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Category Archives: Self Insured Health Plans
Health-reform regs overhaul claims appeals process
The Obama Administration released interim final regulations aimed at creating a system of checks and balances for the internal and external appeals processes of health claims.
Governed by the Patient Protection and Affordable Care Act, the interim final rule requires group health plans and insurers to establish a comprehensive appeals processfor patients who appeal decisions on coverage, services and claim payments. The interim final regulations apply to self-funded health plans, but not to grandfathered plans under the PPACA.
The Departments of Health and Human Services, Labor and the Treasury issued the interim final rule, which will take effect on Sept. 21, 2010. Continue reading
Healthcare Reform Bill Overview: Specifics to Self Insurance
The Patient Protection and Affordable Care Act (PPACA) of 2010
An Overview of the Health Care Reform Bill as it relates to the Self Insurance Industry.
The Patient Protection and Affordable Care Act of 2010 will bring about direct impacts on the self-insurance industry. The below bullet points summarize some of the implementations specific to self-funded health care plans.
The following changes are effective for all plans as they renew on September 23, 2010 and thereafter:
A.) Coverage of Emergency Services: All non-grandfathered self insured health plans (SIHP) must cover emergency services without the need for prior authorization; if services are out-of-network, cost sharing is the same as in-network.
B.) Restricted annual limits for essential benefits.
C.) Prohibition of Lifetime Limits: SIHP are prohibited from establishing lifetime limits on the dollar value of benefits. Exclusion: SIHP may place restrictions on non-essential health benefits.
D.) Prohibition of Pre-existing conditions: SIHP may not impose any pre-existing condition exclusions on enrollees under age 19. Effective January 1, 2014, all SIHP are prohibited from imposing pre-existing exclusions on any enrollee.
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