One of the many ongoing battles over the Patient Protection and Affordable Care Act (PPACA) involves the federal minimum medical loss ratio (MLR) standards for private insurers. Under this provision, health insurance plans in the small group market are required to spend at least 80 percent of premiums on medical costs and no more than 20 percent on administrative costs (15 percent for the large group market). If a plan fails to meet the minimum MLR standard, the insurer is required to pay rebates to enrollees and policyholders.
The COBRA Blog
The health insurance exchanges opened last week, drawing a great deal of interest and some poor reviews. Unfortunately, heavy traffic caused functional difficulties for many.
Critics of the Patient Protection and Affordable Care Act (PPACA) have been concerned about the recent mandate delay, suggesting it will put everyone on the honor system for income verification and qualification for the tax credits. Because the IRS can pay these tax credits in advance to help consumers buy coverage, critics claim it’s an open invitation to fraud and abuse.
Workplace wellness programs used to consist of a few wall posters encouraging healthy behavior or maybe even a gym at the office. But employers are increasingly turning to more incentives and penalties to encourage healthier choices. In fact, according to a recent survey from Fidelity Investments and the National Business Group on Health, almost 90% of employers offer some kind of wellness incentives to their employees.
With the implementation of the new health insurance exchanges under the Affordable Care Act (ACA) just months away, employers and employees are gearing up for big changes in the health insurance market. Your employees will have more options under the new law, and they probably have a lot of unanswered questions.
As part of the new regulatory expansion regarding the Health Insurance Portability and Accountability Act (HIPAA), the Department of Health and Human Services’ Office issued its final ruling regarding the modification of the act’s security, privacy, and breach notification requirements. The final rule, which came into effect on March 26, 2013, requires that all employers, vendors, and health care providers become compliant by September 23rd or face significant financial penalties up to $50,000 per violation and $1.5 million for multiple infractions of the same kind.
A recent rule Affordable Care Act (ACA) rule limits the out-of-pocket expenses that group health care plan providers can ask employees to pay.