Lack of affordable comprehensive coverage To meet these challenges, reinsurance programs have different reimbursement structures. Their designs establish at which level individual claims will be reimbursed and up to what annual limit the reimbursement payments apply. Publicly Subsidized Programs New York Healthy New York Features Funding Automatically reinsures all enrolled individuals. Provides health insurance coverage to uninsured employees of small businesses (fewer than 50 employees), the self employed, and low-wage workers ix All Health Maintenance Organizations (HMOs) in the state are required to offer policies through the program Premiums are based on county of residence and family composition. Funding is provided by an assessment on participating health insurance providers, a state government subsidy, and a tax on tobacco products HMO pays 100% of claims up to $5,000 x. Above that the reinsurance program pays 90% and the HMO pays 10% of claims between $5,000 and $75,000. Upon reaching $75,000, the primary insurer assumes full responsibility for the claims $149 million in state funds Reinsurance Bands $5,000 to $75,000 90% of claims within the reinsurance layer Achievements Limitations Premium reduction of 17% when the reinsurance corridor was lowered to $5,000 iv Currently improved access to more than 150,000 people who previously would have been uninsured xi Standard benefit package less comprehensive than the mandated benefits in New York State law vii Coverage meets the needs of healthy individuals, but falls short for those with high health care needs. Coverage does NOT include: mental health, alcohol or substance abuse treatment, chiropractic care, hospice care, ambulance, dental, vision, and durable medical equipment. (see Reinsurance and its Role in Increasing Access to Health Insurance for Workers with Disabilities.4.
5 New York s Direct Payment Stop-Loss Relief Program Features iv Funding Direct Pay offers comprehensive coverage Available to any individual denied coverage in the private market, regardless of income. All HMOs are required to offer two standard health insurance packages: one with out-of-network options one that cannot base underwriting decisions on preexisting conditions (Law SS , popularly referred to as The Point of Service law, $40 million in state funds Other sources include designated fund from tobacco settlements and taxes proceeds from a non-profit health insurance company s conversion into a for-profit organization an annual assessment on health insurance companies in the state hospital and laboratory surcharges Reinsurance Bands $5,000 to $75,000 90% of claims within the reinsurance layer Limitations iv Public levels of funding for the program have been frozen at 2003 levels. Ability to pay claims has been significantly reduced, with only about 40% of the claims between $20,000 and $100,000 being paid as of The premium reduction effects of the reinsurance program have been significantly hindered. Healthy New York and Direct Payment Stop-Loss Compared vii Healthy New York and Direct Pay differ in critical ways. The Direct Pay program offers more comprehensive health care coverage. As a result, an individual with high health care needs would prefer to enroll in one of its plans. This leads to a risk selection problem, which pushes Direct Pay premiums higher. Still, the average "standard" Healthy New York premium (drug coverage, no deductible) is approximately 70% lower than the average Direct Pay premium and roughly 40% less than the average small group premium. The underfunding of the Direct Pay reinsurance program directly affects individuals with high health care needs, such as individuals with chronic illnesses or certain types of disabilities, as they have to bear high premium costs for comprehensive health insurance coverage. Finally, unlike Healthy New York, Direct Pay does not have any income eligibility requirements. To enroll in Direct Pay, an individual must not have been able to purchase insurance in the private market and not be eligible for employer-based insurance. Reinsurance and its Role in Increasing Access to Health Insurance for Workers with Disabilities.5.
