This is a presentation by Soraya Ghebleh, Anna Condino, Lauren Dudley, and Ramya Vedula that describes some of the changes that will take place in private insurance after healthcare reform takes effect.

1. Changes to Private Insurance
Under the Patient Protection and
Affordable Care Act (PPAC)
Anna Condino, Lauren Dudley, Soraya Ghebleh, Ramya Vedula
ECS 111
September 14th, 2012

2. COVERAGE REGULATIONS
- Provide insurance for children of
enrollees up to age 26
- Cannot deny children (and
adults, starting in 2014) based on
pre-existing conditions
- Cannot cap benefits lifetime or
annually
- Plans must offer basic preventive
care for free
- Cannot rescind benefits, except
in cases of fraud
- Limit deductible amounts and
waiting periods
- Allow for greater coverage
to all individuals
- Eliminate practices harmful
to consumers
- Keep health insurance
companies from denying
access to high utilizers of
healthcare
- Promote health of the
population through
increased access to
preventative services
Provisions Rationale

3. COST REGULATION
- Establish state-based health
insurance exchanges through
which individuals and small
businesses can buy insurance
- MLR must be at least 85% for large
markets and 80% for smaller ones
- Companies must report what
amount of premium money is
spent on clinical services for
enrollees
- Excise taxes on high-cost,
‘premium coverage’ plans
- Require plans to justify premium
raises
- Pressure insurance
companies to allocate
more resources to
enrollees
- Encourage business
practices that benefit
the consumer
Provisions Rationale

4. ADMINISTRATIVE REGULATIONS
- Uniform Coverage Summaries across
plans
- Transparent reporting including claims
denied, disenrollment, and cost-
sharing Adopt regulations to provide
for administrative simplification
- Consumer advocacy and safety
bureau set up to address consumer
concerns
- Further limit employee compensation/
bonuses beyond the MLR stipulation
- Allowed to sell insurance across state
lines
- Increase
transparency of
operations and
finances
- Standardized
methods of reporting
information
- Improve consume
knowledge
GOOD INFORMATION, FAIR PLAYING FIELD, LOTS OF CHOICES = COMPETITIVE RATES
Provisions Rationale

5. HOW WILL THIS IMPACT PRIVATE INSURERS?
- In the words of Doug Weiners, “They want us gone.”
- Adapt to regulations and adopt new strategies to
attract customers
- Develop innovations within the framework of the
law
- Shift focus from premiums as revenue generator to
cost cutting and savings in relationships with
hospitals/doctors/enrollees to support their bottom
line
- Force them to be transparent and accountable in
their practices
- Do these regulations allow for insurance companies
to still provide “insurance”?