12 CFR 1208.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... authorized by statute to collect for the benefit of any person; (5) The unpaid share of any non-Federal partner in a program involving a Federal payment, and a matching or cost-sharing payment by the non... (including Federal Employees' Group Life Insurance—FEGLI—Basic premium or premium for similar benefit under...

12 CFR 1208.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... authorized by statute to collect for the benefit of any person; (5) The unpaid share of any non-Federal partner in a program involving a Federal payment, and a matching or cost-sharing payment by the non... (including Federal Employees' Group Life Insurance—FEGLI—Basic premium or premium for similar benefit under...

12 CFR 1208.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... authorized by statute to collect for the benefit of any person; (5) The unpaid share of any non-Federal partner in a program involving a Federal payment, and a matching or cost-sharing payment by the non... (including Federal Employees' Group Life Insurance—FEGLI—Basic premium or premium for similar benefit under...

12 CFR 1208.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... authorized by statute to collect for the benefit of any person; (5) The unpaid share of any non-Federal partner in a program involving a Federal payment, and a matching or cost-sharing payment by the non... (including Federal Employees' Group Life Insurance—FEGLI—Basic premium or premium for similar benefit under...

5 CFR 894.402 - Do the premiums I pay reflect the cost of providing benefits?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Do the premiums I pay reflect the cost of providing benefits? 894.402 Section 894.402 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Cost...

5 CFR 894.402 - Do the premiums I pay reflect the cost of providing benefits?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Do the premiums I pay reflect the cost of providing benefits? 894.402 Section 894.402 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Cost...

5 CFR 890.502 - Withholdings, contributions, LWOP, premiums, and direct premium payment.

Code of Federal Regulations, 2014 CFR

2014-01-01

... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM... employee provides documentation that he or she has other coverage for the child(ren).) The employee may...

5 CFR 890.502 - Withholdings, contributions, LWOP, premiums, and direct premium payment.

Code of Federal Regulations, 2013 CFR

2013-01-01

... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM... employee provides documentation that he or she has other coverage for the child(ren).) The employee may...

5 CFR 890.502 - Withholdings, contributions, LWOP, premiums, and direct premium payment.

Code of Federal Regulations, 2012 CFR

2012-01-01

... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM... employee provides documentation that he or she has other coverage for the child(ren).) The employee may...

5 CFR 890.502 - Withholdings, contributions, LWOP, premiums, and direct premium payment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM... employee provides documentation that he or she has other coverage for the child(ren).) The employee may...

Health benefits in 2013: moderate premium increases in employer-sponsored plans.

PubMed

Claxton, Gary; Rae, Matthew; Panchal, Nirmita; Damico, Anthony; Whitmore, Heidi; Bostick, Nathan; Kenward, Kevin

2013-09-01

Employer-sponsored health insurance premiums rose moderately in 2013, the annual Kaiser Family Foundation/Health Research and Educational Trust (Kaiser/HRET) Employer Health Benefits Survey found. In 2013 single coverage premiums rose 5 percent to $5,884, and family coverage premiums rose 4 percent to $16,351. The percentage of firms offering health benefits (57 percent) was similar to that in 2012, as was the percentage of workers at offering firms who were covered by their firm's health benefits (62 percent). The share of workers with a deductible for single coverage increased significantly from 2012, as did the share of workers in small firms with annual deductibles of $1,000 or more. Most firms (77 percent), including nearly all large employers, continued to offer wellness programs, but relatively few used incentives to encourage employees to participate. More than half of large employers offering health risk appraisals to workers offered financial incentives for completing the appraisal.

76 FR 4703 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-26

... regarding medical loss ratio standards and the insurance premium rate review process, and issues premium... Oriented Plan program. Collects, compiles and maintains comparative pricing data for an Internet portal... benefit from the new health insurance system. Collects, compiles and maintains comparative pricing data...

77 FR 73117 - Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2014

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-07

...This proposed rule provides further detail and parameters related to: the risk adjustment, reinsurance, and risk corridors programs; cost-sharing reductions; user fees for a Federally- facilitated Exchange; advance payments of the premium tax credit; a Federally-facilitated Small Business Health Option Program; and the medical loss ratio program. The cost-sharing reductions and advanced payments of the premium tax credit, combined with new insurance market reforms, will significantly increase the number of individuals with health insurance coverage, particularly in the individual market. The premium stabilization programs--risk adjustment, reinsurance, and risk corridors--will protect against adverse selection in the newly enrolled population. These programs, in combination with the medical loss ratio program and market reforms extending guaranteed availability (also known as guaranteed issue) protections and prohibiting the use of factors such as health status, medical history, gender, and industry of employment to set premium rates, will help to ensure that every American has access to high-quality, affordable health insurance.

78 FR 15409 - Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2014

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-11

...This final rule provides detail and parameters related to: the risk adjustment, reinsurance, and risk corridors programs; cost-sharing reductions; user fees for Federally-facilitated Exchanges; advance payments of the premium tax credit; the Federally-facilitated Small Business Health Option Program; and the medical loss ratio program. Cost-sharing reductions and advance payments of the premium tax credit, combined with new insurance market reforms, are expected to significantly increase the number of individuals with health insurance coverage, particularly in the individual market. In addition, we expect the premium stabilization programs--risk adjustment, reinsurance, and risk corridors--to protect against the effects of adverse selection. These programs, in combination with the medical loss ratio program and market reforms extending guaranteed availability (also known as guaranteed issue) and prohibiting the use of factors such as health status, medical history, gender, and industry of employment to set premium rates, will help to ensure that every American has access to high-quality, affordable health insurance.

17 CFR 204.32 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... taxes; federal retirement programs; premiums for life and health insurance benefits; and such other... payments made to employees such as overpayment of benefits, salary or other allowances; loans when insured...

The Effect of Benefits, Premiums, and Health Risk on Health Plan Choice in the Medicare Program

PubMed Central

Atherly, Adam; Dowd, Bryan E; Feldman, Roger

2004-01-01

Objective To estimate the effect of Medicare+Choice (M+C) plan premiums and benefits and individual beneficiary characteristics on the probability of enrollment in a Medicare+Choice plan. Data Source Individual data from the Medicare Current Beneficiary Survey were combined with plan-level data from Medicare Compare. Study Design Health plan choices, including the Medicare+Choice/Fee-for-Service decision and the choice of plan within the M+C sector, were modeled using limited information maximum likelihood nested logit. Principal Findings Premiums have a significant effect on plan selection, with an estimated out-of-pocket premium elasticity of −0.134 and an insurer-perspective elasticity of −4.57. Beneficiaries are responsive to plan characteristics, with prescription drug benefits having the largest marginal effect. Sicker beneficiaries were more likely to choose plans with drug benefits and diabetics were more likely to pick plans with vision coverage. Conclusions Plan characteristics significantly impact beneficiaries' decisions to enroll in Medicare M+C plans and individuals sort themselves systematically into plans based on individual characteristics. PMID:15230931

5 CFR 890.307 - Waiver or suspension of annuity or compensation.

Code of Federal Regulations, 2012 CFR

2012-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Enrollment § 890.307 Waiver or... along with its regular health benefits premiums to OPM in accordance with procedures established by OPM...

5 CFR 890.307 - Waiver or suspension of annuity or compensation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Enrollment § 890.307 Waiver or... along with its regular health benefits premiums to OPM in accordance with procedures established by OPM...

Three large-scale changes to the Medicare program could curb its costs but also reduce enrollment

PubMed Central

Eibner, Christine; Goldman, Dana P.; Sullivan, Jeffrey; Garber, Alan M.

2013-01-01

Medicare spending accounts for a substantial fraction of Federal spending, and significant program changes may be necessary for long-run fiscal balance. We used a microsimulation approach to estimate how benefit changes to Medicare–including Part A, for hospital care, premiums, premium support credits, and changing the eligibility age–affect long-term Medicare spending and enrollment. All policies considered reduce spending, with reductions ranging from 2.4 to 24 percent between 2012 and 2036. However, the policies also reduce coverage among the elderly. To achieve significant costs savings without causing substantial uninsurance among seniors, benefits changes would likely need to occur in combination with other options. PMID:23650322

Employer contribution and premium growth in health insurance.

PubMed

Liu, Yiyan; Jin, Ginger Zhe

2015-01-01

We study whether employer premium contribution schemes could impact the pricing behavior of health plans and contribute to rising premiums. Using 1991-2011 data before and after a 1999 premium subsidy policy change in the Federal Employees Health Benefits Program (FEHBP), we find that the employer premium contribution scheme has a differential impact on health plan pricing based on two market incentives: 1) consumers are less price sensitive when they only need to pay part of the premium increase, and 2) each health plan has an incentive to increase the employer's premium contribution to that plan. Both incentives are found to contribute to premium growth. Counterfactual simulation shows that average premium would have been 10% less than observed and the federal government would have saved 15% per year on its premium contribution had the subsidy policy change not occurred in the FEHBP. We discuss the potential of similar incentives in other government-subsidized insurance systems such as the Medicare Part D and the Health Insurance Marketplace under the Affordable Care Act. Copyright © 2014 Elsevier B.V. All rights reserved.

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Retired Reserve for members of the Retired Reserve. Interim final rule with comment period.

PubMed

2010-08-06

This interim final rule establishes requirements and procedures for implementation of TRICARE Retired Reserve. This interim final rule addresses provisions of the National Defense Authorization Act for Fiscal Year 2010 (NDAA-10). The purpose of this interim final rule is to establish the TRICARE Retired Reserve program that implements section 705 of the NDAA-10. Section 705 allows members of the Retired Reserve who are qualified for non-regular retirement, but are not yet 60 years of age, to qualify to purchase medical coverage equivalent to the TRICARE Standard (and Extra) benefit unless that member is either enrolled in, or is eligible to enroll in, a health benefit plan under Chapter 89 of Title 5, United States Code, as well as certain survivors. The amount of the premium that qualified members pay to purchase these benefits will represent the full cost as determined on an appropriate actuarial basis for coverage under the TRICARE Standard (and Extra) benefit including the cost of the program administration. There will be one premium for member-only coverage and a separate premium for member and family coverage. The rules and procedures otherwise outlined in Part 199 of 32 CFR relating to the operation and administration of the TRICARE Standard and Extra programs including the required cost-shares, deductibles and catastrophic caps for retired members and their dependents will apply to this program. The rule is being published as an interim final rule with comment period in order to comply with statutory effective dates.

Estimation of a Hedonic Pricing Model for Medigap Insurance

PubMed Central

Robst, John

2006-01-01

Objective This paper uses a unique database to examine premiums paid by beneficiaries for Medigap supplemental coverage. Average premiums charged by insurers are reported, as well as premiums by enrollee age and gender, and additional policy characteristics. Marginal prices for Medigap benefits are estimated using hedonic price regressions. In addition, the paper considers how additional policy characteristics and geographic differences in the use and cost of medical care affect premiums. Data Sources/Study Setting A comprehensive database on premiums paid by beneficiaries for newly issued Medigap policies in the year 2000 along with state-level characteristics. Study Design Hedonic pricing equations are used to estimate implicit prices for Medigap benefits. Data Collection/Extraction Methods The Centers for Medicare & Medicaid Services contracted for the creation of a detailed database on Medigap premiums. Data were collected in three stages. First, letters were sent directly to insurers requesting premium data. Second, letters were directly to state insurance commissioner's offices requesting premium data. Last, each state insurance commissioner's office was visited to collect missing data. Principal Findings With the exceptions of the part B deductible and drug benefit, Medigap supplemental insurance is priced consistent with the actuarial value of benefits offered under the standardized plans. Premiums vary substantially based on rating method, whether the policy is guaranteed issue, Medigap Select, or explicitly for smokers. Premiums increase with enrollee age, but do not vary between men and women. The relationship between premiums and enrollee age varies across rating methods. Attained-age policies show the strongest relationship between age and premiums, while community-rated premiums, by definition, do not vary with age. Medigap supplemental insurance premiums are higher in states with poorer health, greater utilization, and greater managed care penetration. Conclusions Despite the high cost, Medigap plans are generally priced in accordance with the actuarial value of benefits. The primary exception is the drug benefit, which appears to be subject to substantial adverse selection. Benefits such as the part B deductible and at-home recovery benefit offer little value to consumers. Several states require insurers to community rate premiums. Such regulation has important implications for premiums, and research needs to consider the impact of such regulation on the Medigap market. PMID:17116111

Estimation of a hedonic pricing model for Medigap insurance.