6 Idaho Idaho Individual High Risk Reinsurance Pool The Idaho High Risk Reinsurance pool was enacted in 2001 to make health insurance coverage accessible to high-risk uninsured individuals or those who were close to reaching the lifetime expense limit of their health coverage.xii Features Funding Reinsurance Bands Achievements Limitations It is an excess of loss program Mandatory for all carriers in the individual market in the Idaho All carriers in the state must offer five standard health plans All carriers must enroll individuals without regard to their health status Primary insurers use a community rating scale that is based on an individual s gender, age, and smoking status A governing board surveys comparable plans and sets premium rates at no more than 150% of rates in the healthy market Guaranteed issue in the private market. If the insurance carrier deems an individual to be a high cost risk, he is offered coverage under the HRP program rates. Premiums paid by insurance carriers Revenues from a premium tax The primary carrier pays 100% of costs up to $5,000 per annual individual claims and 10% of costs of an individual s claims between $5,001 and $25,000. It has a 0% liability for claims $25,000 and above Since its implementation, there has never been a need to charge carriers an assessment to cover the claims xiii Gets coverage to the previously considered, uninsurable populations Does little to limit premium fluctuations. Cost to enrollee is the same as in the private market Challenges in the Small Group Market ix Idaho has another reinsurance program, the Small Employer Health Reinsurance Program. This initiative combines a reinsurance component with a program to encourage small employers to offer health insurance coverage. Its reinsurance bands are different from the Idaho Individual High Risk Reinsurance Pool and it does not receive state subsidies. While the Idaho program helps stabilize costs, it does not produce a substantial reduction on premium rates. The results of this program have been less impressive than the individual reinsurance program, with only 102 lives currently insured. Part of the reason for this low performance refers to the substantial burden health insurance coverage pose to small businesses. Reinsurance and its Role in Increasing Access to Health Insurance for Workers with Disabilities.6.
7 Commercially Funded Programs Connecticut Connecticut s Small Employer Health Reinsurance Program Connecticut s Small Employer Health Reinsurance Program (SEHR) was the first of its kind when it was created in iv Connecticut serves approximately 2,000 small business employees and their dependents each year. xiv The state serves in an administrative capacity, but a third-party administrator manages the pool. Features Funding Reinsurance Bands Achievements Limitations Participation is mandatory for the state s health insurance companies in the small group market x SEHR aims to spread the cost of catastrophic claims across all health insurance carriers in the state Eligibility requirements for participation include being an employee of a small business or a sole proprietor and working 30 or more hours a week The benefit plan of individuals or groups that are reinsured is exactly the same as those for individuals who are not ceded to the pool If the insurer decides to cede the risk, it must pay a premium to the risk pool for that individual or small group Funds come from reinsurance premiums and assessments on all carriers Fifty percent of the costs for the program are paid with funds from these assessments x The program does not allow insurers to charge small employers higher premiums. iv The carrier is responsible for individual claims up to $5,000. Above $5,000, the reinsurance pool picks up 100% of the medical costs for that member x Uses the reinsurance pool to spread the costs among all insurers. Increases market competition. Ensuring survival of smaller insurance companies when faced with catastrophic illness claims by an individual or group. Guarantees coverage to very small groups Does not noticeably reduce premium costs for the enrolled individuals. Reinsurance and its Role in Increasing Access to Health Insurance for Workers with Disabilities.7.
8 Arizona Arizona Health Care Group (until 2005) The Health Care Cost Containment System, a division of Arizona s Medicaid program, created the Health Care Group of Arizona (HCG) in 1985 to provide guaranteed issue coverage to selfemployed individuals and employees of small businesses. Its reinsurance component was introduced in xv Features Reinsurance Bands Premium rates based on age, gender, and geographical region in the state Aggregate stop loss coverage for claims exceeding 86% of the health plan contractors total capped premium paid by HCG xii Funding Until 2006, hybrid reinsurance program using state funds for claims between $75,000 and $100,000, and premiums paid by participating insurers to cover costs above the maximum Achievements Limitations Above $125,000 per member per year are paid for by private reinsurance company Until 2007, the program did not consider health status to determine premiums, which in practice meant lower costs for individuals with chronic illnesses or pre-existing conditions xvi With the advent of health status considerations, premium costs increased for individuals with chronic conditions and or pre-existing conditions. Program has not proved reliably sustainable without state subsidies. Ending HCG s State Subsidies xi In 2007, HCG suffered heavy losses. As a result of a system-wide audit, the state legislature stopped the subsidies. In addition to ending the subsidies, legislative changes also allowed carriers to include health status and group size as variables in the determination of premiums. The changes also involved new fine-tuned incentives for insurers to contain costs, and the suspension in enrollment of groups of 1 while allowing those already enrolled to keep their membership. As a result of the new regulations, HCG s premiums increased by double digits, hitting groups of one enrollee particularly hard. Higher premiums and the more stringent eligibility requirements have led to a drop in enrollment in the program in 2008 and Enrollment fell from approximately 27,000 members in the beginning of 2008 to roughly 15,000 in May Reinsurance and its Role in Increasing Access to Health Insurance for Workers with Disabilities.8.
