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Medical Loss Ratio Requirements Under The Patient Protection And Affordable Care Act Aca
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Book Synopsis Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care ACT (ACA) by : Suzanne M. Kirchhoff
Download or read book Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care ACT (ACA) written by Suzanne M. Kirchhoff and published by CreateSpace. This book was released on 2015-06-26 with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt: The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148) requires certain health insurers to provide consumer rebates if they do not meet a set financial target known as a medical loss ratio (MLR). At its most basic, a MLR measures the share of health care premium dollars spent on medical benefits, as opposed to company expenses such as overhead or profits. For example, if an insurer collects $100,000 in premiums and spends $85,000 on medical care, the MLR is 85%. In general, the higher the MLR, the more value a policyholder receives for his or her premium dollar. The ACA requires an annual, minimum 80% MLR for individual and small group insurance plans, and an annual, minimum 85% MLR for large group plans. Congress imposed the MLR to provide "greater transparency and accountability around the expenditures made by health insurers and to help bring down the cost of health care."
Book Synopsis Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act (ACA): Issues for Congress by : Suzanne M. Kirchhoff
Download or read book Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act (ACA): Issues for Congress written by Suzanne M. Kirchhoff and published by Createspace Independent Pub. This book was released on 2012-10-20 with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt: The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) requires certain health insurers to provide rebates to their customers for each year that the insurers do not meet a set financial target called a medical loss ratio (MLR). At its most basic, a MLR measures the share of a health care premium dollar spent on medical benefits, as opposed to company expenses such as overhead or profits. For example, if total premiums collected are $100,000, and $85,000 is spent on medical care, the MLR would be 85%. The ACA sets the minimum required MLR at 80% for the individual and small group markets and at 85% for the large group market. In general, the higher the MLR, the more value a policyholder receives for his or her premium payment. Congress imposed the MLR in an effort to provide “greater transparency and accountability around the expenditures made by health insurers and to help bring down the cost of health care.” Insurers that fail to meet these minimum standards must provide rebates to policyholders. The Department of Health and Human Services (HHS), with input from state insurance commissioners who are the main regulators of health insurance, issued rules for implementing the provisions. These rules provided greater details for calculating the MLR and issuing rebate payments. ACA allows companies to include quality improvements along with medical benefits when calculating the MLR. In addition, state and local taxes and some licensing fees are subtracted (i.e., disregarded) from expenses in the MLR formula. ACA's requirements are different from those imposed by state laws, which generally compare only medical claims to premiums. Though a number of states have their own MLRs, the ACA is now the minimum standard that must be met nationwide by certain health insurers. About 12.8 million U.S. consumers were due more than $1.1 billion in ACA MLR rebate payments in August 2012, for an average award of $151 per qualifying household. Employers or insurers can provide the rebates, which are based on activity in 2011, via a check, an electronic deposit in a bank account, a reduction in future insurance premiums in the amount of the rebate, or by spending the funds for the benefit of employees. About 66.7 million people were insured by covered companies that met or exceeded MLR standards for 2011, and will not receive rebates. The MLR is based on the aggregate performance of a health plan, not individual policy history. Even if a beneficiary had no medical claims during a given year, he or she would not receive a rebate if the broader plan met the MLR requirements. In addition, many Americans were enrolled in health plans that were not covered by the ACA MLR provisions in 2011. The ACA MLR provisions cover only fully funded health plans, which are plans where insurance companies assume the full risk for medical expenses incurred. The requirements do not extend to self-funded plans, which are health care plans offered by businesses in which the employer assumes the risk for, and pays for, medical care. Non-profit insurers and some Medicare Advantage plans were not covered by the ACA MLR standards in 2012, though the MLR provisions will be phased in during 2013 and 2014, respectively. In addition, some states won special exceptions for individual insurance policies, based on a HHS determination that meeting the MLR requirement would harm a state's insurance market. Several issues have been raised about the MLR provisions since the ACA was enacted. These include considerations regarding the treatment of insurance agent and broker bonuses and commissions, the impact of the MLR on insurers that provide high deductible plans, and special rules for non-profit health insurers.
Book Synopsis Crs Report for Congress by : Suzanna M. Kirchhoff
Download or read book Crs Report for Congress written by Suzanna M. Kirchhoff and published by BiblioGov. This book was released on 2013-11 with total page 34 pages. Available in PDF, EPUB and Kindle. Book excerpt: The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) requires certain health insurers to provide rebates to their customers for each year that the insurers do not meet a set financial target called a medical loss ratio (MLR). At its most basic, an MLR measures the share of a health care premium dollar spent on medical benefits, as opposed to company expenses such as overhead or profits. For example, if total premiums collected are $100,000, and $85,000 is spent on medical care, the MLR would be 85%. The ACA sets the minimum required MLR at 80% for the individual and small group markets and at 85% for the large group market. In general, the higher the MLR, the more value a policyholder receives for his or her premium payment. Congress imposed the MLR in an effort to provide "greater transparency and accountability around the expenditures made by health insurers and to help bring down the cost of health care." Insurers that fail to meet these minimum standards must provide rebates to policyholders. The Department of Health and Human Services (HHS), with input from state insurance commissioners who are the main regulators of health insurance, issued rules ...