PubMed

Robst, John

2006-12-01

This paper uses a unique database to examine premiums paid by beneficiaries for Medigap supplemental coverage. Average premiums charged by insurers are reported, as well as premiums by enrollee age and gender, and additional policy characteristics. Marginal prices for Medigap benefits are estimated using hedonic price regressions. In addition, the paper considers how additional policy characteristics and geographic differences in the use and cost of medical care affect premiums. A comprehensive database on premiums paid by beneficiaries for newly issued Medigap policies in the year 2000 along with state-level characteristics. Hedonic pricing equations are used to estimate implicit prices for Medigap benefits. The Centers for Medicare & Medicaid Services contracted for the creation of a detailed database on Medigap premiums. Data were collected in three stages. First, letters were sent directly to insurers requesting premium data. Second, letters were directly to state insurance commissioner's offices requesting premium data. Last, each state insurance commissioner's office was visited to collect missing data. With the exceptions of the part B deductible and drug benefit, Medigap supplemental insurance is priced consistent with the actuarial value of benefits offered under the standardized plans. Premiums vary substantially based on rating method, whether the policy is guaranteed issue, Medigap Select, or explicitly for smokers. Premiums increase with enrollee age, but do not vary between men and women. The relationship between premiums and enrollee age varies across rating methods. Attained-age policies show the strongest relationship between age and premiums, while community-rated premiums, by definition, do not vary with age. Medigap supplemental insurance premiums are higher in states with poorer health, greater utilization, and greater managed care penetration. Despite the high cost, Medigap plans are generally priced in accordance with the actuarial value of benefits. The primary exception is the drug benefit, which appears to be subject to substantial adverse selection. Benefits such as the part B deductible and at-home recovery benefit offer little value to consumers. Several states require insurers to community rate premiums. Such regulation has important implications for premiums, and research needs to consider the impact of such regulation on the Medigap market.

32 CFR 199.20 - Continued Health Care Benefit Program (CHCBP).

Code of Federal Regulations, 2010 CFR

2010-07-01

...) § 199.20 Continued Health Care Benefit Program (CHCBP). (a) Purpose. The CHCBP is a premium based... institution of higher learning; or (2) Is incapable of self-support because of a mental or physical incapacity... retired or retainer pay of a member or former member or an annuity based on the retainer pay of the member...

Will choice-based reform work for Medicare? Evidence from the Federal Employees Health Benefits Program.

PubMed

Florence, Curtis S; Atherly, Adam; Thorpe, Kenneth E

2006-10-01

. To examine the effect of premiums and benefits on the health plan choices of older enrollees who choose Federal Employees Health Benefits Program (FEHBP) health plans as their primary payer. Administrative enrollment data from the Office of Personnel Management (OPM) and plan premiums and benefits data taken from the Checkbook Guide to health plans. We estimate individual plan choice models where the choice of health plan is a function of out-of-pocket premium, actuarial value, plan attributes, and individual characteristics. Plan attributes include plan structure (fee-for-service/preferred provider organization, point-of-service, or health maintenance organization), drug benefit structure, and whether or not the plan covers other types of spending such as dental services and diabetic supplies. The models are estimated by conditional logit. Our study focuses on three populations that currently choose FEHBP as their primary health care coverage and are similar to the Medicare population: current employees and retirees who are approaching the age of Medicare eligibility (ages 60-64) and current federal employees age 65+. Current employees age 65+ are eligible for Medicare, but their FEHBP plan is their primary payer. Retirees and employees 60-64 are not yet eligible for Medicare but are similar in many respects to recently age-eligible Medicare beneficiaries. We also estimate our model for current employees age 55 and younger as a comparison group. We select a random sample of retirees and employees age 60-64, as well as all current employees age 65+, from the OPM administrative database for the calendar year 2001. The plan choices available to each person are determined by the plans participating in their metropolitan statistical area. We match plan premium and attribute information from the Checkbook Guide to each plan in the enrollee's list of choices. We find that current workers 65+, 60-64, and non-Medicare eligible retirees are sensitive to variation in plan premiums. The premium elasticities for these groups are similar in magnitude to those of the age 55 and under employee group. Older workers and retirees not yet eligible for Medicare are willing to pay a substantial amount for plans with open provider networks. The willingness to pay for open networks is significantly greater for these groups than for younger employees. Willingness to pay for open network plans varies significantly by income, but varies little by age within group. Our finding that older workers and non-Medicare eligible retirees are sensitive to plan premiums suggests that choice-based reform of Medicare would lead to cost-conscious choices by Medicare beneficiaries. However, our finding that these groups are willing to pay more for open network plans than younger employees suggest that higher risk individuals may migrate toward higher benefit, higher cost plans. Our findings on the relationship between income and willingness to pay for open network plans suggest that means testing is a viable reform for lowering Medicare program costs.

42 CFR 423.800 - Administration of subsidy program.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Administration of subsidy program. 423.800 Section 423.800 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Premiums and Cost...

5 CFR 892.303 - Can I pay my premiums directly by check under the premium conversion plan?

Code of Federal Regulations, 2010 CFR

2010-01-01

... under the premium conversion plan? 892.303 Section 892.303 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Contributions and Withholdings § 892.303 Can I pay my premiums directly...

5 CFR 892.303 - Can I pay my premiums directly by check under the premium conversion plan?

Code of Federal Regulations, 2013 CFR

2013-01-01

... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Contributions and Withholdings § 892.303 Can I pay my premiums directly...

5 CFR 892.303 - Can I pay my premiums directly by check under the premium conversion plan?

Code of Federal Regulations, 2014 CFR

2014-01-01

... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Contributions and Withholdings § 892.303 Can I pay my premiums directly...

5 CFR 892.303 - Can I pay my premiums directly by check under the premium conversion plan?

Code of Federal Regulations, 2011 CFR

2011-01-01

... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Contributions and Withholdings § 892.303 Can I pay my premiums directly...

Health benefits in 2014: stability in premiums and coverage for employer-sponsored plans.

PubMed

Claxton, Gary; Rae, Matthew; Panchal, Nirmita; Whitmore, Heidi; Damico, Anthony; Kenward, Kevin

2014-10-01

The annual Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey found that in 2014 the average annual premium (employer and worker contributions combined) for single coverage was $6,025, similar to 2013. The premium for family coverage was $16,834--3 percent higher than a year ago. Average deductibles and most other cost-sharing amounts were similar to those in 2013. On average, in 2014 covered workers paid nearly $5,000 per year for family health insurance premiums, and 18 percent of covered workers were in a plan with an annual single coverage deductible of $2,000 or more. Fifty-five percent of employers offered health benefits in 2014, similar to 2013. The Affordable Care Act has not yet led to substantial changes in the employer-based market. However, the next few years could present a different picture as delayed provisions and other changes take effect. This year's survey included new questions on firms' policies related to enrolling spouses and dependents, enrollment in private exchanges, and the use of narrow networks and financial incentives for wellness programs. Project HOPE—The People-to-People Health Foundation, Inc.

5 CFR 892.204 - How do I waive participation in premium conversion before the benefit first becomes effective?

Code of Federal Regulations, 2013 CFR

2013-01-01

... BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.204 How do I waive participation in premium conversion before the benefit first becomes effective? You must file a... conversion before the benefit first becomes effective? 892.204 Section 892.204 Administrative Personnel...

5 CFR 892.204 - How do I waive participation in premium conversion before the benefit first becomes effective?

Code of Federal Regulations, 2011 CFR

2011-01-01

... BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.204 How do I waive participation in premium conversion before the benefit first becomes effective? You must file a... conversion before the benefit first becomes effective? 892.204 Section 892.204 Administrative Personnel...

5 CFR 892.204 - How do I waive participation in premium conversion before the benefit first becomes effective?

Code of Federal Regulations, 2014 CFR

2014-01-01

... BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.204 How do I waive participation in premium conversion before the benefit first becomes effective? You must file a... conversion before the benefit first becomes effective? 892.204 Section 892.204 Administrative Personnel...

The CLASS Act: is it dead or just sleeping?

PubMed

Wiener, Joshua M

2012-01-01

The Affordable Care Act (ACA) established a voluntary public insurance program for long-term care: the Community Living Assistance Services and Supports (CLASS) Act. In October 2011, the Obama Administration announced that the program would not be implemented because of the high risk of fiscal insolvency. Under the legislative design, adverse selection was a major risk and premiums would have been very high. This article discusses several CLASS Act design and implementation issues, including the design features that led to the decision not to implement the program: the voluntary enrollment, the weak work requirement, the lifetime and cash benefits, and the premium subsidy for low-income workers and students.

29 CFR 825.210 - Employee payment of group health benefit premiums.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 3 2011-07-01 2011-07-01 false Employee payment of group health benefit premiums. 825.210... and Medical Leave Act § 825.210 Employee payment of group health benefit premiums. (a) Group health... make arrangements with the employer for payment of group health plan benefits when simultaneously...

29 CFR 825.210 - Employee payment of group health benefit premiums.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 3 2013-07-01 2013-07-01 false Employee payment of group health benefit premiums. 825.210... and Medical Leave Act § 825.210 Employee payment of group health benefit premiums. (a) Group health... arrangements with the employer for payment of group health plan benefits when simultaneously taking FMLA leave...

29 CFR 825.210 - Employee payment of group health benefit premiums.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 3 2014-07-01 2014-07-01 false Employee payment of group health benefit premiums. 825.210... and Medical Leave Act § 825.210 Employee payment of group health benefit premiums. (a) Group health... arrangements with the employer for payment of group health plan benefits when simultaneously taking FMLA leave...

29 CFR 825.210 - Employee payment of group health benefit premiums.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 3 2012-07-01 2012-07-01 false Employee payment of group health benefit premiums. 825.210... and Medical Leave Act § 825.210 Employee payment of group health benefit premiums. (a) Group health... make arrangements with the employer for payment of group health plan benefits when simultaneously...

42 CFR 423.772 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Premiums and Cost-Sharing Subsidies for Low-Income... 42 Public Health 3 2010-10-01 2010-10-01 false Definitions. 423.772 Section 423.772 Public Health... revision required by that section. Full-benefit dual eligible individual means an individual who, for any...

7 CFR 1951.111 - Salary offset.

Code of Federal Regulations, 2010 CFR

2010-01-01

...; premiums for life and health insurance benefits, and such other deductions required by law to be withheld... overpayments, under withholding of amounts payable for life and health insurance, and any amount owed by former... collect money from Federal employee retirement benefits. For delinquent Farm Loan Programs direct loans...

5 CFR 890.307 - Waiver or suspension of annuity or compensation.

Code of Federal Regulations, 2014 CFR

2014-01-01

... compensation. 890.307 Section 890.307 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Enrollment § 890.307 Waiver or... along with its regular health benefits premiums to OPM in accordance with procedures established by OPM...

5 CFR 890.307 - Waiver or suspension of annuity or compensation.

Code of Federal Regulations, 2013 CFR

2013-01-01

... compensation. 890.307 Section 890.307 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Enrollment § 890.307 Waiver or... along with its regular health benefits premiums to OPM in accordance with procedures established by OPM...

Will Choice-Based Reform Work for Medicare? Evidence from the Federal Employees Health Benefits Program

PubMed Central

Florence, Curtis S; Atherly, Adam; Thorpe, Kenneth E

2006-01-01

Objective To examine the effect of premiums and benefits on the health plan choices of older enrollees who choose Federal Employees Health Benefits Program (FEHBP) health plans as their primary payer. Data Sources Administrative enrollment data from the Office of Personnel Management (OPM) and plan premiums and benefits data taken from the Checkbook Guide to health plans. Study Design We estimate individual plan choice models where the choice of health plan is a function of out-of-pocket premium, actuarial value, plan attributes, and individual characteristics. Plan attributes include plan structure (fee-for-service/preferred provider organization, point-of-service, or health maintenance organization), drug benefit structure, and whether or not the plan covers other types of spending such as dental services and diabetic supplies. The models are estimated by conditional logit. Our study focuses on three populations that currently choose FEHBP as their primary health care coverage and are similar to the Medicare population: current employees and retirees who are approaching the age of Medicare eligibility (ages 60–64) and current federal employees age 65+. Current employees age 65+ are eligible for Medicare, but their FEHBP plan is their primary payer. Retirees and employees 60–64 are not yet eligible for Medicare but are similar in many respects to recently age-eligible Medicare beneficiaries. We also estimate our model for current employees age 55 and younger as a comparison group. Data Collection Methods We select a random sample of retirees and employees age 60–64, as well as all current employees age 65+, from the OPM administrative database for the calendar year 2001. The plan choices available to each person are determined by the plans participating in their metropolitan statistical area. We match plan premium and attribute information from the Checkbook Guide to each plan in the enrollee's list of choices. Principal Findings We find that current workers 65+, 60–64, and non-Medicare eligible retirees are sensitive to variation in plan premiums. The premium elasticities for these groups are similar in magnitude to those of the age 55 and under employee group. Older workers and retirees not yet eligible for Medicare are willing to pay a substantial amount for plans with open provider networks. The willingness to pay for open networks is significantly greater for these groups than for younger employees. Willingness to pay for open network plans varies significantly by income, but varies little by age within group. Conclusions Our finding that older workers and non-Medicare eligible retirees are sensitive to plan premiums suggests that choice-based reform of Medicare would lead to cost-conscious choices by Medicare beneficiaries. However, our finding that these groups are willing to pay more for open network plans than younger employees suggest that higher risk individuals may migrate toward higher benefit, higher cost plans. Our findings on the relationship between income and willingness to pay for open network plans suggest that means testing is a viable reform for lowering Medicare program costs. PMID:16987300

78 FR 69140 - Submission of Information Collections for OMB Review; Comment Request; Payment of Premiums...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-18

... PENSION BENEFIT GUARANTY CORPORATION Submission of Information Collections for OMB Review; Comment Request; Payment of Premiums; Termination Premium AGENCY: Pension Benefit Guaranty Corporation. ACTION... Benefit Guaranty Corporation (PBGC) is requesting that the Office of Management and Budget (OMB) extend...

Retirement and Health Insurance: Finding New Solutions to the Benefits Puzzle.