9 New Mexico New Mexico Health Insurance Alliance The New Mexico Health Insurance Alliance (NMHIA) was created in 1994 to increase access to health insurance coverage for small businesses and the self-employed, who constitute a significant part of New Mexico s economy. Features Funding Mandatory, requiring all health insurance carriers that do business with state institutions must offer plans under the NMHIA xvii NMHIA coverage is offered with no medical screening or underwriting Guaranteed issue clause, that is, individuals cannot be rejected or charged more for health or occupation The program has no employer contribution level requirements Coverage includes prescription drugs, hospital services, physician and outpatient services, mental health services, and preventive and wellness care xviii. NMHIA is funded through a premium surcharge of up to 5% for the first year and 10% in subsequent years for small groups and 15% for renewal of individuals xix. If the program suffers a loss, assessments on all participating insurance carriers cover those losses Reinsurance premiums Assessments on carriers Reinsurance Bands The program reimburses insurers the amount of total claims that exceed 75% of the premiums they collect from individual policy holders Achievements Limitations Increases access to insurance for individuals who may not otherwise be able to obtain coverage for specific conditions, or at all. Premiums charged to an individual are based on the average premium rate of comparable packages offered by other carriers in the small group market as dictated by New Mexico law (New Mexico Law 59A-23E-12, Premiums are competitive in the NMHIA, but they are not substantially lower than the competition in the small group market. Reinsurance and its Role in Increasing Access to Health Insurance for Workers with Disabilities.9.
10 Critical Questions for Reinsurance Programs xx Should the state mandate participation in the reinsurance program? Voluntary programs would benefit large insurers. Large insurers already spread the risk of high cost cases across their many members and would therefore have no incentive to contribute to the reinsurance program. The mandatory nature of the program should be limited to offering policies under the program and paying the assessments. In programs where carriers must decide whether to cede the risk to the pool, insurers would still be able not to cede any lives. This would mean no reinsurance premiums, while they would still have to contribute to the assessments. Small carriers would be able to spread some risk across all carriers, increasing incentives to competition. The National Association of Insurance Commissioners (http://www.naic.org) offers model legislation found in section 12 of the Individual Health Insurance Model Act that outlines a generic non-subsidized reinsurance program for the small group market (http://www.naic.org/documents/committees_models_118.doc). What is the benefit package offered? Subsidized plans designed to reduce premium costs usually offer less comprehensive packages. The goals of the program and the target audience should be taken into account when designing the reinsurance plan. Non-subsidized plans offer the same benefit package options available in the small group or individual market in the state. What will be the reinsurance layers and who will pay for the reimbursements? Fine-tuned reinsurance levels can be efficient in reducing premiums. Subsidized programs in particular have to be mindful of an incentive structure for carriers to contain costs even as the state will pick up the tab in the reinsurance bands. How can reinsurance reduce premiums? Legislation should identify the cost and payment structure for subsidized reimbursements. Preapproval or review of premiums may also be considered as a way keep premiums in check and to prevent reimbursements from simply increasing insurance companies profits. The Healthy New York legislation provides an example of the issues to be addressed in a subsidized plan. Reinsurance and its Role in Increasing Access to Health Insurance for Workers with Disabilities.10.
11 Related Research The Urban Institute s Microsimulation Model for Reinsurance: Model Construction and State Specific Application The Urban Institute has published a microsimulation of the effect of reinsurance on health care affordability using survey data from the Medical Expenditure Panel Survey. The Robert Wood Johnson Foundation State Coverage Initiatives Reinsurance Institute The Reinsurance Institute provides information and assistance to state leaders in order to help them move health care reform forward at the state level. This site compiles presentations of several state implementation experiences with reinsurance. The Robert Wood Johnson Foundation State Coverage Initiatives Reinsurance in State Health Reform The Reinsurance Institute published a study on the impact of state reinsurance programs and broader state-level health care reform, including a discussion of policy measures that should accompany the implementation of reinsurance programs in order to maximize its benefits for high-risk individuals. The Robert Wood Johnson Foundation State Coverage Initiatives SCI Coverage Institute The State Coverage Initiatives program Web site discusses grant opportunities to fund health care reform programs at the state level, including reinsurance programs. Reinsurance and its Role in Increasing Access to Health Insurance for Workers with Disabilities.11.
