HHS issues mini-med guidance

Posted on December 10, 2010 | No Comments
Filed under Department of Health and Human Services, Health Insurance, Key Developments, Office of Consumer Information and Insurance Oversight, Rulemaking, Rules, and Guidance

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Key Developments

Implementation Briefs

The Department of Health and Human Services has issued guidance on the one-year waiver granted to “mini-med” plans on new regulations concerning annual coverage limits. The sale of such plans are restricted to limited circumstances and insurers are required to “notify consumers in plain language that their plan offers extremely limited benefits and direct them to www.HealthCare.gov where they can get more information about other coverage options.”

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HHS issues MLR interim final rule

December 2, 2011

The U.S. Department of Health and Human Services (HHS) has issued an interim final rule (IFR), with public comment, on the medical loss ratio (MLR) requirement under the Affordable Care Act (ACA). Beginning in 2012, the ACA requires that health insurers spend at least 80% (in some cases 85%) of premiums on health care services, or be required to pay rebates to plan members. HHS issued both the rule itself as well as a separate IFR on the rebate requirements, each allowing for public comment. For more information on medical loss ratios, click here. An update to the previous brief is pending.

Update: Medical Loss Ratio and Rebates in Private Health Insurance

November 23, 2010

This is an updated version of a brief originally published on August 25, 2010. This brief is current as of November 22, 2010. A medical loss ratio (MLR) is the proportion of premium dollars that an insurer spends on health care services relative to health insurance premium paid by subscribers. Prior to the enactment of the health reform law, the federal government required Medicare supplemental insurance (or Medigap policies) to meet minimum federal loss ratio requirements, but did not establish federal standards to define how insurers should categorize losses, nor did those requirements apply to other types of private insurance policies.

Immediate Private Health Insurance Reforms

May 10, 2010

Although most changes in health insurance access rules are not effective until 2014, a number of reforms are designed to go into effect more quickly. These changes apply to health insurance issuers in the group and individual insurance markets as well as to self-funded group health plans and multiple employer welfare arrangements (MEWAs).