ERIC Educational Resources Information Center

Stanley, Ron

1993-01-01

Presents guidelines for colleges on selecting employee health insurance carriers and retirement investment programs. Reviews types of insurance programs, presenting examples from several states. Discusses mechanisms for reducing insurance premiums, including claim reduction, self-funding, mail-order pharmaceuticals, and forming consortia with…

32 CFR 199.20 - Continued Health Care Benefit Program (CHCBP).

Code of Federal Regulations, 2014 CFR

2014-07-01

... program. However, unlike the Standard program there is a cost for enrollment to the CHCBP and these premium costs are payable by enrollees before any care may be provided. (b) General provisions. Except for... 55 or transitional healthcare under 10 U.S.C. 1145, and (iii) Who would otherwise not be eligible for...

32 CFR 199.20 - Continued Health Care Benefit Program (CHCBP).

Code of Federal Regulations, 2012 CFR

2012-07-01

... program. However, unlike the Standard program there is a cost for enrollment to the CHCBP and these premium costs are payable by enrollees before any care may be provided. (b) General provisions. Except for... 55 or transitional healthcare under 10 U.S.C. 1145, and (iii) Who would otherwise not be eligible for...

32 CFR 199.20 - Continued Health Care Benefit Program (CHCBP).

Code of Federal Regulations, 2013 CFR

2013-07-01

... program. However, unlike the Standard program there is a cost for enrollment to the CHCBP and these premium costs are payable by enrollees before any care may be provided. (b) General provisions. Except for... 55 or transitional healthcare under 10 U.S.C. 1145, and (iii) Who would otherwise not be eligible for...

5 CFR 892.206 - Can I cancel my waiver and participate in premium conversion?

Code of Federal Regulations, 2013 CFR

2013-01-01

... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.206 Can I cancel my waiver and participate in premium...

5 CFR 892.206 - Can I cancel my waiver and participate in premium conversion?

Code of Federal Regulations, 2011 CFR

2011-01-01

... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.206 Can I cancel my waiver and participate in premium...

5 CFR 892.206 - Can I cancel my waiver and participate in premium conversion?

Code of Federal Regulations, 2014 CFR

2014-01-01

... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.206 Can I cancel my waiver and participate in premium...

5 CFR 892.206 - Can I cancel my waiver and participate in premium conversion?

Code of Federal Regulations, 2010 CFR

2010-01-01

... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.206 Can I cancel my waiver and participate in premium...

5 CFR 892.102 - What is premium conversion and how does it work?

Code of Federal Regulations, 2010 CFR

2010-01-01

...) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS... FEHB insurance premium. If you are a participant in the premium conversion plan, Section 125 of the...

Private Health Insurance Flans in 1978 and 1979: A Review of Coverage, Enrollment, and Financial Experience

PubMed Central

Carroll, Marjorie Smith; Arnett, Ross H.

1981-01-01

The private health insurance industry collected $55.9 billion in premiums in 1979 and returned $50.2 billion in benefits to its subscribers. Premiums rose 12.4 percent, slightly faster than in 1978 when premiums rose 11.4 percent, to $49.7billion. Benefits rose 11.4 percent in 1979, down from the 12.6 rate in 1978. After operating expenses were deducted, the industry showed underwriting losses of $1.4 billion in 1979 and $1.5 billion in 1978. About 78 percent of the population was insured for hospital care, 76 percent for x-ray and laboratory examinations, and about 75 percent for surgical services in 1979. Smaller percentages had coverage for other types of care. An estimated 64 percent of the aged bought private hospital insurance, and about 43 percent bought surgical insurance, mostly to supplement Medicare benefits. An estimated 12 percent of persons under age 65 had no protection against the cost of hospital care either through private insurance or a public program such as Medicare or Medicaid. PMID:10309475

42 CFR 423.782 - Cost-sharing subsidy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Cost-sharing subsidy. 423.782 Section 423.782... (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Premiums and Cost-Sharing Subsidies... cents. (c) When the out-of-pocket cost for a covered Part D drug under a Part D sponsor's plan benefit...

29 CFR 825.210 - Employee payment of group health benefit premiums.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Employee payment of group health benefit premiums. 825.210... LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee Leave Entitlements Under the Family and Medical Leave Act § 825.210 Employee payment of group health benefit premiums. (a) Group health...

Financial Impact of Effective Human Resources Management

ERIC Educational Resources Information Center

Driessnack, Carl H.

1976-01-01

Some of the most important facets of the business to be considered are compensation policies and procedures; benefits programs and insurance premiums; taxes; recruiting, training, and management development; affirmative action; and turnover and outplacement. (Author/IRT)

76 FR 57082 - Premium Penalty Relief; Alternative Premium Funding Target Election Relief

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-15

... PENSION BENEFIT GUARANTY CORPORATION Premium Penalty Relief; Alternative Premium Funding Target... situations involving alternative premium funding target elections. FOR FURTHER INFORMATION CONTACT: Catherine...; Alternative Premium Funding Target Elections; Box 5 Relief).\\1\\ \\1\\ http://www.pbgc.gov/res/other-guidance/tu...

29 CFR 4006.4 - Determination of unfunded vested benefits.

Code of Federal Regulations, 2011 CFR

2011-07-01

... target under § 4006.5(g) is in effect, its alternative premium funding target under § 4006.5(g). (2... the premium payment year is the excess (if any) of the plan's premium funding target for the premium...) Premium funding target—(1) In general. A plan's premium funding target is its standard premium funding...

29 CFR 4006.4 - Determination of unfunded vested benefits.

Code of Federal Regulations, 2010 CFR

2010-07-01

... target under § 4006.5(g) is in effect, its alternative premium funding target under § 4006.5(g). (2... the premium payment year is the excess (if any) of the plan's premium funding target for the premium...) Premium funding target—(1) In general. A plan's premium funding target is its standard premium funding...

29 CFR 4006.4 - Determination of unfunded vested benefits.

Code of Federal Regulations, 2012 CFR

2012-07-01

... target under § 4006.5(g) is in effect, its alternative premium funding target under § 4006.5(g). (2... the premium payment year is the excess (if any) of the plan's premium funding target for the premium...) Premium funding target—(1) In general. A plan's premium funding target is its standard premium funding...

Raising premiums and other costs for Oregon health plan enrollees drove many to drop out.

PubMed

Wright, Bill J; Carlson, Matthew J; Allen, Heidi; Holmgren, Alyssa L; Rustvold, D Leif

2010-12-01

The Oregon Health Plan was created to be a sustainable program that could weather budgetary storms without having to cut enrollees from Medicaid. A 2003 redesign of the program increased premiums, raised cost sharing, and imposed rigid premium payment deadlines for members in the "Standard" version of the program but not for members of the "Plus" version. This paper adds two years of longitudinal data to a previous study on the impacts of these changes. It shows that the redesign was a key factor driving a 77 percent disenrollment rate in the Standard program, from a high of 104,000 enrollees in February 2003 to just 24,000 by the end of the study period, November 2005. Those who were in the Standard plan when the reduced benefits and higher member costs went into effect were also nearly twice as likely to have unmet health care needs compared to those in the Plus plan. These changes underscore that in a period of economic downturn, policy makers must understand the impact of increased cost sharing on vulnerable populations.

The potential premium range of risk-rating in competitive markets for supplementary health insurance.

PubMed

Paolucci, Francesco; Prinsze, Femmeke; Stam, Pieter J A; van de Ven, Wynand P M M

2009-09-01

In this paper, we simulate several scenarios of the potential premium range for voluntary (supplementary) health insurance, covering benefits which might be excluded from mandatory health insurance (MI). Our findings show that, by adding risk-factors, the minimum premium decreases and the maximum increases. The magnitude of the premium range is especially substantial for benefits such as medical devices and drugs. When removing benefits from MI policymakers should be aware of the implications for the potential reduction of affordability of voluntary health insurance coverage in a competitive market.

Transitions from private to public health coverage among children: estimating effects on out-of-pocket medical costs and health insurance premium costs.

PubMed

Shaefer, H Luke; Grogan, Colleen M; Pollack, Harold A

2011-06-01

To assess the effects of transitions from private to public health insurance by children on out-of-pocket medical expenditures and health insurance premium costs. Data are drawn from the 1996 and 2001 panels of the Survey of Income and Program Participation. We construct a nationally representative, longitudinal sample of children, ages 0-18, and their families for the period 1998-2003, a period in which states raised public health insurance eligibility rates for children. We exploit the Survey of Income and Program Participation's longitudinal design to identify children in our sample who transition from private to public health insurance. We then use a bootstrapped instrumental variable approach to estimate the effects of these transitions on out-of-pocket expenditures and health insurance premium costs. Children who transition from private to public coverage are relatively low-income, are disproportionately likely to live in single-mother households, and are more likely to be Black or of Hispanic origin. Child health status is highly predictive of transitions. We estimate that these transitions provide a cash-equivalent transfer of nearly U.S.$1,500 annually for families in the form of reduced out-of-pocket and health insurance premium costs. Transitions from private to public health coverage by children can bring important social benefits to vulnerable families. This suggests that instead of being a net societal cost, such transitions may provide an important social benefit. © Health Research and Educational Trust.

Gettysburg College Takes Work-Life Balance Seriously

ERIC Educational Resources Information Center

Wilson, Robin

2009-01-01

This article describes the work-life benefits Gettysburg College offers its employees. 400 of Gettysburg's 725 full-time employees participate in the college's wellness program. About half of them stick with it long enough to earn discounts of up to $500 a year on their health-insurance premiums. The wellness program--which includes free on-campus…

Medicaid and Children's Health Insurance Programs: essential health benefits in alternative benefit plans, eligibility notices, fair hearing and appeal processes, and premiums and cost sharing; exchanges: eligibility and enrollment. Final rule.

PubMed

2013-07-15

This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act. This final rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and amends requirements for benchmark and benchmark-equivalent benefit packages consistent with sections 1937 of the Social Security Act (which we refer to as ``alternative benefit plans'') to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also updates and simplifies the complex Medicaid premium and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. It includes transition policies for 2014 as applicable.

5 CFR 892.301 - How do I pay my premium?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false How do I pay my premium? 892.301 Section 892.301 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Contributions and...

5 CFR 892.301 - How do I pay my premium?

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false How do I pay my premium? 892.301 Section 892.301 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Contributions and...

5 CFR 892.301 - How do I pay my premium?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false How do I pay my premium? 892.301 Section 892.301 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Contributions and...

5 CFR 892.202 - Are retirees eligible for the premium conversion plan?

Code of Federal Regulations, 2010 CFR

2010-01-01

... conversion plan? 892.202 Section 892.202 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.202 Are retirees eligible for the premium conversion plan? No...

5 CFR 892.301 - How do I pay my premium?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false How do I pay my premium? 892.301 Section 892.301 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Contributions and...

5 CFR 892.201 - Who is covered by the premium conversion plan?

Code of Federal Regulations, 2010 CFR

2010-01-01

... plan? 892.201 Section 892.201 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.201 Who is covered by the premium conversion plan? (a) All...

42 CFR 403.253 - Calculation of benefits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the gross premiums are computed to provide coverage. (iv) Reserve for future contingent benefits means... the loss ratio calculation period. (iii) Net premium means the level portion of the gross premium used... period, to— (B) The total policy reserve at the last day of the loss ratio calculation period: and (ii...

Calculation of benefit reserves based on true m-thly benefit premiums

NASA Astrophysics Data System (ADS)

Riaman; Susanti, Dwi; Supriatna, Agus; Nurani Ruchjana, Budi

2017-10-01

Life insurance is a form of insurance that provides risk mitigation in life or death of a human. One of its advantages is measured life insurance. Insurance companies ought to give a sum of money as reserves to the customers. The benefit reserves are an alternative calculation which involves net and cost premiums. An insured may pay a series of benefit premiums to an insurer equivalent, at the date of policy issue, to the sum of to be paid on the death of the insured, or on survival of the insured to the maturity date. A balancing item is required and this item is a liability for one of the parties and the other is an asset. The balancing item, in loan, is the outstanding principle, an asset for the lender and the liability for the borrower. In this paper we examined the benefit reserves formulas corresponding to the formulas for true m-thly benefit premiums by the prospective method. This method specifies that, the reserves at the end of the first year are zero. Several principles can be used for the determined of benefit premiums, an equivalence relation is established in our discussion.

Health insurance premium increases for the 5 largest school districts in the United States, 2004-2008.

PubMed

Cantillo, John R

2010-03-01

Local school districts are often one of the largest, if not the largest, employers in their respective communities. Like many large employers, school districts offer health insurance to their employees. There is a lack of information about the rate of health insurance premiums in US school districts relative to other employers. To assess the change in the costs of healthcare insurance in the 5 largest public school districts in the United States, between 2004 and 2008, as representative of large public employers in the country. Data for this study were drawn exclusively from a survey sent to the 5 largest public school districts in the United States. The survey requested responses on 3 data elements for each benefit plan offered from 2004 through 2008; these included enrollment, employee costs, and employer costs. The premium growth for the 5 largest school districts has slowed down and is consistent with other purchasers-Kaiser/Health Research & Educational Trust and the Federal Employee Health Benefit Program. The average increase in health insurance premium for the schools was 5.9% in 2008, and the average annual growth rate over the study period was 7.5%. For family coverage, these schools provide the most generous employer contribution (80.8%) compared with the employer contribution reported by other employers (73.5%) for 2008. Often the largest employers in their communities, school districts demonstrate a commitment to provide choice of benefits and affordability for employees and their families. Despite constraints typical of public employers, the 5 largest school districts in the United States have decelerated in premium growth consistent with other purchasers, albeit at a slower pace.