12 Health care access is a key consideration for those faced with a choice to reduce hours or exit the workforce due to a disability. While loss of insurance is a serious concern for any individual, it is an especially serious consideration for those with ongoing health care needs related to a chronic condition, disability, or the onset of disability. When people with disabilities are uninsured, they lack access to preventive and ongoing medical care, a situation that can lead to secondary health conditions that might otherwise be prevented. The high costs of health care coverage and the perceptions of cost by employers may make people with disabilities especially vulnerable, and lack of health insurance and access to health care can be one of the largest barriers preventing people with disabilities from seeking and obtaining steady employment. Policy initiatives that increase access to health care are important points for research, as they may directly influence a person s ability and motivation to stay in the workforce, or to re-enter the workforce after a period of receiving public insurance coverage. Reinsurance programs represent a promising policy initiative for offering affordable health insurance to individuals and employees of small businesses. Access to health insurance through reinsurance programs offers individuals with disabilities and/or chronic conditions opportunity and incentive to remain in or re-enter the workforce. This document was developed under a contract with the U.S. Department of Labor, Office of Disability Employment Policy (Contract DOLU ). The opinions expressed herein do not necessarily reflect the position or the policy of the U.S. Department of Labor, nor does mention of trade names, commercial products, or organizations imply the endorsement of the U.S. Department of Labor. Reinsurance and its Role in Increasing Access to Health Insurance for Workers with Disabilities.12.
13 Endnotes i Houtenville, A. J., Erickson, W. A., & Lee, C. G. (2007). Disability statistics from the American community survey (ACS Available from ii Bureau of Labor Statistics (2009). Labor force statistics from the current population survey : New monthly data series on the employment status of people with a disability Retrieved February 3, 2009, from iii Hanes, Pamela (2000). Testimony presented at the House Ways and Means Subcommittee on Social Security Hearing Work Incentives for Blind and Disabled Social Security Beneficiaries. Retrieved from iv Hill, Steven C., Livermore & Houtenville. (2003). High health care expenditures and the employment of people with high cost chronic conditions. In The Decline in Employment of People with Disabilities: A Policy Puzzle. Kalamazoo, MI: W.E. Upjohn Institute. v Kruger, Hillary, Lynn Ellinson, Roline Milfort. (2006). Role of Intermediaries in ODEP Youth Demonstration Programs. In Gladnet Collection. Retrieved January 3, 2009, from vi O Day, B., Stapleton, D., Horvath-Rose, A. (2007). Health insurance coverage among youth and young adults with work limitations. Ithaca, NY: Cornell University, Rehabilitation Research and Training Center on Disability Demographics and Statistics. Retrieved November 21, 2008, from vii Stapleton, D., Livermore, G.,Scrivner, S.,& Tucker, A.(1997). Exploratory study of health care coverage and employment of people with disabilities: A literature review. (Report).Washington, D.C.: U.S. Department of Health and Human Services. viii National Coalition on State Legislatures [NCLS] (2009). Facts about health care. Retrieved June 12, 2009, from ix Wickler, B., & Fish-Parcham, C. (Eds.). (2008). Reinsurance: A primer. Washington, DC: Families USA. x Swartz, K. (2001). Healthy New York: Making insurance affordable for low-income workers(pp.1-48) Available from Insurance-More-Affordable-for-Low-Income-Workers.aspsx xi L. Basini, Personal Communication, May 22, xii Idaho Department of Insurance (2008). Individual High Risk Reinsurance Pool Plans for Idaho Residents. T. I. D. o. Insurance. Boise, ID, Idaho Department of Insurance. xiii B. Deal, Personal Communication, May 11, xiv K. Ideman, Personal communication, May 20, 2009 xv Anonymous (2006) Reinsurance Call Background Information: 1-5. xvi M. Steigerwald, Personal Communication, June 09, xvii M. Onstott, Personal Communication, June 03, xviii New Mexico Health Insurance Alliance (2009). "We Provide Access ". Retrieved May 14, 2009, 2009, from xix D. Belloff, J.C. Cantor, M.M. Koller and A.C. Monheit (2007) Reinsurance options for New Jersey s Health Insurance Market. State Planning Grant #6 P09 OA N. J. D. o. H. S. (NJDHS), Rutgers Center for State Health Policy. xx Reinsurance and its Role in Increasing Access to Health Insurance for Workers with Disabilities.13.
