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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.
This final rule with comment period revises the regulations implementing medical loss ratio (MLR) requirements for health insurance issuers under the Public Health Service Act in order to address the treatment of “mini-med” and expatriate policies under these regulations for years after 2011; modify the way the regulations treat ICD-10 conversion costs; change the rules on deducting community benefit expenditures; and revise the rules governing the distribution of rebates by issuers in group markets.
Click here to read the HHS fact sheet, or here to review the complete rule document.
Many of you have commented on our various social media venues with regard to your concerns about the NAIC vote and how many insurance commissioners were not in support of our broker/agent community. With 20 of the 26 “yes” votes coming from the Republican Party and 16 of the 20 “no” votes coming from the Democratic Party, there now appears to be signs that these issues will be supported or rejected by party lines over the actual merits of the proposed amendments. Now more than ever, we should be reaching out to our Insurance Commissioners and elected officials to share our concerns and fears for our industry and health care as a whole.
Click here to see a list of Insurance Commissioners and their vote, or here to access their contact information.
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