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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 effect.

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Soraya Ghebleh - Changes to Private Health Insurance

  1. 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. 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. 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. 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. 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”?