Posts Tagged - ‘mlr’

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State Health Insurance Commissioners To Rule on Medical Loss Ratios

Thursday, October 21st, 2010

Image: turtlemom4bacon under CC 3.0

All eyes are on Orlando today, but not because of anything Mickey Mouse has done. Rather, it is a meeting of several states’ insurance commissioners. Their topic: coming up with the rules that insurers will have to abide by post-healthcare reform.

Specifically, they are responsible for calculating minimum medical loss ratios. MLRs are also known as the percentage of premiums spent on providing health care, as opposed to profits and administrative expenses. Proponents of the limits believe that they will result in more affordable health insurance for consumers. However, some are worried that the new rules will make some niches and entire markets–such as small groups–less appealing, and that people will become uninsured as a result.

The group’s recommendations will become effective next year. Although the already-determined limits are 85% for large group plans and 80% for small groups and individuals, the commissioners will consider tax exemptions and a longer phasing-in period. Most significantly, they will help determine what counts as a medical expense. Insurers obviously want a wider definition of qualified medical costs.

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Sen. Rockefeller Accuses Health Insurance Companies of Weakening Reform

Tuesday, May 11th, 2010

Image: West Virginia Blue under CC 3.0

Health insurance reform is already starting to make many changes to how insurers do business. Obviously, they were opposed to the legislation, but since it passed they have been attempting to ensure that it’s enforced in the most favorable way.

Democratic Senator Jay Rockefeller thinks they may be going too far in trying to weaken healthcare reform provisions. He accuses them of hiring lobbyists to water down the spending rules that will force them to spend higher percentages of the health insurance plan premiums collected on providing medical services (as opposed to shareholder dividends or administrative costs). The National Association of Insurance Commissioners (NAIC) and Secretary of Health Insurance Kathleen Sebelius must make their recommendations on the issue by June 1st.

Specifically, he is warning the Obama administration of accounting and statistical tricks that mask the fact that while many insurers already meet the new standards (a medical loss ratio of 85% in large group policies and 80% for individual and small group policies) in many products and areas, they are not yet universally compliant–although they may aggregate their information together in a way that claims to be. In addition, they may be trying–in advance of the 2014 deadline–to classify as many costs as possible as medical expenses.

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