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Soraya Ghebleh - Changes to Private Health Insurance

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This is a presentation by Soraya Ghebleh, Anna Condino, Lauren Dudley, and Ramya Vedula that describes some of the changes that will take place in private insurance after healthcare reform takes …

This is a presentation by Soraya Ghebleh, Anna Condino, Lauren Dudley, and Ramya Vedula that describes some of the changes that will take place in private insurance after healthcare reform takes effect.

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  • 1. Changes to Private Insurance Under the Patient Protection and Affordable Care Act (PPAC) Anna Condino, Lauren Dudley, Soraya Ghebleh, Ramya Vedula ECS 111 September 14th, 2012
  • 2. COVERAGE REGULATIONS -  Provide insurance for children of enrollees up to age 26 -  Cannot deny children (and adults, starting in 2014) based on pre-existing conditions -  Cannot cap benefits lifetime or annually -  Plans must offer basic preventive care for free -  Cannot rescind benefits, except in cases of fraud -  Limit deductible amounts and waiting periods -  Allow for greater coverage to all individuals -  Eliminate practices harmful to consumers -  Keep health insurance companies from denying access to high utilizers of healthcare -  Promote health of the population through increased access to preventative services Provisions Rationale
  • 3. COST REGULATION -  Establish state-based health insurance exchanges through which individuals and small businesses can buy insurance -  MLR must be at least 85% for large markets and 80% for smaller ones -  Companies must report what amount of premium money is spent on clinical services for enrollees -  Excise taxes on high-cost, ‘premium coverage’ plans -  Require plans to justify premium raises -  Pressure insurance companies to allocate more resources to enrollees -  Encourage business practices that benefit the consumer Provisions Rationale
  • 4. ADMINISTRATIVE REGULATIONS -  Uniform Coverage Summaries across plans -  Transparent reporting including claims denied, disenrollment, and cost- sharing Adopt regulations to provide for administrative simplification -  Consumer advocacy and safety bureau set up to address consumer concerns -  Further limit employee compensation/ bonuses beyond the MLR stipulation -  Allowed to sell insurance across state lines -  Increase transparency of operations and finances -  Standardized methods of reporting information -  Improve consume knowledge GOOD INFORMATION, FAIR PLAYING FIELD, LOTS OF CHOICES = COMPETITIVE RATES Provisions Rationale
  • 5. HOW WILL THIS IMPACT PRIVATE INSURERS? -  In the words of Doug Weiners, “They want us gone.” -  Adapt to regulations and adopt new strategies to attract customers -  Develop innovations within the framework of the law -  Shift focus from premiums as revenue generator to cost cutting and savings in relationships with hospitals/doctors/enrollees to support their bottom line -  Force them to be transparent and accountable in their practices -  Do these regulations allow for insurance companies to still provide “insurance”?

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