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Insurance limit in State societies

Insurance commissioners suggest barring health plans from bearing in mind anti-fraud efforts, coding upgrades and some consumption review as medical expenditures.
Physician and hospital associations have expressed general support for a proposal from state insurance commissioners on what health insurers should be allowable to believe medical spending under new  individual health insurance system improvement regulations.
On Aug. 17, the NAIC unanimously accepted the forms that insurers will fill up  to report their financial information to state regulators, who then will compute the medical-loss ratios. If plans have not used up enough premium dollars on patient care, they will be required by the health reform law to provide rebate to subscribers.
By setting precise criteria for what can be measured quality improvement expenses, the NAIC efficiently has proposed definitions for what constitute a medical cost. It will subject the final report on these recommendations this fall. However, the Dept. of Health and Human Services immobile must give final endorsement to the criteria, meaning the rules could become more or less warning on insurers before they take effect in 2011.
The NAIC has given insurers a number of leeways in its proposal. Health plan behavior that would count as excellence improvement include comprehensive release planning, case management, care management, chronic disease organization, and health information technology expenses related to preventing hospital readmissions and plummeting medical errors. Insurers would be talented to consider costs associated with certain public health education campaign to be in the wellness and health endorsement category, also a medical expense.

This entry was posted on Monday, August 30th, 2010 at 4:16 am and is filed under Group Health Insurance, Health Insurance, Individual Health Insurance. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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