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05 September 2011
A look at the changes coming in 2012, 2013 & 2014.
Companies sponsoring group health plans should be aware of the changes coming to the health insurance industry as part of the “second stage” of health care reform. These major and minor adjustments should be kept on your radar.
What’s new for 2012? Insurers that issue group health plans will have to abide by some new requirements.
- Should plan benefits materially change, the plan issuer will have to provide notice in writing at least 6o days beforehand to plan sponsors and participants.
- Health care plan summaries will have to meet new formatting and content guidelines for clarity, and in the case of fully insured plans, the plan issuer must provide electronic or hard-copy summaries at designated times during the enrollment process.
- Group health plan participants could actually get rebates in 2012 under certain conditions. In 2011, insurers had to start notifying the Department of Health and Human Services of their medical loss ratios – that is, the percentage of premiums that they spend on clinical services and efforts to improve health care quality as opposed to administrative overhead. The minimum medical loss ratio is 80% for individual and small group insurers and 85% for large group insurers. If a plan issuer doesn’t meet this medical loss ratio test for 2011, it must issue rebates to enrollees beginning on August 1, 2012.1,2