Social Dynamics, LLC Health and Wellness Research Study Delivery Order: Reinsurance Issue Paper Government Contract Number: DOLU089428186 Reinsurance: A National Snapshot Authors Marilia Mochel Heather
Arizona Health Care Cost Containment System Issue Paper on High-Risk Pools Prepared by: T. Scott Bentley, A.S.A. Associate Actuary David F. Ogden, F.S.A. Consulting Actuary August 27, 2001 Arizona Health
May 2007 S t a t e Co v e r a g e I n i t i a t i v e s Profiles in Coverage: Arizona Healthcare Group Overview Healthcare Group of Arizona (HCG) was created by the Arizona State Legislature in 1985 to
The Health Benefit Exchange and the Commercial Insurance Market Overview The federal health care reform law directs states to set up health insurance marketplaces, called Health Benefit Exchanges, that
Providing Health Care Access to Workers with Disabilities through Community-Based Financing Community-based financing for health care access (CBF-HC) is any funding arrangement used by a group of individuals
OnPoint: Health Policy Brief A Bi-Monthly Publication by the Massachusetts Association of Health Plans Volume III, June 2015 Written by Elizabeth (Fluet) Murphy, Esq. and Edited by Eric Linzer What are
The Policy Debate on Government Sponsored Health Care Reinsurance Mechanisms Colorado s Proposal and a Look at the New York and Arizona Models Robert M. Ferm, Esq. 303.628.3380 Introduction Recently many
State of Arkansas Department of Insurance Consideration of the Basic Health Plan in Arkansas May 31, 2012 Purpose The Arkansas Insurance Department requested that PCG develop a report describing the potential
www.thinkhr.com 877-225-1101 Employer Health ThinkHR grants the reader non-exclusive, non-transferable, and limited permission to use this document. The reader may not sell or otherwise use this document
www.thinkhr.com AFFORDABLE CARE ACT SMALL EMPLOYER HEALTH REFORM CHECKLIST Employers that provide health coverage to employees are responsible for complying with many of the provisions of the Affordable
Overall approach to expanding health care coverage Amends the Insurance Code to create Health Care Affordability Fund within Treasury. These funds are used to: expand MIChild to 300% of poverty level Subsidize
Freedom Life Insurance Company of America Actuarial Memorandum for Policy Forms EHB-2016-IP-KY-FLIC with EHB-2016-SCH-KY-FLIC, EHBC-2016-IP-KY-FLIC with EHBC-2016-SCH-KY-FLIC I. GENERAL INFORMATION Insurance
ACA Impact on Premium Rates in the Individual and Small Group Markets Paul R. Houchens, FSA, MAAA BACKGROUND The Patient Protection and Affordable Care Act (ACA) introduces significant changes in covered
OVERVIEW OF PRIVATE INSURANCE MARKET REFORMS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AND RESOURCES FOR FREQUENTLY ASKED QUESTIONS Brief Prepared by MATTHEW COKE Senior Research Attorney LEGISLATIVE
AFFORDABLE CARE ACT Employers that provide health coverage to employees are responsible for complying with many of the provisions of the Affordable Care Act (ACA). Provisions take effect on staggered dates
issue brief April 20, 2011 Medicaid: A Key Source of Insurance in New Hampshire As state and federal policymakers come to grips with substantial budget shortfalls both now and into the future one public
Arizona State Senate Issue Brief June 22, 2010 Note to Reader: The Senate Research Staff provides nonpartisan, objective legislative research, policy analysis and related assistance to the members of the
Health Insurance Reform at a Glance Implementation Timeline 2010 Access to Insurance for Uninsured Americans with a Pre-Existing Condition. Provides uninsured Americans with pre-existing conditions access
Prevention and Screening Services Cost-sharing Eliminates cost sharing requirements for requirements for all preventive services (including prevention and colorectal cancer screening) that have a screening
Health Care Reform Frequently Asked Questions On March 23, 2010, President Obama signed federal health care reform into law, also known as the Patient Protection and Affordability Act. A second, or reconciliation
SJR 35: HEALTH CARE Comparison of Selected Elements of the Major Federal Health Care Reform Proposals Prepared for the Children, Families, Health, and Human Services Interim Committee Sept. 11, 2009 Baucus
Implementation Timeline Reflecting the Affordable Care Act 2010 Access to Insurance for Uninsured Americans with a Pre-Existing Condition. Provides uninsured Americans with pre-existing conditions access
