David M. Gilston Insurance Agency, Inc.

The Kaiser Family Foundation released a report estimating the impact the Patient Protection and Affordable Care Act’s (PPACA) medical loss ratio (MLR) provisions will have on health insurance consumers this year in the form of premium rebate checks that are supposed to be mailed to health insurance consumers this August. Although $1.3 billion, the total amount of the projected rebates seems large, when you read the fine print, it becomes apparent that these rebates aren’t quite the bonus some have been predicting. Furthermore, the coverage disruptions, loss of agent services, and higher overall premiums caused by both the MLR requirements specifically and PPACA generally, negate any consumer benefit the rebates may provide.

As discussed in our previous blog article, earlier this year, Mary Landrieu (D-LA) had submitted legislation (S. 2068) to try to help protect health insurance agent and broker jobs by attempting to exclude independent health insurance producer compensation from the medical loss ratio (MLR) requirements in the Patient Protection and Affordable Care Act (PPACA). On April 17th, Landrieu, along with cosponsors Johnny Isakson (R-GA), Lisa Murkowski (R-AK) and Ben Nelson (D-NE) re-filed the bill, now titled S. 2288.

The Department of Human Health Services released its rules for states regarding the implementation of health insurance exchanges. According to the HHS, the rules provide “a framework to assist states in building Affordable Insurance Exchanges.” They also “set minimum standards for Exchanges, give states the flexibility they need to design Exchanges that best fit their unique insurance markets, and are consistent with steps states have already taken to move forwards with Exchanges.”

Mary Landrieu (D-LA) has submitted legislation (S 2068) to try to help protect health insurance agent and broker jobs by attempting to exclude independent health insurance producer compensation from the medical loss ratio (MLR) requirements in the Patient Protection and Affordable Care Act (PPACA). The bill’s co-sponsors are Ben Nelson (D-Neb.), Johnny Isakson (R-GA) and [...]

The essential benefits report, created by the Institute of Medicine (IOM), has been released. The Affordable Care Act requires the package to reflect benefits covered by a typical employer plan and include 10 categories. According to the report, HHS officials will compare potential services and products against a set of critera, created by the IOM, including medial effectiveness, safety and relative value compared with alternative options, and evaluate whether the package as a whole protects the most vulnerable individuals, promotes services that have proved effective and addresses the medical concerns of greatest important to the public. In keeping with their assigned task, the IOM did not address and specific types of benefits in their recommendations. It instead tells the Secretary of HHS how to define the minimum benefits. Click here to view additional recourses by the IOM including the IOM’s press release, criteria, report brief and report release presentation.

HHS issued two rules on August 1st addressing the preventive care requirements in the Patient Protection and Affordable Care Act (PPACA). The first is a proposed rule, which would require new health insurance plans to cover women’s preventive services without charging a co-payment, co-insurance or deductibles for plan years starting on or after August 1, 2012. The requirement will not apply to grandfathered plans that were in effect before the law was enacted on March 23, 2010.

The first “unintended consequence” of the Patient Protection and Affordable Care Act (PPACA) addressed in Part 1 of the blog described how routine physical exams were not specifically listed as a preventive service under health reform so insurance companies do not have to cover this service. The second “unintended consequence” of health reform addressed in Part 2 of the blog revealed how most insurance companies are not offering individual insurance policies to children under 19 since they are prohibited from applying pre-existing conditions exclusions. The third and final “unintended consequence” of health reform that I will discuss relates to dependent children under the age of 26 staying on their parents’ plans.

The first “unintended consequence” of the Patient Protection and Affordable Care Act (PPACA) addressed in Part 1 of our blog described how routine physical exams were not specifically listed as a preventive service under health reform so insurance companies do not have to cover this service. Today, we will discuss the second “unintended consequence” of health reform, which addresses how new individual insurance policies are prohibited from applying pre-existing conditions exclusions for children under 19.

Wikipedia states that the law of unintended consequences is a warning that an intervention in a complex system always creates unanticipated and often undesirable outcomes. Unfortunately, health reform has “unintended consequences” written all over it. Three specific examples include: preventive care, no pre-existing conditions for children under 19, and dependent children under the age of 26 staying on parents’ plans. I’ll focus on the first topic today: preventive care.

On May 31, 2011, the U.S. Department of Health and Human Services (HHS) announced that premiums will be reduced and eligibility requirements will be eased when enrolling in the federally administrated Pre-Existing Condition Insurance Plan (PCIP).