Health Insurance Premium Increases for the 5 Largest School Districts in the United States, 2004–2008

PubMed Central

Cantillo, John R.

2010-01-01

Background Local school districts are often one of the largest, if not the largest, employers in their respective communities. Like many large employers, school districts offer health insurance to their employees. There is a lack of information about the rate of health insurance premiums in US school districts relative to other employers. Objective To assess the change in the costs of healthcare insurance in the 5 largest public school districts in the United States, between 2004 and 2008, as representative of large public employers in the country. Methods Data for this study were drawn exclusively from a survey sent to the 5 largest public school districts in the United States. The survey requested responses on 3 data elements for each benefit plan offered from 2004 through 2008; these included enrollment, employee costs, and employer costs. Results The premium growth for the 5 largest school districts has slowed down and is consistent with other purchasers—Kaiser/Health Research & Educational Trust and the Federal Employee Health Benefit Program. The average increase in health insurance premium for the schools was 5.9% in 2008, and the average annual growth rate over the study period was 7.5%. For family coverage, these schools provide the most generous employer contribution (80.8%) compared with the employer contribution reported by other employers (73.5%) for 2008. Conclusions Often the largest employers in their communities, school districts demonstrate a commitment to provide choice of benefits and affordability for employees and their families. Despite constraints typical of public employers, the 5 largest school districts in the United States have decelerated in premium growth consistent with other purchasers, albeit at a slower pace. PMID:25126311

29 CFR 4006.3 - Premium rate.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 9 2013-07-01 2013-07-01 false Premium rate. 4006.3 Section 4006.3 Labor Regulations Relating to Labor (Continued) PENSION BENEFIT GUARANTY CORPORATION PREMIUMS PREMIUM RATES § 4006.3 Premium rate. Subject to the provisions of § 4006.5 (dealing with exemptions and special rules) and § 4006.7...

29 CFR 4006.3 - Premium rate.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Premium rate. 4006.3 Section 4006.3 Labor Regulations Relating to Labor (Continued) PENSION BENEFIT GUARANTY CORPORATION PREMIUMS PREMIUM RATES § 4006.3 Premium rate. Subject to the provisions of § 4006.5 (dealing with exemptions and special rules) and § 4006.7...

29 CFR 4006.3 - Premium rate.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 9 2012-07-01 2012-07-01 false Premium rate. 4006.3 Section 4006.3 Labor Regulations Relating to Labor (Continued) PENSION BENEFIT GUARANTY CORPORATION PREMIUMS PREMIUM RATES § 4006.3 Premium rate. Subject to the provisions of § 4006.5 (dealing with exemptions and special rules) and § 4006.7...

29 CFR 4006.3 - Premium rate.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 9 2011-07-01 2011-07-01 false Premium rate. 4006.3 Section 4006.3 Labor Regulations Relating to Labor (Continued) PENSION BENEFIT GUARANTY CORPORATION PREMIUMS PREMIUM RATES § 4006.3 Premium rate. Subject to the provisions of § 4006.5 (dealing with exemptions and special rules) and § 4006.7...

29 CFR 4006.3 - Premium rate.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 9 2014-07-01 2014-07-01 false Premium rate. 4006.3 Section 4006.3 Labor Regulations Relating to Labor (Continued) PENSION BENEFIT GUARANTY CORPORATION PREMIUMS PREMIUM RATES § 4006.3 Premium rate. Subject to the provisions of § 4006.5 (dealing with exemptions and special rules) and § 4006.7...

76 FR 79714 - Premium Changes Based On Recharacterization of Contributions

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-22

... PENSION BENEFIT GUARANTY CORPORATION Premium Changes Based On Recharacterization of Contributions AGENCY: Pension Benefit Guaranty Corporation. ACTION: Policy statement. SUMMARY: This policy statement..., Legislative and Regulatory Department, Pension Benefit Guaranty Corporation, 1200 K Street NW., Washington DC...

5 CFR 892.402 - I am a survivor annuitant as well as an active Federal employee; am I eligible for premium...

Code of Federal Regulations, 2010 CFR

2010-01-01

... Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Reemployed Annuitants and Survivor Annuitants... employed in a position that conveys FEHB eligibility and is covered by the premium conversion plan, you are...

5 CFR 892.401 - Am I eligible for premium conversion if I retire and then come back to work for the Federal...

Code of Federal Regulations, 2010 CFR

2010-01-01

... Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Reemployed Annuitants and Survivor Annuitants... reemployed in a position that conveys FEHB eligibility and is covered by the premium conversion plan, you are...

A new measure of the impact of managed care on healthcare markets.

PubMed

Pawlson, L G; Moy, E M; Kim, J I; Griner, P F

2001-11-01

Most studies of managed care impact have used health maintenance organization (HMO) penetration or index of competition as the marker of managed care impact. However, little empirical evidence has been found to support the validity of these or other measures in current use. In addition, as managed care evolves to forms other than HMOs and managed care penetration in large metropolitan areas approaches 100% of commercially insured patients, the utility of the most commonly used measure, HMO penetration, will decrease still further. To provide a preliminary analysis of the use of premiums as a measure of market impact of managed care. Retrospective analysis (quartile, correlation, multiple-variable linear regression) of publicly available datasets. Labor market-adjusted HMO premiums from 3 publicly available sources, for the 56 largest metropolitan areas in the United States, were compared with penetration and index of competition as predictors of the dependent market variable, hospital bed-days per 1000 population. Health maintenance organization premiums in the Federal Employees Health Benefits Program emerged as the best predictor of HMO market impact. Average HMO premiums reported in the Interstudy database and for the Medicare+Choice program also outperformed penetration or index of competition in relating to several commonly available markers of competition such as bed-days per 1000. Premiums charged by HMOs are a useful measure of the impact of managed care on healthcare markets in large metropolitan areas.

Increasing health insurance coverage through an extended Federal Employees Health Benefits Program.

PubMed

Fuchs, B C

2001-01-01

The Federal Employees Health Benefits Program (FEHBP) could be combined with health insurance tax credits to extend coverage to the uninsured. An extended FEHBP, or "E-FEHBP," would be open to all individuals who were not covered through work or public programs and who also were eligible for the tax credits on the basis of income. E-FEHBP also would be open to employees of very small firms, regardless of their eligibility for tax credits. Most plans available to FEHBP participants would be required to offer enrollment to E-FEHBP participants, although premiums would be rated separately. High-risk individuals would be diverted to a separate high-risk pool, the cost of which would be subsidized by the federal government. E-FEHBP would be administered by the states, or if a state declined, by an entity that contracted with the Office of Personnel Management. While E-FEHBP would provide group insurance to people who otherwise could not get it, premiums could exceed the tax-credit amount and some people still might find the coverage unaffordable.

The effect of premiums on the decision to participate in health insurance and other fringe benefits offered by the employer: evidence from a real-world experiment.

PubMed

Royalty, Anne Beeson; Hagens, John

2005-01-01

In this paper, we investigate the effect of the out-of-pocket premium on the decision to enroll in employer health insurance and other benefits plans including dental insurance, vision care, long-term care insurance, and wellness benefits. Previous estimates of the effects of premium on takeup of health insurance could be biased toward zero due to a correlation between premium and unobservable demand or plan quality. We solve this problem using data representing hypothetical choices by employees under three different price regimes, providing price variation uncorrelated with either individual-specific or plan-specific unobservables. We find that workers are insensitive to price in health insurance takeup. Workers show much greater price sensitivity to decisions about dental insurance, vision plans, long-term care insurance, and wellness benefits. We conclude that premium subsidies are unlikely to have a substantial impact on increasing insurance rates of workers already offered employer insurance.

24 CFR 257.203 - Calculation of up-front and annual mortgage insurance premiums for H4H program mortgages.

Code of Federal Regulations, 2010 CFR

2010-04-01

... mortgage insurance premiums for H4H program mortgages. 257.203 Section 257.203 Housing and Urban... mortgage insurance premiums for H4H program mortgages. (a) Applicable premiums. Any mortgage presented for... LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES HOPE FOR HOMEOWNERS PROGRAM...

24 CFR 257.203 - Calculation of up-front and annual mortgage insurance premiums for H4H program mortgages.

Code of Federal Regulations, 2011 CFR

2011-04-01

... mortgage insurance premiums for H4H program mortgages. 257.203 Section 257.203 Housing and Urban... mortgage insurance premiums for H4H program mortgages. (a) Applicable premiums. Any mortgage presented for... LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES HOPE FOR HOMEOWNERS PROGRAM...

Premium increases in state health insurance programs: lessons from a case study of the Massachusetts Medicaid buy-in program.

PubMed

Livermore, Gina A; Goodman, Nanette; Hooven, Fred; Hashemi, Lobat

In March 2003, Massachusetts increased the premiums it charges to most enrollees in its CommonHealth-Working (CH-W) program. This study evaluates the impact of the premium change on disenrollment using a comparison group methodology. The findings indicate that the premium change had only a small, but statistically significant impact on program exits. The CH-W experience differs from other state programs that saw substantial enrollment declines in response to new or increased premiums. This is likely due to factors that make CH-W different from other programs, key of which are administrative procedures intended to minimize disenrollment due to premium nonpayment.

5 CFR 582.103 - Exclusions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... retirement benefits are considered to be supplementary; (f) Are deducted as normal life insurance premiums... coverage. Federal Employees' Group Life Insurance premiums for “Basic Life” coverage are considered to be normal life insurance premiums; all optional Federal Employees' Group Life Insurance premiums and any...

5 CFR 582.103 - Exclusions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... retirement benefits are considered to be supplementary; (f) Are deducted as normal life insurance premiums... coverage. Federal Employees' Group Life Insurance premiums for “Basic Life” coverage are considered to be normal life insurance premiums; all optional Federal Employees' Group Life Insurance premiums and any...

42 CFR 423.773 - Requirements for eligibility.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Requirements for eligibility. 423.773 Section 423.773 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Premiums and Cost-Sharing Subsidies...

5 CFR 892.204 - How do I waive participation in premium conversion before the benefit first becomes effective?

Code of Federal Regulations, 2010 CFR

2010-01-01

... conversion before the benefit first becomes effective? 892.204 Section 892.204 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.204 How do I...

76 FR 40741 - Federal Housing Administration (FHA) Mortgage Insurance Premiums for Multifamily Housing Programs...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-11

... Administration (FHA) Mortgage Insurance Premiums for Multifamily Housing Programs, Health Care Facilities and... mortgage insurance premiums (MIPs) for FHA Multifamily Housing, Health Care Facilities, and Hospital... implement any premium changes for FY 2011 for the multifamily mortgage insurance programs, health care...

Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017. Final rule.

PubMed

2016-03-08

This final rule sets forth payment parameters and provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also provides additional amendments regarding the annual open enrollment period for the individual market for the 2017 and 2018 benefit years; essential health benefits; cost sharing; qualified health plans; Exchange consumer assistance programs; network adequacy; patient safety; the Small Business Health Options Program; stand-alone dental plans; third-party payments to qualified health plans; the definitions of large employer and small employer; fair health insurance premiums; student health insurance coverage; the rate review program; the medical loss ratio program; eligibility and enrollment; exemptions and appeals; and other related topics.

77 FR 55879 - Submission of Information Collection for OMB Review; Comment Request; Payment of Premiums

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-11

... PENSION BENEFIT GUARANTY CORPORATION Submission of Information Collection for OMB Review; Comment Request; Payment of Premiums AGENCY: Pension Benefit Guaranty Corporation. ACTION: Notice of request for OMB approval of revised collection of information. SUMMARY: The Pension Benefit Guaranty Corporation...

77 FR 4839 - Proposed Submission of Information Collection for OMB Review; Comment Request; Payment of Premiums

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-31

... PENSION BENEFIT GUARANTY CORPORATION Proposed Submission of Information Collection for OMB Review; Comment Request; Payment of Premiums AGENCY: Pension Benefit Guaranty Corporation. ACTION: Notice of intention to request OMB approval of revised collection of information. SUMMARY: The Pension Benefit...

42 CFR 423.771 - Basis and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Basis and scope. 423.771 Section 423.771 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Premiums and Cost-Sharing Subsidies for Low...

34 CFR 682.505 - Insurance premium.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 4 2011-07-01 2011-07-01 false Insurance premium. 682.505 Section 682.505 Education... Loan Programs § 682.505 Insurance premium. (a) General. The Secretary charges the lender an insurance premium for each Federal GSL Program loan that is guaranteed, except that no insurance premium is charged...

Dental plan premiums in the Affordable Care Act marketplaces trended downward from 2014 through 2016.

PubMed

Nasseh, Kamyar; Vujicic, Marko

2017-04-01

Pediatric dental benefits must be offered in the health insurance marketplaces created under the Affordable Care Act. The authors analyzed trends over time in premiums and the number of dental insurers participating in the marketplaces. The authors collected dental benefit plan data from 35 states participating in the federally facilitated marketplaces in 2014, 2015, and 2016. For each county, they counted the number of issuers offering stand-alone dental plans (SADPs) and medical plans with embedded pediatric dental benefits. They also analyzed trends in premiums. From 2014 through 2016, the number of issuers of stand-alone dental plans and medical plans with embedded pediatric dental benefits either did not change or increased in most counties. Average premiums for low-actuarial-value SADPs declined from 2014 through 2016. The increase in the number of issuers of stand-alone dental plans and medical plans with embedded dental benefits may be associated with lower premiums. However, more research is needed to determine if this is the case. Affordable dental plans in the marketplaces could induce people with lower incomes to sign up for dental benefits. Newly insured people could have significant oral health needs and pent-up demand for dental care. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

5 CFR 892.205 - May I waive participation in premium conversion after the initial implementation?

Code of Federal Regulations, 2013 CFR

2013-01-01

... PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.205 May I waive...