How Health Reform Will Help Children with Mental Health Needs The new health care reform law, called the Affordable Care Act (or ACA), will give children who have mental health needs better access to the
BILL: SB 516 The Florida Senate BILL ANALYSIS AND FISCAL IMPACT STATEMENT (This document is based on the provisions contained in the legislation as of the latest date listed below.) Prepared By: The Professional
Simple answers to health reform s complex issues facing every employer, and what you can do now to protect your business and your future. If you have any questions, please contact: Health Reform: A Guide
How Health Coverage Works: Coverage Delivery, Risk Assessment, and Regulation The following summarizes the document How Private Health Coverage Works: A Primer 2008 Update published by the Kaiser Family
STATE REGULATION AND INITIATIVES TO EXPAND SMALL GROUP COVERAGE Testimony submitted by Deborah Chollet, Ph.D., Senior Fellow Mathematica Policy Research, Inc. In every state, workers in small businesses
Questions and Answers New Brunswick Drug Plan December 10, 2013 1) What is the New Brunswick Drug Plan? The New Brunswick Drug Plan is a prescription drug insurance plan that provides drug coverage for
AFFORDABLE CARE ACT Employers that offer health care coverage to employees are responsible for complying with many of the provisions of the Affordable Care Act (ACA). Most health reform changes apply regardless
Patient Protection and Affordable Care Act of 2009: Health Insurance Exchanges Provision Notes Standards SUBTITLE D AVAILABLE COVERAGE CHOICES FOR ALL AMERICANS PART I Establishment of Qualified Health
Securing Health Insurance for the Retirement Journey MANAGING RETIREMENT DECISIONS SERIES PEOPLE ARE LIVING LONGER in retirement than ever. Maintaining good health will help make those years vibrant. So
Health Insurance Coverage for Direct Care Workers: Key Provisions for Reform Introduction As an organization dedicated to our nation s 3 million direct-care workers and the millions of elders and people
July 19, 2010 Contact: Stacey Pogue, firstname.lastname@example.org SOMETHING OLD, SOMETHING NEW: TEXAS TWO HIGH-RISK POOLS Thanks to national health reform, Texas now has two separate high-risk pools that offer health
Health Insurance A Small Business Guide New York State Insurance Department Health Insurance A Small Business Guide The Key Health insurance is a key benefit of employment. Most organizations with more
Agent Guide to Guaranteed Issue Health Insurance Table of Contents I. Introduction II. The Plan Outline of Benefits III. 30 Second Indemnity Primer IV. Eligibility V. They Do Not Believe You When You Tell
Preliminary Health Insurance Landscape Analysis Prior to addressing some of the issues listed under Section 3.1 3.5 of the HRSA State Planning Grant report template, here is some of the information available
FACTS from EBRI Employee Benefit Research Institute 2121 K Street, NW, Suite 600 Washington, DC 20037 Employment-Based Health Care Benefits and Self-Funded Employment-Based Plans: An Overview April 2000
EXPLAINING HEALTH CARE REFORM: Risk Adjustment, Reinsurance, and Risk Corridors As of January 1, 2014, insurers are no longer able to deny coverage or charge higher premiums based on preexisting conditions
What s in Healthcare Reform for Women-Owned Small Businesses? In March 2010, Congress passed legislation that will fix the serious problems that all small business owners, including those owned by women,
MARCIA J. NIELSEN, PhD, MPH Executive Director ANDREW ALLISON, PhD Deputy Director SCOTT BRUNNER Chief Financial Officer Report on: Massachusetts Commonwealth Health Insurance Connector Program Presented
Health Reform and the AAP: What the New Law Means for Children and Pediatricians Throughout the health reform process, the American Academy of Pediatrics has focused on three fundamental priorities for
Analysis of the Costs and Impact of Universal Health Care Coverage Under a Single Payer Model for the State of Vermont Prepared for: The Vermont HRSA State Planning Grant, Office of Vermont Health Access
The Continued Need for Reform: Building a Sustainable Health Care System Sustainable reform must address cost and quality, while expanding coverage through a vibrant and functional marketplace As the largest
Key Healthcare Insurance Terms Agent: A person who represents an insurance company and solicits or sells the company s insurance products. An agent may represent a single company or multiple companies.
