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    Sec. 2714. Ensuring Value and Lower Premiums.: N Eneral

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    Chettamils
    This document discusses ensuring value and lower premiums in health insurance. It specifies that health insurance issuers that offer coverage in small or large group markets must provide rebates to enrollees if the coverage has a medical loss ratio below a level set by the Secretary. The Secretary will establish a uniform definition of medical loss ratio and methodology for calculating it, taking into account factors like smaller plans, different plan types, and newer plans. Similar requirements will also apply to health insurance coverage offered in the individual market.

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    Download as PDF, TXT or read online from Scribd

    Sec. 2714. Ensuring Value and Lower Premiums.: N Eneral

    Uploaded by

    Chettamils
    20 views1 page
    This document discusses ensuring value and lower premiums in health insurance. It specifies that health insurance issuers that offer coverage in small or large group markets must provide rebates to enrollees if the coverage has a medical loss ratio below a level set by the Secretary. The Secretary will establish a uniform definition of medical loss ratio and methodology for calculating it, taking into account factors like smaller plans, different plan types, and newer plans. Similar requirements will also apply to health insurance coverage offered in the individual market.

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    NewBillText-1409-53

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    NewBillText-1409-53

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    This document discusses ensuring value and lower premiums in health insurance. It specifies that health insurance issuers that offer coverage in small or large group markets must provide rebates to enrollees if the coverage has a medical loss ratio below a level set by the Secretary. The Secretary will establish a uniform definition of medical loss ratio and methodology for calculating it, taking into account factors like smaller plans, different plan types, and newer plans. Similar requirements will also apply to health insurance coverage offered in the individual market.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    20 views1 page

    Sec. 2714. Ensuring Value and Lower Premiums.: N Eneral

    Uploaded by

    Chettamils
    This document discusses ensuring value and lower premiums in health insurance. It specifies that health insurance issuers that offer coverage in small or large group markets must provide rebates to enrollees if the coverage has a medical loss ratio below a level set by the Secretary. The Secretary will establish a uniform definition of medical loss ratio and methodology for calculating it, taking into account factors like smaller plans, different plan types, and newer plans. Similar requirements will also apply to health insurance coverage offered in the individual market.

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    © All Rights Reserved
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    of 1

    F:\P11\NHI\TRICOMM\AAHCA09_001.

    XML

    54
    1 ‘‘SEC. 2714. ENSURING VALUE AND LOWER PREMIUMS.

    2 ‘‘(a) IN GENERAL.—Each health insurance issuer


    3 that offers health insurance coverage in the small or large
    4 group market shall provide that for any plan year in which
    5 the coverage has a medical loss ratio below a level specified
    6 by the Secretary, the issuer shall provide in a manner
    7 specified by the Secretary for rebates to enrollees of pay-
    8 ment sufficient to meet such loss ratio. Such methodology
    9 shall be set at the highest level medical loss ratio possible
    10 that is designed to ensure adequate participation by
    11 issuers, competition in the health insurance market, and
    12 value for consumers so that their premiums are used for
    13 services.
    14 ‘‘(b) UNIFORM DEFINITIONS.—The Secretary shall
    15 establish a uniform definition of medical loss ratio and
    16 methodology for determining how to calculate the medical
    17 loss ratio. Such methodology shall be designed to take into
    18 account the special circumstances of smaller plans, dif-
    19 ferent types of plans, and newer plans.’’.
    20 (b) INDIVIDUAL HEALTH INSURANCE COVERAGE.—
    21 Such title is further amended by inserting after section
    22 2753 the following new section:
    23 ‘‘SEC. 2754. ENSURING VALUE AND LOWER PREMIUMS.

    24 ‘‘The provisions of section 2714 shall apply to health


    25 insurance coverage offered in the individual market in the

    f:\VHLC\071409\071409.140.xml (444390|2)
    July 14, 2009 (12:51 p.m.)
    VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC

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