5 CFR 892.205 - May I waive participation in premium conversion after the initial implementation?

Code of Federal Regulations, 2014 CFR

2014-01-01

... PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.205 May I waive...

5 CFR 892.205 - May I waive participation in premium conversion after the initial implementation?

Code of Federal Regulations, 2011 CFR

2011-01-01

... PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.205 May I waive...

5 CFR 892.205 - May I waive participation in premium conversion after the initial implementation?

Code of Federal Regulations, 2010 CFR

2010-01-01

... PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.205 May I waive...

20 CFR 422.601 - Scope and purpose.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Under the Coal Industry Retiree Health Benefit Act of 1992 § 422.601 Scope and purpose. The regulations... assignments it makes under provisions of the Coal Industry Retiree Health Benefit Act of 1992 (the Coal Act... the annual health and death benefit premiums for these beneficiaries as well as the annual premiums...

20 CFR 422.601 - Scope and purpose.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Under the Coal Industry Retiree Health Benefit Act of 1992 § 422.601 Scope and purpose. The regulations... assignments it makes under provisions of the Coal Industry Retiree Health Benefit Act of 1992 (the Coal Act... the annual health and death benefit premiums for these beneficiaries as well as the annual premiums...

20 CFR 422.601 - Scope and purpose.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Under the Coal Industry Retiree Health Benefit Act of 1992 § 422.601 Scope and purpose. The regulations... assignments it makes under provisions of the Coal Industry Retiree Health Benefit Act of 1992 (the Coal Act... the annual health and death benefit premiums for these beneficiaries as well as the annual premiums...

75 FR 28304 - Proposed Submission of Information Collection for OMB Review; Comment Request; Payment of Premiums

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-20

... PENSION BENEFIT GUARANTY CORPORATION Proposed Submission of Information Collection for OMB Review; Comment Request; Payment of Premiums AGENCY: Pension Benefit Guaranty Corporation. ACTION: Notice of... Benefit Guaranty Corporation (PBGC) is modifying the collection of information under Part 4007 of its...

'Benefits cycle' replacing premium cycle as consumerism takes hold.

PubMed

2002-05-01

The traditional premium cycle of ups and downs in rates is giving way to a new phenomenon--driven by the advent of consumerism in health care--termed the "benefits cycle" by one consultant. Rather than shifts in rates, he argues, the future will see shifts in benefits packages.

29 CFR 4006.4 - Determination of unfunded vested benefits.

Code of Federal Regulations, 2014 CFR

2014-07-01

... effect, its alternative premium funding target under § 4006.5(g). (2) Standard premium funding target. A... the UVB valuation year is the excess (if any) of the plan's premium funding target for the UVB... consistent with generally accepted actuarial principles and practices. (b) Premium funding target—(1) In...

Medicare program; prohibition of midyear benefit enhancements for Medicare Advantage organizations. Final rule.

PubMed

2008-07-28

This final rule prohibits Medicare Advantage (MA) organizations, including organizations offering MA plans to employer and union group health plan sponsors, from making midyear changes to nonprescription drug benefits, premiums, and cost-sharing submitted in their approved bids for a given contract year. This final rule also clarifies that MA organizations offering certain kinds of plans restricted to employer and union group health plan sponsors and not open to general enrollment may continue to offer benefit enhancements as they do currently, through means other than midyear benefit enhancements (MYBEs). Programs of all-inclusive care for elderly (PACE) are not subject to the provisions of this final rule and may continue to offer enhanced benefits as specified in our guidance for PACE plans.

Suspension of enrollment in the Federal Employees Health Benefits (FEHB) Program for Peace Corps volunteers. Final rule.

PubMed

2006-11-17

The Office of Personnel Management is issuing a final regulation to allow Peace Corps volunteers who are FEHB Program enrolled annuitants, survivors, and former spouses to suspend their FEHB enrollments and then return to the FEHB Program during the Open Season, or return to FEHB coverage immediately, if they involuntarily lose health benefits coverage under the Peace Corps. The intent of this final rule is to allow these beneficiaries to avoid the expense of continuing to pay FEHB Program premiums while they have other health coverage as Peace Corps volunteers, without endangering their ability to return to the FEHB Program in the future.

Putting a premium on medical staffs. A novel way to insure physician liability (and loyalty).

PubMed

Jones, T M; O'Hare, P K

1989-05-01

The physician malpractice insurance crisis is having an adverse financial impact on both hospitals and their medical staffs. Innovative hospitals are exploring ways to create insurance arrangements to cover the professional liability of their medical staffs. Hospital risk managers often have theorized that if the same insurer covered both hospitals and their staff physicians, providers and their patients would benefit. These programs--often referred to as "channeling" or "channeled programs"--use a common risk management program, common claims administration, and a common claims defense for insured hospitals and their medical staffs, reducing costs, unfavorable verdicts, and, thus, premiums. Unfortunately only a few commercial carriers now offer such a program. Some hospitals and systems have therefore turned to "captive" insurance companies to provide the benefits of a channeled program. Hospitals or systems and their medical staffs can establish a captive (i.e., a controlled insurance company designed to insure its owners and their affiliates) either offshore (typically in a tax-free jurisdiction such as the Cayman Islands, Barbados, or Bermuda) or onshore (typically in a state with facilitating legislation). The Tax Reform Act of 1986, together with the Liability Risk Retention Act of 1986, generally tips the regulatory balance in favor of onshore captives by allowing these entities to operate as risk retention groups (RRGs).

The individual insurance market before reform: low premiums and low benefits.

PubMed

Whitmore, Heidi; Gabel, Jon R; Pickreign, Jeremy; McDevitt, Roland

2011-10-01

Based on analyses of individual market health plans sold through ehealthinsurance and enrollment information collected from individual market carriers, this article profiles the individual health insurance market in 2007, before health reform. The article examines premiums, plan enrollment, cost sharing, and covered benefits and compares individual and group markets. Premiums for the young are lower than in the group market but higher for older people. Cost sharing is substantial in the individual insurance market. Seventy-eight percent of people were enrolled in plans with deductibles for single coverage, which averaged $2,117. Annual out-of-pocket maximums averaged $5,271. Many plans do not cover important benefits. Twelve percent of individually insured persons had no coverage for office visits and only 43% have maternity benefits in their basic coverage. With the advent of health exchanges and new market rules in 2014, covered benefits may become richer, cost sharing will decline, but premiums for the young will rise.

Private Health Insurance Plans in 1977: Coverage, Enrollment, and Financial Experience

PubMed Central

Carroll, Marjorie Smith; Arnett, Ross H.

1979-01-01

The private health insurance industry collected $47.1 billion in premiums in 1977 and returned $41.6 billion in benefits to their subscribers. Premiums rose 16.3 percent as a direct consequence of rapid claims growth in 1976. After operating expenses were deducted, the industry showed a small, $.4 billion underwriting loss. About 78 percent of the population were insured for hospital care, and about 76 percent for surgical services. Smaller percentages had coverage for other types of care. An estimated 61.8 percent of the aged bought private hospital insurance, and 47.1 percent bought surgical insurance, mostly to supplement Medicare benefits. About 12 percent of persons under age 65 had no protection against the cost of hospital care either through private insurance or a public program such as Medicare or Medicaid. PMID:10309113

Pharmaceutical Pricing in Germany: How Is Value Determined within the Scope of AMNOG?

PubMed

Lauenroth, Victoria Desirée; Stargardt, Tom

To analyze how value is determined within the scope of the German Pharmaceutical Restructuring Act, which came into effect in 2011. Using data from all pharmaceuticals that had undergone assessment, appraisal, and price negotiations in Germany before June 30, 2016, we applied generalized linear model regression to analyze the impact of added benefit on the difference between negotiated prices and the prices of comparators. Data were extracted from the Federal Joint Committee's appraisals and price databases. We specified added benefit in various ways. In all models, we controlled for additional criteria such as size of patient population, European price levels, and whether the comparators were generic. Our regression results confirmed the descriptive results, with price premiums reflecting the extent of added benefit as appraised by the Federal Joint Committee. On the substance level, an added benefit was associated with an increase in price premium of 227.2% (P < 0.001) compared with no added benefit. Moreover, we saw increases in price premium of 377.5% (P < 0.001), 90.0% (P < 0.001), and 336.8% (P < 0.001) for added benefits that were "considerable," "minor," and "not quantifiable," respectively. Beneficial effects on mortality were associated with the greatest price premium (624.3%; P < 0.001), followed by such effects on morbidity (174.7%; P < 0.001) and adverse events (93.1%; P = 0.019). Price premiums, or "value," are driven by health gain, the share of patients benefiting from a pharmaceutical, European price levels, and whether comparators are generic. No statement can be made, however, about the appropriateness of the level of price premiums. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

5 CFR 892.207 - Can I make changes to my FEHB enrollment while I am participating in premium conversion?

Code of Federal Regulations, 2013 CFR

2013-01-01

... OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.207 Can I make...

5 CFR 892.207 - Can I make changes to my FEHB enrollment while I am participating in premium conversion?

Code of Federal Regulations, 2014 CFR

2014-01-01

... OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.207 Can I make...

5 CFR 892.207 - Can I make changes to my FEHB enrollment while I am participating in premium conversion?

Code of Federal Regulations, 2011 CFR

2011-01-01

... OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.207 Can I make...

5 CFR 892.207 - Can I make changes to my FEHB enrollment while I am participating in premium conversion?

Code of Federal Regulations, 2010 CFR

2010-01-01

... OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.207 Can I make...

A truly healthy bottom line: improving financial results through effective health and productivity programs.

PubMed

Wolff, Shelly

2008-01-01

Financially speaking, an effective, comprehensive, properly executed health and productivity (H&P) program can drive significant business results. Unfortunately, many companies are not getting the same return on their investments in H&P programs as their peers. This article defines program effectiveness and describes the specific activities of employers that have implemented successful H&P strategies leading to improved health, increased productivity and lower benefit costs-and, in turn, higher levels of performance, returns to shareholders and market premium.

24 CFR 4001.203 - Calculation of upfront and annual mortgage insurance premiums for Program mortgages.

Code of Federal Regulations, 2010 CFR

2010-04-01

... mortgage insurance premiums for Program mortgages. 4001.203 Section 4001.203 Housing and Urban Development... HOMEOWNERS PROGRAM HOPE FOR HOMEOWNERS PROGRAM Rights and Obligations Under the Contract of Insurance § 4001.203 Calculation of upfront and annual mortgage insurance premiums for Program mortgages. (a...

24 CFR 4001.203 - Calculation of upfront and annual mortgage insurance premiums for Program mortgages.

Code of Federal Regulations, 2011 CFR

2011-04-01

... mortgage insurance premiums for Program mortgages. 4001.203 Section 4001.203 Housing and Urban Development... HOMEOWNERS PROGRAM HOPE FOR HOMEOWNERS PROGRAM Rights and Obligations Under the Contract of Insurance § 4001.203 Calculation of upfront and annual mortgage insurance premiums for Program mortgages. (a...

Federal employees health program experiences lack of competition in some areas, raising cost concerns for exchange plans.

PubMed

McBride, Timothy D; Barker, Abigail R; Pollack, Lisa M; Kemper, Leah M; Mueller, Keith J

2012-06-01

The Affordable Care Act calls for creation of health insurance exchanges designed to provide private health insurance plan choices. The Federal Employees Health Benefits Program is a national model that to some extent resembles the planned exchanges. Both offer plans at the state level but are also overseen by the federal government. We examined the availability of plans and enrollment levels in the Federal Employees Health Benefits Program throughout the United States in 2010. We found that although plans were widely available, enrollment was concentrated in plans owned by just a few organizations, typically Blue Cross/Blue Shield plans. Enrollment was more concentrated in rural areas, which may reflect historical patterns of enrollment or lack of provider networks. Average biweekly premiums for an individual were lowest ($58.48) in counties where competition was extremely high, rising to $65.13 where competition was extremely low. To make certain that coverage sold through exchanges is affordable, policy makers may need to pay attention to areas where there is little plan competition and take steps through risk-adjustment policies or other measures to narrow differences in premiums and out-of-pocket expenses for consumers.

Premium assistance in Medicaid and SCHIP: ace in the hole or house of cards?

PubMed

Shirk, Cynthia; Ryan, Jennifer

2006-07-17

This issue brief explores the use of premium assistance in publicly financed health insurance coverage programs. In the context of Medicaid and the State Children's Health Insurance Program (SCHIP), premium assistance entails using federal and state funds to subsidize the premiums for the purchase of private insurance coverage for eligible individuals. This paper considers the evolution of premium assistance and some of the statutory and administrative limitations, as well as private market factors, that have prevented widespread enrollment in Medicaid or SCHIP premium assistance programs. Finally, this issue brief offers some ideas for potential legislative and/or programmatic changes that could facilitate the use of premium assistance as a mechanism for health coverage expansion.