Senate Bill No. 2 CHAPTER 673 An act to amend Section 6254 of the Government Code, to add Article 3.11 (commencing with Section 1357.20) to Chapter 2.2 of Division 2 of the Health and Safety Code, to add
Primer: Private Health Insurance Nathan Barton l September 2011 Introduction In its simplest form, health insurance is the business of shared medical risk. There are two players in this industry: insurers
Health Care Reform Frequently Asked Questions On March 23, 2010, President Obama signed federal health care reform into law, also known as the Patient Protection and Affordability Act. A second, or reconciliation
The American Association of Payers, Administrators and Networks provides a look at the vital role the selffunded insurance market plays in the U.S. healthcare system and the challenges and opportunities
Nevada Health Plan Project Health Plan Basics Health Savings Accounts A Threat - The Fair Share Act New Trends - Wellness Programs Opportunity - High Risk Pools 1 Who is NAHU? Larry S. Harrison, President
http://www.naic.org/ FUNDAMENTALS OF HEALTH INSURANCE: PURPOSE The purpose of this session is to acquaint the participants with the basic principles of health insurance, areas of health insurance regulation
Judge David L. BAZELON CENTER for Mental Health Law How Will Health Reform Help People with Mental Illnesses? An analysis of the Affordable Care Act passed by Congress in 2010 and how it will affect people
GAO United States Government Accountability Office Report to the Committee on Health, Education, Labor, and Pensions, U.S. Senate March 2008 HEALTH INSURANCE Most College Students Are Covered through Employer-Sponsored
PPACA, COMPLIANCE & THE USA MARKET INTRODUCTION The USA healthcare market is the largest in the world followed by Switzerland and Germany It consists of broad services offered by various hospitals, physicians,
Fact Sheet Setting the Record Straight about Medicare Keith D. Lind, JD, MS As the nation considers the future of Medicare, it is important to separate the facts from misconceptions about Medicare coverage,
Analysis of the Costs and Impact of Universal Health Care Models for the State of Maryland: The Single-Payer and Multi-Payer Models Final Report Presented to: The Maryland Citizens Health Initiative Education
0 SESSION -0 0/0 HOUSE BILL AN ACT -FN-A establishing a single payer health care system and making an appropriation therefor. SPONSORS: Rep. McNamara, Hills ; Rep. Suzanne Smith, Graf ; Rep. Moody, Rock
Prepared by: FSA, MAAA 2010 Commercial Health Insurance Market: New Financial and Enrollment Data Available from the Supplemental Exhibit is among the world s largest independent actuarial and consulting
Statement of Linda J. Blumberg, Ph.D. Senior Fellow The Urban Institute Committee on Energy and Commerce Subcommittee on Oversight and Investigations United States House of Representatives Hearing: The
New Federal Rating Rules The Patient Protection and Affordable Care Act ( PPACA ) includes new federal rules limiting the extent to which insurance companies can impose premium surcharges on individuals
Health Insurance Exchange Study Minnesota Department of Health February, 2008 Division of Health Policy Health Economics Program PO Box 64882 St. Paul, MN 55164-0882 (651) 201-3550 www.health.state.mn.us
Basic Health Plan Offers a Chance to Provide Comprehensive Health Care Coverage for Low-Income Minnesotans The number of uninsured in Minnesota has been on the rise over the last decade, with one out of
Affordable Care Act 101: What The Health Care Law Means for Small Businesses February 2013 These materials are provided for informational purposes only and are not intended as legal or tax advice. Readers
WWW.BKLAWYERS.COM HEALTH REFORM AND MULTIEMPLOYER PLAN COVERAGE 2014 AND BEYOND ABA SECTION OF LABOR AND EMPLOYMENT LAW EMPLOYEE BENEFITS COMMITTEE MID- WINTER MEETING 201 BLITMAN & KING LLP Franklin Center,
FOR PRODUCERS AND EMPLOYERS Health care reform for large businesses A guide to what you need to know now DECEMBER 2013 CONTENTS 2 Introduction Since 2010 when the Affordable Care Act (ACA) was signed into
Senate Finance Committee Health Care Reform Bill Below is a review of those measures contained in the Senate Finance Committee s draft on health care reform that correspond to issues contained in the NLN