Book Synopsis Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act (Aca) by : Congressional Research Service
Download or read book Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act (Aca) written by Congressional Research Service and published by CreateSpace. This book was released on 2015-01-29 with total page 30 pages. Available in PDF, EPUB and Kindle. Book excerpt: The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148) requires certain health insurers to provide consumer rebates if they do not meet a set financial target known as a medical loss ratio (MLR). At its most basic, a MLR measures the share of health care premium dollars spent on medical benefits, as opposed to company expenses such as overhead or profits. For example, if an insurer collects $100,000 in premiums and spends $85,000 on medical care, the MLR is 85%. In general, the higher the MLR, the more value a policyholder receives for his or her premium dollar. The ACA requires an annual, minimum 80% MLR for individual and small group insurance plans, and an annual, minimum 85% MLR for large group plans. Congress imposed the MLR to provide “greater transparency and accountability around the expenditures made by health insurers and to help bring down the cost of health care.” The Department of Health and Human Services (HHS) issued rules to implement the MLR with input from state insurance commissioners, who are the main regulators of health insurance. The ACA statute and regulations allow companies to include both quality improvements and medical services when calculating total MLR medical spending. Insurers may subtract (i.e., disregard) state and local taxes and some licensing fees from total MLR expenses. The federal ACA requirements differ from many state MLR laws, which generally compare medical claims to premiums. The ACA MLR is now the national minimum standard that must be met by covered health insurers. The ACA MLR is based on an insurer's annual aggregate performance, not on each individual's policy history. A consumer who paid health insurance premiums but did not file any medical claims during a plan year would not qualify for a rebate if his or her insurer met minimum MLR requirements. In addition, many Americans are enrolled in health plans that are not covered by the ACA MLR. The MLR provisions apply to fully funded health plans, which are plans where insurance companies assume full risk for incurred medical expenses. The MLR does not extend to self-funded plans, which are health care plans offered by businesses where the employer assumes the risk for, and pays for, medical care. Medicare plans were not subject to the MLR during the first two years the ACA was in effect. These insurers began complying with MLR provisions beginning in calendar 2014. The HHS granted three-year MLR waivers to select states where it determined that MLR implementation could harm the individual insurance market. Congress included language in the Consolidated and Further Continuing Appropriations Act of 2015 (H.R. 83, P.L. 113-235) exempting expatriate insurance plans from MLR reporting requirements. For the 2013 plan year, insurers owed $332 million in MLR rebate payments to 6.8 million consumers. That is significantly less than the $1.1 billion in rebates to 12.8 million individuals in 2011, the first year the MLR was in effect. Insurers and employers may provide the rebates via a check, an electronic deposit in a bank account, a reduction in insurance premiums, or by spending the funds for the benefit of employees. Lawmakers have raised some concerns about the MLR provisions, including the fact that insurers are not allowed to deduct insurance agent and broker bonuses and commissions from their MLR expenses.
Author :United States. Congress. Senate. Committee on Commerce, Science, and Transportation Publisher : ISBN 13 : Total Pages :76 pages Book Rating :4.:/5 (319 download)
Book Synopsis Delivering Better Health Care Value to Consumers by : United States. Congress. Senate. Committee on Commerce, Science, and Transportation
Download or read book Delivering Better Health Care Value to Consumers written by United States. Congress. Senate. Committee on Commerce, Science, and Transportation and published by . This book was released on 2014 with total page 76 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Affordable Care Act by : Sean R. Abernathy
Download or read book Affordable Care Act written by Sean R. Abernathy and published by Nova Science Publishers. This book was released on 2014 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Congress is deeply divided over implementation of the Patient Protection and Affordable Care Act (ACA). Since the ACA's enactment, lawmakers opposed to specific provisions in the ACA, or to the entire law, have debated implementation of the law on numerous occasions and considered multiple bills to repeal, defund, delay, or otherwise amend the law. Topics discussed in this compilation include the legislative actions to repeal, defund, or delay the Affordable Care Act; health insurance exchanges under the patient protection and ACA; health insurance premium credits in the patient protection and ACA; physician supply; annual fees on health insurers; and medical loss ratio requirements under the patient protection and ACA.