Worth of data and natural disaster insurance

USGS Publications Warehouse

Attanasi, E.D.; Karlinger, M.R.

1979-01-01

The Federal Government in the past has provided medical and economic aid to victims of earthquakes and floods. However, regulating the use of hazard-prone areas would probably be more efficient. One way to implement such land use regulation is through the national flood and earthquake insurance program. Because insurance firms base their premium rates on available information, the benefits from additional data used to improve parameter estimates of the probability distribution (governing actual disaster events) can be computed by computing changes in the premiums as a function of additional data. An insurance firm is assumed to set rates so as to trade off penalties of overestimation and underestimation of expected damages. A Bayesian preposterior analysis is applied to determine the worth of additional data, as measured by changes in consumers’ surplus, by examining the effects of changes in premiums as a function of a longer hydrologic record.

78 FR 63208 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-23

... Regulations CMS-10260 Medicare Advantage and Prescription Drug Program: Final Marketing Provisions CMS-L564... the Social Security Act as well as the entitlement of the applicant or a spouse regarding a benefit or annuity paid by the Social Security Administration or the Office of Personnel Management for premium...

42 CFR 423.440 - Prohibition of State imposition of premium taxes; relation to State laws.

Code of Federal Regulations, 2010 CFR

2010-10-01

...; relation to State laws. 423.440 Section 423.440 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Organization Compliance with State Law and Preemption by Federal Law § 423.440 Prohibition of...

45 CFR 149.200 - Use of reimbursements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... premiums or health benefit costs, (2) To reduce health benefit premium contributions, copayments... 45 Public Welfare 1 2010-10-01 2010-10-01 false Use of reimbursements. 149.200 Section 149.200 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS...

The Effect of Health Plan Characteristics on Medicare+Choice Enrollment

PubMed Central

Dowd, Bryan E; Feldman, Roger; Coulam, Robert

2003-01-01

Objective To provide national estimates of the effect of out-of-pocket premiums and benefits on Medicare beneficiaries' choice among managed care health plans. Data Sources/Study Setting The data represent the population of all Medicare+Choice (M+C) plans offered to Medicare beneficiaries in the United States in 1999. Study Design The dependent variable is the log of the ratio of the market share of the jth health plan to the lowest cost plan in the beneficiary's county of residence. The explanatory variables are measures of premiums and benefits in the jth health plan relative to the premiums and benefits in the lowest cost plan. Data Collection Methods The data are from the 1999 Medicare Compare database, and M+C enrollment data from the Centers for Medicare and Medicaid Services (CMS). Principal Findings A $10 increase in an M+C plan's out-of-pocket premium, relative to its competitors, is associated with a decrease of four percentage points in the jth plan's market share (i.e., from 25 to 21 percent), holding the premiums of competing plans constant. Conclusions Although our price elasticity estimates are low, the market share losses associated with small changes in a health plan's premium, relative to its competitors, may be sufficient to discipline premiums in a competitive market. Bidding behavior by plans in the Medicare Competitive Pricing Demonstration supports this conclusion. PMID:12650384

Health insurance of rural/township schoolchildren in Pinggu, Beijing: coverage rate, determinants, disparities, and sustainability.

PubMed

Zhu, Jane M; Zhu, Yiliang; Liu, Rui

2008-11-03

As China re-establishes its health insurance system through various cooperative schemes, little is known about schoolchildren's health insurance. This paper reports findings from a study that examined schoolchildren's insurance coverage, disparities between farmer and non-farmer households, and effects of low-premium cooperative schemes on healthcare access and utilization. It also discusses barriers to sustainable enrollment and program growth. A survey of elementary school students was conducted in Pinggu, a rural/suburban district of Beijing. Statistical analyses of association and adjusted odds ratio via logistic regression were conducted to examine various aspects of health insurance. Children's health insurance coverage rose to 54% by 2005, the rates are comparable for farmers' and non-farmer's children. However, 76% of insured farmers' children were covered under a low-premium scheme protecting only major medical events, compared to 42% among insured non-farmers' children. The low-premium schemes improved parental perceptions of children's access to and affordability of healthcare, their healthcare-seeking behaviors, and overall satisfaction with healthcare, but had little impact on utilization of outpatient care. Enrolling and retaining schoolchildren in health insurance are threatened by the limited tangible value for routine care and low reimbursement rate for major medical events under the low-premium cooperative schemes. Coverage rates may be improved by offering complimentary and supplementary benefit options with flexible premiums via a multi-tier system consisting of national, regional, and commercial programs. Health insurance education by means of community outreach can reinforce positive parental perceptions, hence promoting and retaining insurance enrollment in short-term.

42 CFR 422.404 - State premium taxes prohibited.

Code of Federal Regulations, 2012 CFR

2012-10-01

... (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Organization Compliance With State Law and Preemption by Federal Law § 422.404 State premium taxes prohibited. (a) Basic rule. No premium tax...

San Francisco's 'pay or play' employer mandate expanded private coverage by local firms and a public care program.

PubMed

Colla, Carrie H; Dow, William H; Dube, Arindrajit

2013-01-01

In 2008 San Francisco implemented a pay-or-play employer mandate that required firms operating in the city to provide health insurance coverage for employees or contribute to the city's "public option" health access program, Healthy San Francisco. Using data from our Bay Area Employer Health Benefits Survey, we found that in the first two years after implementation, more employers offered insurance and provided employee health benefit coverage relative to employers outside San Francisco not subject to the mandate. Sixty-seven percent reported in 2009 that they had expanded benefits since 2007. Although 22 percent of firms responding to the survey reported contributing to Healthy San Francisco for some employees, we observed no crowd-out of private insurance. Premium changes between 2007 and 2009 were similar in San Francisco and surrounding areas, but more of the burden of premium contributions in San Francisco shifted from workers to employers. Overall, 64 percent of firms responding to the survey supported the employer mandate. San Francisco's experience indicates that such a mandate is feasible, increases access, and is acceptable to many employers, which bodes well for the national employer mandate that will take effect under the Affordable Care Act in 2014.

Who really pays for health insurance? The incidence of employer-provided health insurance with sticky nominal wages.

PubMed

Sommers, Benjamin D

2005-03-01

This paper addresses two seeming paradoxes in the realm of employer-provided health insurance: First, businesses consistently claim that they bear the burden of the insurance they provide for employees, despite theory and empirical evidence indicating that workers bear the full incidence. Second, benefit generosity and the percentage of premiums paid by employers have decreased in recent decades, despite the preferential tax treatment of employer-paid benefits relative to wages-trends unexplained by the standard incidence model. This paper offers a revised incidence model based on nominal wage rigidity, in an attempt to explain these paradoxes. The model predicts that when the nominal wage constraint binds, some of the burden of increasing insurance premiums will fall on firms, particularly small companies with low-wage employees. In response, firms will reduce employment, decrease benefit generosity, and require larger employee premium contributions. Using Current Population Survey data from 2000-2001, I find evidence for this kind of wage rigidity and its associated impact on the employment and premium contributions of low-wage insured workers during a period of rapid premium growth.

The effect of Medicaid premiums on enrollment: a regression discontinuity approach.

PubMed

Dague, Laura

2014-09-01

This paper estimates the effect that premiums in Medicaid have on the length of enrollment of program beneficiaries. Whether and how low income-families will participate in the exchanges and in states' Medicaid programs depends crucially on the structure and amounts of the premiums they will face. I take advantage of discontinuities in the structure of Wisconsin's Medicaid program to identify the effects of premiums on enrollment for low-income families. I use a 3-year administrative panel of enrollment data to estimate these effects. I find an increase in the premium from 0 to 10 dollars per month results in 1.4 fewer months enrolled and reduces the probability of remaining enrolled for a full year by 12 percentage points, but other discrete changes in premium amounts do not affect enrollment or have a much smaller effect. I find no evidence of program enrollees intentionally decreasing labor supply in order to avoid the premiums. Copyright © 2014 Elsevier B.V. All rights reserved.

5 CFR 892.202 - Are retirees eligible for the premium conversion plan?

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Are retirees eligible for the premium conversion plan? 892.202 Section 892.202 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS...

5 CFR 892.102 - What is premium conversion and how does it work?

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false What is premium conversion and how does it work? 892.102 Section 892.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS...

5 CFR 892.201 - Who is covered by the premium conversion plan?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Who is covered by the premium conversion plan? 892.201 Section 892.201 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS...

5 CFR 892.201 - Who is covered by the premium conversion plan?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Who is covered by the premium conversion plan? 892.201 Section 892.201 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS...

5 CFR 892.202 - Are retirees eligible for the premium conversion plan?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Are retirees eligible for the premium conversion plan? 892.202 Section 892.202 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS...

5 CFR 892.102 - What is premium conversion and how does it work?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false What is premium conversion and how does it work? 892.102 Section 892.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS...

5 CFR 892.102 - What is premium conversion and how does it work?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false What is premium conversion and how does it work? 892.102 Section 892.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS...

5 CFR 892.202 - Are retirees eligible for the premium conversion plan?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Are retirees eligible for the premium conversion plan? 892.202 Section 892.202 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS...

5 CFR 892.201 - Who is covered by the premium conversion plan?

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Who is covered by the premium conversion plan? 892.201 Section 892.201 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS...

76 FR 67570 - Medicare Program; Part A Premiums for CY 2012 for the Uninsured Aged and for Certain Disabled...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-01

... 0938-AQ15 Medicare Program; Part A Premiums for CY 2012 for the Uninsured Aged and for Certain Disabled...'') and by certain disabled individuals who have exhausted other entitlement. The monthly Part A premium... monthly premium for certain disabled individuals who have exhausted other entitlement. These are...

77 FR 69859 - Medicare Program; Part A Premiums for CY 2013 for the Uninsured Aged and for Certain Disabled...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-21

... 0938-AR15 Medicare Program; Part A Premiums for CY 2013 for the Uninsured Aged and for Certain Disabled...'') and by certain disabled individuals who have exhausted other entitlement. The monthly Part A premium... monthly premium for certain disabled individuals who have exhausted other entitlement. These are...

42 CFR 457.810 - Premium assistance programs: Required protections against substitution.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., must provide the protections against substitution of CHIP coverage for coverage under group health... under premium assistance programs must not be greater than the cost of other CHIP coverage for these... of coverage for children under premium assistance programs to the cost of other CHIP coverage for...

42 CFR 457.810 - Premium assistance programs: Required protections against substitution.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., must provide the protections against substitution of CHIP coverage for coverage under group health... under premium assistance programs must not be greater than the cost of other CHIP coverage for these... of coverage for children under premium assistance programs to the cost of other CHIP coverage for...

42 CFR 457.810 - Premium assistance programs: Required protections against substitution.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., must provide the protections against substitution of CHIP coverage for coverage under group health... under premium assistance programs must not be greater than the cost of other CHIP coverage for these... of coverage for children under premium assistance programs to the cost of other CHIP coverage for...

42 CFR 457.810 - Premium assistance programs: Required protections against substitution.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., must provide the protections against substitution of CHIP coverage for coverage under group health... under premium assistance programs must not be greater than the cost of other CHIP coverage for these... of coverage for children under premium assistance programs to the cost of other CHIP coverage for...

Influence of variable milk quality premiums on observed milk quality.

PubMed

Nightingale, C; Dhuyvetter, K; Mitchell, R; Schukken, Y

2008-03-01

The objective of this study was to evaluate a premium program for very high quality milk in a US cooperative. Data were available on a monthly basis from a large US milk cooperative from April 1998 through December 2005. The data set consisted of 36,930 observations representing producer-months. The actual amount of the low bulk tank somatic cell count (BTSCC) premium varied from $0.15 per hundred pounds (cwt.) of milk to $1.00/cwt. with steps in between of $0.50 and $0.60 per cwt. of milk during the data collection period. Data analysis was done to evaluate the impact of the premium program on average BTSCC and on the probability of a producer to ship milk with <100,000 cells/mL in a given month. The results showed a strong effect of the premium program on both the average BTSCC and the probability of producing milk with very low BTSCC. On average, the BTSCC of all the milk in the cooperative was reduced by 22,000 cells during the high premium period. The probability of producing milk with BTSCC <100,000 doubled during some months of the high premium period from 4 to 8%, and an associated 10% increase in probability to produce milk below 200,000 cells/mL was observed. The data clearly indicate that premium offerings for very high quality milk affect the overall milk quality in the population affected by the premium. Producers responded to the high premiums and the overall impact on milk quality was substantial. We argue that the combination of a penalty program for high BTSCC milk with a premium program for very high quality milk (low BTSCC) provides a strong incentive for improvement of milk quality.

75 FR 15496 - Agency Information Collection (Service-Disabled Veterans Insurance-Waiver of Premiums) Activities...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-29

...-Disabled Veterans Insurance--Waiver of Premiums) Activities: Under OMB Review AGENCY: Veterans Benefits...-Disabled Veterans Insurance--Waiver of Premiums, VA Form 29-0812. OMB Control Number: 2900-0700. Type of Review: Extension of a currently approved collection. Abstract: Claimants who become totally disabled...