MAWD or Marketplace? What Pennsylvanians with Disabilities Need to Know About Choosing Health Insurance Coverage Summary Choosing health insurance coverage that best meets one s needs is important, especially
AN ACT RELATING TO HEALTH INSURANCE; MAKING CHANGES IN THE HEALTH INSURANCE PORTABILITY ACT TO FULFILL FEDERAL LAW REQUIREMENTS; AMENDING PROVISIONS OF THE INSURANCE CODE TO PROVIDE CONSISTENCY; DECLARING
http://healthreform.gov/about/answers.html Answers For Families And Small Business Q: What is the small business tax credit and how do I know if I am eligible? A: Effective January 1, 2010, tax credits
Small Employer Health Insurance Survey South Carolina State Planning Grant So that we can ensure our survey sample is geographically representative of the state, it is very important that you provide the
Health Care Coverage and Financing in Minnesota: Public Sector Programs January 2003 h ealth e conomics p rogram Health Policy and Systems Compliance Division Minnesota Department of Health Health Care
GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 00 S 1 SENATE BILL Short Title: Small Business Health Insurance Expansion. (Public) Sponsors: Referred to: Senators Stein; Apodaca, Berger of Franklin, Dorsett,
Appendix B Overview of State High Risk Insurance Pools and Catastrophic Health Insurance Plans Health Insurance Pools Roughly 37 million Americans under the age of 65 do not have adequate health insurance.
CHAPTER 7 (Senate Bill 6) AN ACT concerning Working Families and Small Business Health Coverage Act FOR the purpose of establishing a Small Employer Health Insurance Benefit Plan Premium Subsidy Program;
Household health care spending: comparing the Consumer Expenditure Survey and the National Health Expenditure Accounts Ann C. Foster Health care spending data produced by the Federal Government include
Summary of the Major Provisions in the Patient Protection and Affordable Care Act Updated 10/22/10 On March 23, 2010, President Barack Obama signed into law comprehensive health care reform legislation,
If I have a psychiatric disability Will Health Reform Help Me? For consumers of mental health services, a review of the bills passed by Congress in 2009 This paper was written by Chris Koyanagi, policy
The Healthcare Law April 19, 2010 This healthcare bill, recently made law, is a comprehensive overhaul that increases coverage to 94% of Americans and makes sweeping changes to our current healthcare system.
Federal Health Care Reform: Implications for New York Division of Coverage and Enrollment Office of Health Insurance Programs Health Bureau Insurance Department June 2010 Federal Health Care Reform: Where
EXPANDING COVERAGE FOR THE ILLINOIS UNINSURED: A PROPOSAL BY THE ILLINOIS HOSPITAL ASSOCIATION EXPANDING COVERAGE FOR THE ILLINOIS UNINSURED: A PROPOSAL BY THE ILLINOIS HOSPITAL ASSOCIATION March 21, 2006
Laurus Strategies Legislative Brief: COMPREHENSIVE HEALTH COVERAGE ESSENTIAL HEALTH BENEFITS PACKAGE The Affordable Care Act (ACA) requires non grandfathered health insurance plans in the individual and
Home Care Association of Washington Conference MaryAnne Lindeblad, State Medicaid Director Washington Health Care Authority April 25, 2013 Overview Overview of Health Care Authority Public Employees Benefits
CHAPTER 26.1-36.3 SMALL EMPLOYER EMPLOYEE HEALTH INSURANCE 26.1-36.3-01. Definitions. As used in this chapter and section 26.1-36-37.2, unless the context otherwise requires: 1. "Actuarial certification"
8/17/2006 06 RM 045 Date: August 17, 2006 Research Memo Author: Don C. Richards, Senior Research Analyst Joy N. Hill, Associate Research Analyst Re: Comparison of Wyoming and Montana s High-Risk Health
This page provides answers to frequently asked questions (FAQ) regarding The Patient Protection and Affordable Care Act (PPACA; P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010
Article 68. Health Insurance Portability and Accountability. 58-68-1 through 58-68-20: Repealed by Session Laws 1997-259, s. 1(a). Part A. Group Market Reforms. Subpart 1. Portability, Access, and Renewability
A Healthy Florida Works Program Policy Proposal The smart choice for individuals and businesses in Florida TABLE OF CONTENTS Introduction Executive Summary Program Description 3 5 6 Coverage Population