Special Publication Announcement

HealthCheck’s next scheduled publication date is Friday, September 3. Due to the Labor Day weekend, we are moving HealthCheck’s next publication date to Friday, Sept. 10. We’ll resume bi-weekly publication from that date. Enjoy the holiday weekend and look for HealthCheck in three weeks.

Academy Activities

The Academy’s Grandfathering Provisions Work Group submitted a letter to the Department of Health and Human Services (HHS) commenting on the interim final rule (IFR) that addresses the status of health insurance coverage as a grandfathered plan. In addition to responding to specific requests for comments within the IFR, the work group provided comments on transitional rules, the maintenance of grandfathered status, and the applicability of the IFR to individual coverage and plan rolls.

The Academy’s Medical Loss Ratio (MLR) Regulation Work Group submitted a comment letter to HHS as a follow-up to a conference call on credibility issues for the purpose of calculating rebates under the new MLR requirements. The work group provided HHS with input on a proposal of the National Association of Insurance Commissioners’ Actuarial PPACA Subgroup to create a hierarchy for applying credibility and pooling techniques in the implementation of these rebates.

Legislative and Regulatory Updates

The National Association of Insurance Commissioners’ (NAIC) Executive Committee/Plenary voted overwhelmingly to adopt the Medical Loss Ratio (MLR) Blanks Proposal. The Aug. 17 vote came at NAIC’s 2010 National Meeting in Seattle. The Affordable Care Act (ACA) requires insurers to have medical loss ratios of 85 percent in the large group market and 80 percent in the small group and individual markets. Regulators will review the data submitted by insurers through this “blank” and then calculate the MLR and determine any rebate required under the ACA.

In the News

Karen Bender, a volunteer on the Academy’s Committee on Federal Health Issues, discussed the purpose of health insurance capital and surplus in an Aug. 13 report by the Kansas City Business Journal that was published by regional business journals throughout the country. Bender said that surplus and capital are used to ensure health insurer solvency.

An op-ed by Rep. Charles W. Boustany Jr. (R-La.) published by the Washington Examiner on Aug. 18 cited an Academy letter to the U.S. Senate Committee on Health, Education, Labor and Pensions regarding actuarial issues with the Community Living Assistance Services and Supports (CLASS) Act. The Academy wrote that there is a “significant potential for increased adverse selection, necessitating further changes, which may make the program unsustainable.”

News links are to external websites. The Academy is not responsible for the content of these websites.