75 FR 2593 - Proposed Information Collection (Service-Disabled Veterans Insurance-Waiver of Premiums); Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-15

... (Service-Disabled Veterans Insurance--Waiver of Premiums); Comment Request AGENCY: Veterans Benefits... information technology. Title: Service-Disabled Veterans Insurance--Waiver of Premiums, VA Form 29-0812. OMB...: Claimants who become totally disabled complete VA Form 29-0812 to apply for a waiver of their Service...

77 FR 6675 - Premium Penalty Relief for Certain Delinquent Plans

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-09

... Delinquent Plans AGENCY: Pension Benefit Guaranty Corporation. ACTION: Policy statement. SUMMARY: Executive... limited window for covered plans that have never paid required premiums to pay past-due premiums without... Security Act of 1974 (ERISA). Under sections 4006 and 4007 of ERISA, plans covered by title IV must pay...

78 FR 64951 - Medicare Program; Part A Premiums for CY 2014 for the Uninsured Aged and for Certain Disabled...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-30

... 0938-AR57 Medicare Program; Part A Premiums for CY 2014 for the Uninsured Aged and for Certain Disabled...'') and by certain disabled individuals who have exhausted other entitlement. The monthly Part A premium... payment of a monthly premium for certain disabled individuals who have exhausted other entitlement. These...

Analysis of private health insurance premium growth rates: 1985-1992.

PubMed

Feldstein, P J; Wickizer, T M

1995-10-01

The rate of increase in health care expenditures has been a central policy concern for well over a decade, yet little empirical research has been conducted to examine expenditure growth rates. This study analyzed health insurance premium growth rates for a selected sample of 95 insured groups over the period 1985 to 1992. During this time, premiums increased by approximately 150% in nominal terms and by 45% in real terms. The observed rate of growth was not constant over time, however. The most rapid growth occurred during the years 1986 to 1989; thereafter, the rate of increase in premiums declined. Multivariate analysis was conducted to assess the effects on premium growth rates of selected variables representing insurance benefit design features, market competitive factors, insurance system factors, and group-specific factors. In addition to the percentage increase in benefit payments, other factors found to affect premium growth rates were health maintenance organization market penetration, deductible level, the coinsurance rate, and state insurance mandates. Further, this analysis suggests that the insurance underwriting cycle may play an important role in influencing insurance premium growth rates. These results support the belief that health maintenance organization induced competition has potential to control the rate of increase in health care costs.

5 CFR 892.103 - What can I do if I disagree with my agency's decision about my pre-or post-tax election?

Code of Federal Regulations, 2010 CFR

2010-01-01

... OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Administration and General Provisions § 892.103... reconsider its initial decision affecting your participation in the premium conversion plan. ...

Three large-scale changes to the Medicare program could curb its costs but also reduce enrollment.

PubMed

Eibner, Christine; Goldman, Dana P; Sullivan, Jeffrey; Garber, Alan M

2013-05-01

With Medicare spending projected to increase to 24 percent of all federal spending and to equal 6 percent of the gross domestic product by 2037, policy makers are again considering ways to curb the program's spending growth. We used a microsimulation approach to estimate three scenarios: imposing a means-tested premium for Part A hospital insurance, introducing a premium support credit to purchase health insurance, and increasing the eligibility age to sixty-seven. We found that the scenarios would lead to reductions in cumulative Medicare spending in 2012-36 of 2.4-24.0 percent. However, the scenarios also would increase out-of-pocket spending for enrollees and, in some cases, cause millions of seniors not to enroll in the program and to be left without coverage. To achieve substantial cost savings without causing substantial lack of coverage among seniors, policy makers should consider benefit changes in combination with other options, such as some of those now being contemplated by the Obama administration and Congress.

75 FR 68790 - Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual Deductible...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-09

... 0938-AP81 Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual... (SMI) program beginning January 1, 2011. In addition, this notice announces the monthly premium for... beneficiaries with modified adjusted gross income above certain threshold amounts. The monthly actuarial rates...

76 FR 67572 - Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual Deductible...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-01

... 0938-AQ16 Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual... (SMI) program beginning January 1, 2012. In addition, this notice announces the monthly premium for... beneficiaries with modified adjusted gross income above certain threshold amounts. The monthly actuarial rates...

78 FR 64943 - Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual Deductible...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-30

... 0938-AR58 Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual... (SMI) program beginning January 1, 2014. In addition, this notice announces the monthly premium for... beneficiaries with modified adjusted gross income above certain threshold amounts. The monthly actuarial rates...

38 CFR 8.5 - Authorization for deduction of premiums from compensation, retirement pay, or pension.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Authorization for deduction of premiums from compensation, retirement pay, or pension. 8.5 Section 8.5 Pensions, Bonuses, and... Authorization for deduction of premiums from compensation, retirement pay, or pension. Deductions from benefits...

42 CFR 408.210 - Termination of SMI premium surcharge agreement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Supplementary Medical Insurance Premium Surcharge Agreements § 408.210 Termination of SMI premium surcharge agreement. (a... 42 Public Health 2 2010-10-01 2010-10-01 false Termination of SMI premium surcharge agreement. 408...

42 CFR 408.210 - Termination of SMI premium surcharge agreement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HUMAN SERVICES MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Supplementary Medical Insurance Premium Surcharge Agreements § 408.210 Termination of SMI premium surcharge agreement. (a... 42 Public Health 2 2011-10-01 2011-10-01 false Termination of SMI premium surcharge agreement. 408...

European Long-Term Care Programs: Lessons for Community Living Assistance Services and Supports?

PubMed Central

Nadash, Pamela; Doty, Pamela; Mahoney, Kevin J; von Schwanenflugel, Matthias

2012-01-01

Objective To uncover lessons from abroad for Community Living Assistance Services and Supports (CLASS), a federally run voluntary public long-term care (LTC) insurance program created under the Accountable Care Act of 2010. Data Sources Program administrators and policy researchers from Austria, England, France, Germany, and the Netherlands. Study Design Qualitative methods focused on key parameters of cash for care: how programs set benefit levels; project expenditures; control administrative costs; regulate the use of benefits; and protect workers. Data Collection/Extraction Methods Structured discussions were conducted during an international conference of LTC experts, followed by personal meetings and individual correspondence. Principal Findings Germany's self-financing mandate and tight targeting of benefits have resulted in a solvent program with low premiums. Black markets for care are likely in the absence of regulation; France addresses this via a unique system ensuing legal payment of workers. Conclusions Programs in the five countries studied have lessons, both positive and negative, relevant to CLASS design. PMID:22091672

76 FR 36857 - Federal Employees Health Benefits Program: New Premium Rating Method for Most Community Rated Plans

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-23

..., beginning in calendar year 2011, meet an MLR of 85% for large groups, (i.e., non-claim costs may not exceed... groups subsidize the less healthy groups that use more health services. This subsidization is by design... shall be equivalent to the subscription rates given to the carrier's similarly sized subscriber groups...

5 CFR Appendix A to Subpart F of... - Recommended Language for Court Orders Dividing Employee Annuities

Code of Federal Regulations, 2011 CFR

2011-01-01

... contain a formula that has the effect of creating other types of annuity, but the court order may only do... reduced only by the amount deducted as premiums for basic life insurance under the Federal Employee Group Life Insurance Program. “[Employee] is (or will be) eligible for retirement benefits under the Civil...

77 FR 69850 - Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual Deductible...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-21

... percent reserve has been the normal target used to calculate the Part B premium. In view of the strong... 0938-AR16 Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual...

Insurance premiums and insurance coverage of near-poor children.

PubMed

Hadley, Jack; Reschovsky, James D; Cunningham, Peter; Kenney, Genevieve; Dubay, Lisa

States increasingly are using premiums for near-poor children in their public insurance programs (Medicaid/SCHIP) to limit private insurance crowd-out and constrain program costs. Using national data from four rounds of the Community Tracking Study Household Surveys spanning the seven years from 1996 to 2003, this study estimates a multinomial logistic regression model examining how public and private insurance premiums affect insurance coverage outcomes (Medicaid/SCHIP coverage, private coverage, and no coverage). Higher public premiums are significantly associated with a lower probability of public coverage and higher probabilities of private coverage and uninsurance; higher private premiums are significantly related to a lower probability of private coverage and higher probabilities of public coverage and uninsurance. The results imply that uninsurance rates will rise if both public and private premiums increase, and suggest that states that impose or increase public insurance premiums for near-poor children will succeed in discouraging crowd-out of private insurance, but at the expense of higher rates of uninsurance. Sustained increases in private insurance premiums will continue to create enrollment pressures on state insurance programs for children.

Health Benefits In 2016: Family Premiums Rose Modestly, And Offer Rates Remained Stable.

PubMed

Claxton, Gary; Rae, Matthew; Long, Michelle; Damico, Anthony; Whitmore, Heidi; Foster, Gregory

2016-10-01

The annual Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey found that in 2016, average annual premiums (employer and worker contributions combined) were $6,435 for single coverage and $18,142 for family coverage. The family premium in 2016 was 3 percent higher than that in 2015. On average, workers contributed 18 percent of the premium for single coverage and 30 percent for family coverage. The share of firms offering health benefits (56 percent) and of workers covered by their employers' plans (62 percent) remained statistically unchanged from 2015. Employers continued to offer financial incentives for completing wellness or health promotion activities. Almost three in ten covered workers were enrolled in a high-deductible plan with a savings option-a significant increase from 2014. The 2016 survey included new questions on cost sharing for specialty drugs and on the prevalence of incentives for employees to seek care at alternative settings. Project HOPE—The People-to-People Health Foundation, Inc.

Plan choice, health insurance cost and premium sharing.

PubMed

Kosteas, Vasilios D; Renna, Francesco

2014-05-01

We develop a model of premium sharing for firms that offer multiple insurance plans. We assume that firms offer one low quality plan and one high quality plan. Under the assumption of wage rigidities we found that the employee's contribution to each plan is an increasing function of that plan's premium. The effect of the other plan's premium is ambiguous. We test our hypothesis using data from the Employer Health Benefit Survey. Restricting the analysis to firms that offer both HMO and PPO plans, we measure the amount of the premium passed on to employees in response to a change in both premiums. We find evidence of large and positive effects of the increase in the plan's premium on the amount of the premium passed on to employees. The effect of the alternative plan's premium is negative but statistically significant only for the PPO plans. Copyright © 2014 Elsevier B.V. All rights reserved.

42 CFR 422.404 - State premium taxes prohibited.

Code of Federal Regulations, 2010 CFR

2010-10-01

....404 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Organization Compliance With State Law and Preemption by Federal Law § 422.404 State premium taxes prohibited. (a) Basic rule. No premium tax, fee, or...

Study of the Insurance Premium Charged to Borrowers under the Guaranteed Student Loan Program. Report No. 3.

ERIC Educational Resources Information Center

Touche Ross and Co., Washington, DC.

Insurance premiums being charged to borrowers under the Guaranteed Student Loan (GSL) program were studied to determine if the rate exceeded the rate necessary to protect the reserves of the insurer. Attention was directed to whether historical changes in the GSL program have affected insurance premiums. Guaranty agency's sources and uses of funds…

Maintaining health insurance during a recession: likely COBRA eligibility: an updated analysis using the Commonwealth Fund 2007 Biennial Health Insurance Survey.

PubMed

Doty, Michelle; Rustgi, Sheila D; Schoen, Cathy; Collins, Sara R

2009-01-01

As the U.S. economic downturn continues and job losses mount, more working Americans are likely to lose access to affordable health benefits subsidized by their employers. Analysis of the 2007 Commonwealth Fund Biennial Health Insurance Survey finds that two of three working adults would be eligible to extend job-based coverage, under the 1985 Consolidated Omnibus Budget Reconciliation Act (COBRA) if they became unemployed. Under COBRA, however, unemployed workers would have to pay four to six times their current contribution at a time of sharply reduced income. In fact, the latest national figures indicate that, because of high premiums, only 9 percent of unemployed workers have COBRA coverage. Substantial financial assistance of 75 percent to 85 percent of premiums could help laid-off workers maintain coverage. In addition, expansion of Medicaid and the State Children's Health Insurance Program would benefit low-income, laid-off workers and their families who are ineligible for COBRA.

26 CFR 1.419-1T - Treatment of welfare benefit funds. (Temporary)

Code of Federal Regulations, 2010 CFR

2010-04-01

... reserve or a premium stabilization reserve maintained by an insurance company is a “fund,” or part of a... in the reserve applied against its future years' benefit costs or insurance premiums. Also, if an... reserves. Q-2: When do the deduction rules of section 419, as enacted by the Tax Reform Act of 1984, become...

78 FR 58290 - TRICARE; Calendar Year 2014 TRICARE Young Adult Program Premium Update

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-23

... DEPARTMENT OF DEFENSE Office of the Secretary TRICARE; Calendar Year 2014 TRICARE Young Adult... Young Adult Premiums for Calendar Year 2014. SUMMARY: This notice provides the updated TRICARE Young Adult program premiums for Calendar Year (CY) 2014. DATES: The CY 2014 rates contained in this notice...

Does Specialization Explain Marriage Penalties and Premiums?