Book Synopsis The Affordable Care Act and Health Insurance Markets by : Christine Eibner
Download or read book The Affordable Care Act and Health Insurance Markets written by Christine Eibner and published by Rand Corporation. This book was released on 2013-08-29 with total page 117 pages. Available in PDF, EPUB and Kindle. Book excerpt: In this report, the authors estimate the effects of the Affordable Care Act on health insurance enrollment and premiums for ten states (Florida, Kansas, Louisiana, Minnesota, New Mexico, North Dakota, Ohio, Pennsylvania, South Carolina, and Texas) and for the nation overall, with a focus on outcomes in the nongroup and small group markets.
Book Synopsis The Affordable Care Act by : Tamara Thompson
Download or read book The Affordable Care Act written by Tamara Thompson and published by Greenhaven Publishing LLC. This book was released on 2014-12-02 with total page 130 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Patient Protection and Affordable Care Act (ACA) was designed to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage, and reduce the costs of healthcare overall. Along with sweeping change came sweeping criticisms and issues. This book explores the pros and cons of the Affordable Care Act, and explains who benefits from the ACA. Readers will learn how the economy is affected by the ACA, and the impact of the ACA rollout.
Book Synopsis The Affordable Care Act by : Sean R. Abernathy
Download or read book The Affordable Care Act written by Sean R. Abernathy and published by . This book was released on 2014 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: Congress is deeply divided over implementation of the Patient Protection and Affordable Care Act (ACA). Since the ACA's enactment, lawmakers opposed to specific provisions in the ACA, or to the entire law, have debated implementation of the law on numerous occasions and considered multiple bills to repeal, defund, delay, or otherwise amend the law. Topics discussed in this compilation include the legislative actions to repeal, defund, or delay the Affordable Care Act; health insurance exchanges under the patient protection and ACA; health insurance premium credits in the patient protection and ACA; physician supply; annual fees on health insurers; and medial loss ratio requirements under the patient protection and ACA. (Imprint: Nova)
Book Synopsis Health Benefits Coverage Under Federal Law--. by :
Download or read book Health Benefits Coverage Under Federal Law--. written by and published by . This book was released on 2010 with total page 108 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author :National Academies of Sciences Engineering and Medicine Publisher : ISBN 13 :9780309685061 Total Pages : pages Book Rating :4.6/5 (85 download)
Book Synopsis The Future of Nursing 2020-2030 by : National Academies of Sciences Engineering and Medicine
Download or read book The Future of Nursing 2020-2030 written by National Academies of Sciences Engineering and Medicine and published by . This book was released on 2021-09-30 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The decade ahead will test the nation's nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions. A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report.
Author :National Academies of Sciences, Engineering, and Medicine Publisher :National Academies Press ISBN 13 :0309452961 Total Pages :583 pages Book Rating :4.3/5 (94 download)
Book Synopsis Communities in Action by : National Academies of Sciences, Engineering, and Medicine
Download or read book Communities in Action written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2017-04-27 with total page 583 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.
Book Synopsis An American Sickness by : Elisabeth Rosenthal
Download or read book An American Sickness written by Elisabeth Rosenthal and published by Penguin. This book was released on 2017-04-11 with total page 434 pages. Available in PDF, EPUB and Kindle. Book excerpt: A New York Times bestseller/Washington Post Notable Book of 2017/NPR Best Books of 2017/Wall Street Journal Best Books of 2017 "This book will serve as the definitive guide to the past and future of health care in America.”—Siddhartha Mukherjee, Pulitzer Prize-winning author of The Emperor of All Maladies and The Gene At a moment of drastic political upheaval, An American Sickness is a shocking investigation into our dysfunctional healthcare system - and offers practical solutions to its myriad problems. In these troubled times, perhaps no institution has unraveled more quickly and more completely than American medicine. In only a few decades, the medical system has been overrun by organizations seeking to exploit for profit the trust that vulnerable and sick Americans place in their healthcare. Our politicians have proven themselves either unwilling or incapable of reining in the increasingly outrageous costs faced by patients, and market-based solutions only seem to funnel larger and larger sums of our money into the hands of corporations. Impossibly high insurance premiums and inexplicably large bills have become facts of life; fatalism has set in. Very quickly Americans have been made to accept paying more for less. How did things get so bad so fast? Breaking down this monolithic business into the individual industries—the hospitals, doctors, insurance companies, and drug manufacturers—that together constitute our healthcare system, Rosenthal exposes the recent evolution of American medicine as never before. How did healthcare, the caring endeavor, become healthcare, the highly profitable industry? Hospital systems, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes. Research charities are in bed with big pharmaceutical companies, which surreptitiously profit from the donations made by working people. Patients receive bills in code, from entrepreneurial doctors they never even saw. The system is in tatters, but we can fight back. Dr. Elisabeth Rosenthal doesn't just explain the symptoms, she diagnoses and treats the disease itself. In clear and practical terms, she spells out exactly how to decode medical doublespeak, avoid the pitfalls of the pharmaceuticals racket, and get the care you and your family deserve. She takes you inside the doctor-patient relationship and to hospital C-suites, explaining step-by-step the workings of a system badly lacking transparency. This is about what we can do, as individual patients, both to navigate the maze that is American healthcare and also to demand far-reaching reform. An American Sickness is the frontline defense against a healthcare system that no longer has our well-being at heart.
