NAIC

Love it or hate it, the Affordable Care Act has sparked a great deal of debate within the health care industry. One section of the Patient Protection and Affordable Care Act (PPACA) that has proven to be particularly problematic is a provision establishing Medical Loss Ratio (MLR) benchmarks for health insurance carriers. Several congressional bills have been filed in an attempt to remedy the situation. 

The Department of Health and Human Services (HHS) just released its final Medical Loss Ratio rule, and the outcome does not bode well for the broker/agent community. In the ruling HHS has rejected the NAIC recommendation to exclude broker/agent fees from insurance companies’ allowed administrative costs.

Under the rule beginning this year, individual and small group market insurance plans will be required to spend 80% of the premiums on medical care and health care improvement. Only the remaining 20% will be allowed towards administrative costs. Much the same, large group plans will have an 85% of premium requirement.

The National Association of Insurance Commissioners (NAIC) has passed a resolution (26-20-5) to change health care reform laws related to Medical Loss Ratio. They are recommending that the Department of Human Health and Services (HHS) and Congress work to ensure that the role of professional health insurance agents remains a strong part of the healthcare process. The NAIC resolution strongly supports the need of agents to serve as consumer advocates in the process of securing health care coverage.

Last month, the NAIC published a brief video to help answer questions posed by consumers regarding the Patient Protection and Affordable Care Act (PPACA).[1] Brokers and agents may want to use this video as a reference tool for their clients.  Subjects covered by the video include:

• Individual and employer mandates
• Pre-existing conditions
• Healthcare exchanges
• Preventive care measures
• Medicare. [2]

Click HERE to view the video.