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Health Reform’s Progress To Date

Today, Secretary Sebelius issued a letter to Congressional leadership outlining the roll-out of reform’s early deliverables. Below is an overview:

Dependent Coverage Expansion
The law states that by September 23rd, insurance plans must allow children up to age 26 to be able to stay on their parent’s insurance plan; 65 insurance companies have voluntarily agreed to implement the provision earlier than that deadline. With young adults holding the highest rate of uninsurance by age group (30%), the provision will allow 1.2 million children to remain on their parents’ insurance at a premium increase of as little as 0.7%.

Pre-Existing Conditions
Children with pre-existing conditions are slated to be completely protected from coverage denial in September; insurance companies agreed to this in full in March. As an equal clause for adults does not go into effect until 2014, $5 billion for high risk pools will be issued on July 1 to provider assistance. Applications were sent yesterday to the 30 states that indicated they wish to run their own pool (California included).

Early Retiree Insurance Program
The $5 billion program had its start date moved up to June 1 in order to provide earlier assistance to businesses that offer coverage to retirees age 55-64. Read the recently released HHS fact sheet here. Both self-funded and insured plans may apply, including plans sponsored by private entities, state and local governments, nonprofits, religious entities, and unions.

Medicare Part D Doughnut Hole
Seniors will begin to receive $250 rebate checks as soon as June 15, with 4 million beneficiaries receiving checks in 2010.

Medical Loss Ratios
The law will require insurance plans in the large group market to spend 85% of premium dollars on clinical services, and 80% in the small group market. The National Association of Insurance Commissioners (NAIC) is instructed to submit uniform definitions and methods of the MLRs by the end of the year, but recently agreed to accelerate submission of these definitions by June 1. It is imperative that these definitions only include services and expenses that actually relate to delivery and quality of care, as opposed to artificially inflating MLRs with administrative costs.

You can read more about these provisions (as well as submit comments) at the new Office of Consumer Information and Insurance Oversight (OCIIO) website.

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