Author :United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health Publisher : ISBN 13 : Total Pages :180 pages Book Rating :4.:/5 (319 download)
Book Synopsis PPACA's Effects on Maintaining Health Coverage and Jobs by : United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health
Download or read book PPACA's Effects on Maintaining Health Coverage and Jobs written by United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health and published by . This book was released on 2012 with total page 180 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Small Business and the Affordable Care Act by : Shane R. Lincoln
Download or read book Small Business and the Affordable Care Act written by Shane R. Lincoln and published by Nova Science Publishers. This book was released on 2014 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Patient Protection and Affordable Care Act contains several provisions to encourage employer-sponsored health coverage, particularly among small businesses. The provisions that most directly relate to small businesses are, an employer penalty for not providing health insurance; a tax credit to increase the affordability of health care for the smallest firms; and small business health insurance exchanges designed to increase plan options and lower plan costs. First, this book explains how employer-sponsored insurance can be used to address concerns about health insurance coverage and cost. It summarises the three ACA provisions most relevant to small businesses, listed above, and analyses these provisions for their potential effects on small businesses. The book then presents several approaches that could address some concerns associated with these provisions (particularly the employer penalty).
Book Synopsis 2020 Healthcare Reform Facts by : Michael D. Thomas
Download or read book 2020 Healthcare Reform Facts written by Michael D. Thomas and published by . This book was released on 2019-11 with total page 736 pages. Available in PDF, EPUB and Kindle. Book excerpt: Healthcare Reform Facts is the comprehensive, go-to source for information regarding the impact of the Patient Protection and Affordable Care Act (PPACA). Uniquely organized in a convenient and easy-to-understand question and answer format, 2020 Healthcare Reform Facts helps you quickly and confidently find the answers you need to the most frequently asked questions on the PPACA. This publication helps you understand the continuing implementation of the ACA and related legislation, rules, regulations and requirements, ensuring that you and your clients are in compliance with the Affordable Care Act. It clearly explains: "Medicare for All" and the future of healthcare reform Types of health insurance affected by healthcare reform Reasons employers should or should not continue to offer health insurance Tax incentives for offering health insurance and required coverages Tax and other benefits of a grandfathered or grandmothered plan How the health insurance exchanges work as well as a host of other valuable information New in the 2020 Edition: 165 newly added questions and answers, including 20 new questions on Short-Term Limited Duration policies and 76 new questions on the future of healthcare reform Update on the continuing legal challenges to the Affordable Care Act Updates on the status of Grandfathered Plans and Grandmothered Plans New developments with Cafeteria Plans and SIMPLE Cafeteria Plans Changes to Medical Loss Ratio and limited wrap around coverage Changes in Qualified Health Plan (QHP) certifications Changes in how Individual Health Insurance Tax Credits are calculated Changes in participation of Health Exchanges from state to federal sites Medicaid Expansion update and analysis Update in reporting requirements Effect of HRAs and QSEHRAs Updated deductible values, cost sharing limits, Wellness program information, and Federal Poverty Guidelines Changes in Employer Mandate to offer coverage and the penalty for not meeting affordability requirements Effect of the repeal of Individual Mandate 2020 update on related taxes, such as tanning bed tax, the additional Medicare tax, medical device tax, and Medicare tax on investment income of 3.8%, and the continuing delay in the implementation of the Cadillac Tax Topics Covered: Goals and major components of healthcare reform Impact of healthcare reform on employer fringe benefits Timeline for implementation of provisions Health reform provisions that have been repealed, expired, or not implemented Small business provisions Grandfathered health plans And More! See the "Table of Contents" section for a full list of topics
Book Synopsis Health Care in the United States by : Leone Giangiulio
Download or read book Health Care in the United States written by Leone Giangiulio and published by Nova Science Publishers. This book was released on 2013-02 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The health care reform debate in the United States, raises many complex issues including those of coverage, accessibility, cost, accountability, and quality of health care. Underlying these policy considerations are issues regarding the status of health care as a constitutional or legal right. This book series analyses the constitutional and legal issues pertaining to the right of health care and the power of Congress to enact and fund health care programs. Other topics discussed in this volume include the constitutionality of the individual mandate; health insurance exchanges under the Patient Protection and Affordable Care Act (ACA); health care flexible spending accounts; tax-advantaged accounts for health care expenses; medical loss ratio requirements under the ACA; and an overview of health savings account rules.