PubMed Central

Killewald, Alexandra; Gough, Margaret

2013-01-01

Married men’s wage premium is often attributed to within-household specialization: men can devote more effort to wage-earning when their wives assume responsibility for household labor. We provide a comprehensive evaluation of the specialization hypothesis, arguing that, if specialization causes the male marriage premium, married women should experience wage losses. Furthermore, specialization by married parents should augment the motherhood penalty and the fatherhood premium for married as compared to unmarried parents. Using fixed-effects models and data from the NLSY79, we estimate within-gender differences in wages according to marital status and between-gender differences in the associations between marital status and wages. We then test whether specialization on time use, job traits, and tenure accounts for the observed associations. Results for women do not support the specialization hypothesis. Childless men and women both receive a marriage premium. Marriage augments the fatherhood premium but not the motherhood penalty. Changes in own and spousal employment hours, job traits, and tenure appear to benefit both married men and women, although men benefit more. Marriage changes men’s labor market behavior in ways that augment wages, but these changes do not appear to occur at the expense of women’s wages. PMID:24039271

The demand for health insurance coverage for tobacco dependence treatments: support for a benefit mandate and willingness to pay.

PubMed

Halpin, Helen Ann; McMenamin, Sara B; Shade, Starley B

2007-12-01

One solution for reducing tobacco use is to expand health insurance coverage for tobacco dependence treatments (TDTs), but the public demand for a coverage mandate is unknown. This study finds that demand for coverage of TDTs among a random sample of adult Californians with employer-sponsored health insurance is strong, with 62% indicating that health insurers should be required to offer coverage as part of their standard plans and a majority (56%) indicating a willingness to pay $3 more for their annual health insurance premium to finance cessation coverage. Compared to never smokers, current and former smokers are no more likely to support a benefit mandate to require coverage of cessation treatments, but the adjusted odds are approximately three times greater that current and former smokers are willing to pay $3 more toward their annual premium to finance cessation coverage. Liberals had higher adjusted odds of supporting a benefit mandate and of being willing to pay a higher premium compared to conservatives. Non-whites had higher adjusted odds of supporting a mandate compared to whites, with no differences by race/ethnicity in willingness to pay a higher premium. There were no differences in preferences for a benefit mandate or willingness to pay a higher premium as a function of age, gender or income. These findings have important policy implications for a state health insurance mandate to cover tobacco dependence treatments.

12 CFR 221.122 - Applicability of margin requirements to credit in connection with Insurance Premium Funding...

Code of Federal Regulations, 2011 CFR

2011-01-01

... in connection with Insurance Premium Funding Programs. 221.122 Section 221.122 Banks and Banking...) Interpretations § 221.122 Applicability of margin requirements to credit in connection with Insurance Premium Funding Programs. (a) The Board has been asked numerous questions regarding purpose credit in connection...

12 CFR 221.122 - Applicability of margin requirements to credit in connection with Insurance Premium Funding...

Code of Federal Regulations, 2010 CFR

2010-01-01

... in connection with Insurance Premium Funding Programs. 221.122 Section 221.122 Banks and Banking...) Interpretations § 221.122 Applicability of margin requirements to credit in connection with Insurance Premium Funding Programs. (a) The Board has been asked numerous questions regarding purpose credit in connection...

42 CFR 408.202 - Conditions for participation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Supplementary Medical Insurance Premium... apply to CMS to enter into an SMI premium surcharge agreement if the following conditions are met: (1) Each individual designated for coverage under the premium surcharge agreement must be enrolled in...

42 CFR 408.202 - Conditions for participation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Supplementary Medical Insurance Premium... apply to CMS to enter into an SMI premium surcharge agreement if the following conditions are met: (1) Each individual designated for coverage under the premium surcharge agreement must be enrolled in...

Effect of Mergers on Health Maintenance Organization Premiums

PubMed Central

Feldman, Roger; Wholey, Douglas; Christianson, Jon

1996-01-01

This study estimated the effect of mergers on health maintenance organization (HMO) premiums, using data on all operational non-Medicaid HMOs in the United States from 1985 to 1993. Two critical issues were examined: whether HMO mergers increase or decrease premiums; and whether the effects of mergers differ according to the degree of competition among HMOs in local markets. The only significant merger effect was found in the most competitive markets, where premiums increased, but only for 1 year after the merger. Our research does not support the argument that consolidation of HMOs in local markets will benefit consumers through lower premiums. PMID:10158729

Basic health program: state administration of basic health programs; eligibility and enrollment in standard health plans; essential health benefits in standard health plans; performance standards for basic health programs; premium and cost sharing for basic health programs; federal funding process; trust fund and financial integrity. Final rule.

PubMed

2014-03-12

This final rule establishes the Basic Health Program (BHP), as required by section 1331 of the Affordable Care Act. The BHP provides states the flexibility to establish a health benefits coverage program for low-income individuals who would otherwise be eligible to purchase coverage through the Affordable Insurance Exchange (Exchange, also called Health Insurance Marketplace). The BHP complements and coordinates with enrollment in a QHP through the Exchange, as well as with enrollment in Medicaid and the Children's Health Insurance Program (CHIP). This final rule also sets forth a framework for BHP eligibility and enrollment, benefits, delivery of health care services, transfer of funds to participating states, and federal oversight. Additionally, this final rule amends another rule issued by the Secretary of the Department of Health and Human Services (Secretary) in order to clarify the applicability of that rule to the BHP.

Health Benefits In 2015: Stable Trends In The Employer Market.

PubMed

Claxton, Gary; Rae, Matthew; Panchal, Nirmita; Whitmore, Heidi; Damico, Anthony; Kenward, Kevin; Long, Michelle

2015-10-01

The annual Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey found that in 2015, average annual premiums (employer and worker contributions combined) were $6,251 for single coverage and $17,545 for family coverage. Both premiums rose 4 percent from 2014, continuing several years of modest growth. The percentage of firms offering health benefits and the percentage of workers covered by their employers' plans remained statistically unchanged from 2014. Eighty-one percent of covered workers were enrolled in a plan with a general annual deductible. Among those workers, the average deductible for single coverage was $1,318. Half of large employers either offered employees the opportunity or required them to complete biometric screening. Of firms that offer an incentive for completing the screening, 20 percent provide employees with incentives or penalties that are tied to meeting those biometric outcomes. The 2015 survey included new questions on financial incentives to complete wellness programs and meet specified biometric outcomes as well as questions about narrow networks and employers' strategies related to the high-cost plan tax and the employer shared-responsibility provisions of the Affordable Care Act. Project HOPE—The People-to-People Health Foundation, Inc.

42 CFR 408.207 - Billing and payment procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Supplementary Medical Insurance Premium... premium surcharge for each eligible enrollee who is included in the agreement for the time period...

42 CFR 408.207 - Billing and payment procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Supplementary Medical Insurance Premium... premium surcharge for each eligible enrollee who is included in the agreement for the time period...

75 FR 44028 - Submission of Information Collection for OMB Review; Comment Request; Payment of Premiums

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-27

... closed to new entrants. These instructions parallel the benefit-accrual-freeze instructions. Make minor... its premium accounting system to handle the new data element. The collection of information under the...

Federal employees health benefits: payment of premiums for periods of leave without pay or insufficient pay. Final rule.

PubMed

2007-02-05

The Office of Personnel Management (OPM) is issuing final regulations to rewrite certain sections of the Federal regulations in plain language. These final regulations require Federal agencies to provide employees entering leave without pay (LWOP) status, or whose pay is insufficient to cover their Federal Employees Health Benefits (FEHB) premium payments, written notice of their opportunity to continue their FEHB coverage. Employees who want to continue their enrollment must sign a form agreeing to pay their premiums directly to their agency on a current basis, or to incur a debt to be withheld from their future salary. The purpose of this final regulation is to rewrite the existing regulations to ensure that employees who are entering LWOP status, or whose pay is insufficient to pay their FEHB premiums, are fully informed when they decide whether or not to continue their FEHB coverage.

Pricing unit-linked insurance with guaranteed benefit

NASA Astrophysics Data System (ADS)

Iqbal, M.; Novkaniza, F.; Novita, M.

2017-07-01

Unit-linked insurance is an investment-linked insurance, that is, the given benefit is the premium investment out-come. Recently, the most widely marketed insurance in the industry is unit-linked insurance with guaranteed benefit. With guaranteed benefit applied, the insurance benefits form is similar to the payoff form of European call option. Thereby, pricing European call option is involved in pricing unit-linked insurance with guaranteed benefit. The dynamics of investment outcome is assumed to follow stochastic interest rate. Hence, change of measure methods is used in pricing unit-linked insurance. The discount factor with stochastic interest rate needs to be modified as well to be zero coupon bond price. Eventually, the insurance premium is calculated by equivalence principle with guaranteed benefit and insurance period explicitly given.

The capitalized value of rainwater tanks in the property market of Perth, Australia

NASA Astrophysics Data System (ADS)

Zhang, Fan; Polyakov, Maksym; Fogarty, James; Pannell, David J.

2015-03-01

In response to frequent water shortages, governments in Australia have encouraged home owners to install rainwater tanks, often by provision of partial funding for their installation. A simple investment analysis suggests that the net private benefits of rainwater tanks are negative, potentially providing justification for funding support for tank installation if it results in sufficiently large public benefits. However, using a hedonic price analysis we estimate that there is a premium of up to AU18,000 built into the sale prices of houses with tanks installed. The premium is likely to be greater than the costs of installation, even allowing for the cost of time that home owners must devote to research, purchase and installation. The premium is likely to reflect non-financial as well as financial benefits from installation. The robustness of our estimated premium is investigated using both bounded regression analysis and simulation methods and the result is found to be highly robust. The policy implication is that governments should not rely on payments to encourage installation of rainwater tanks, but instead should use information provision as their main mechanism for promoting uptake. Several explanations for the observation that many home owners are apparently leaving benefits on the table are canvased, but no fully satisfactory explanation is identified.

The health plan choices of retirees under managed competition.

PubMed Central

Buchmueller, T C

2000-01-01

OBJECTIVE: To investigate the effect of price on the health insurance decisions of Medicare-eligible retirees in a managed competition setting. DATA SOURCE: The study is based on four years of administrative data from the University of California (UC) Retiree Health Benefits Program, which closely resembles the managed competition model upon which several leading Medicare reform proposals are based. STUDY DESIGN: A change in UC's premium contribution policy between 1993 and 1994 created a unique natural experiment for investigating the effect of price on retirees' health insurance decisions. This study consists of two related analyses. First, I estimate the effect of changes in out-of-pocket premiums between 1993 and 1994 on the decision to switch plans during open enrollment. Second, using data from 1993 to 1996, I examine the extent to which rising premiums for fee-for-service Medigap coverage increased HMO enrollment among Medicare-eligible UC retirees. PRINCIPLE FINDINGS: Price is a significant factor affecting the health plan decisions of Medicare-eligible UC retirees. However, these retirees are substantially less price sensitive than active UC employees and the non-elderly in other similar programs. This result is likely attributable to higher nonpecuniary switching costs facing older individuals. CONCLUSIONS: Although it is not clear exactly how price sensitive enrollees must be in order to generate price competition among health plans, the behavioral differences between retirees and active employees suggest that caution should be taken in extrapolating from research on the non-elderly to the Medicare program. PMID:11130806

49 CFR 260.15 - Credit risk premium.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Credit risk premium. 260.15 Section 260.15... REHABILITATION AND IMPROVEMENT FINANCING PROGRAM Overview § 260.15 Credit risk premium. (a) Where available... pay to the Administrator a Credit Risk Premium adequate to cover that portion of the subsidy cost not...

24 CFR 206.107 - Mortgagee election of assignment or shared premium option.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Obligations Mortgage Insurance Premiums § 206.107 Mortgagee election of assignment or shared premium option... shared premium option. 206.107 Section 206.107 Housing and Urban Development Regulations Relating to... COMMISSIONER, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL...

24 CFR 203.443 - Insurance premium.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Insurance premium. 203.443 Section... premium. All of the provisions of §§ 203.260 through 203.269 1 concerning mortgage insurance premiums... DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE...

24 CFR 2700.315 - Insurance premium.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 5 2011-04-01 2011-04-01 false Insurance premium. 2700.315 Section... HOMEOWNERS' LOAN PROGRAM Mortgage Insurance § 2700.315 Insurance premium. (a) At such times as may be prescribed by HUD, the participating lender shall pay to HUD a mortgage insurance premium equal to one-half...

24 CFR 203.443 - Insurance premium.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Insurance premium. 203.443 Section... premium. All of the provisions of §§ 203.260 through 203.269 1 concerning mortgage insurance premiums... DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE...

24 CFR 206.107 - Mortgagee election of assignment or shared premium option.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Obligations Mortgage Insurance Premiums § 206.107 Mortgagee election of assignment or shared premium option... shared premium option. 206.107 Section 206.107 Housing and Urban Development Regulations Relating to... COMMISSIONER, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL...

The price sensitivity of Medicare beneficiaries: a regression discontinuity approach.

PubMed

Buchmueller, Thomas C; Grazier, Kyle; Hirth, Richard A; Okeke, Edward N

2013-01-01

We use 4 years of data from the retiree health benefits program of the University of Michigan to estimate the effect of price on the health plan choices of Medicare beneficiaries. During the period of our analysis, changes in the University's premium contribution rules led to substantial price changes. A key feature of this 'natural experiment' is that individuals who had retired before a certain date were exempted from having to pay any premium contributions. This 'grandfathering' creates quasi-experimental variation that is ideal for estimating the effect of price. Using regression discontinuity methods, we compare the plan choices of individuals who retired just after the grandfathering cutoff date and were therefore exposed to significant price changes to the choices of a 'control group' of individuals who retired just before that date and therefore did not experience the price changes. The results indicate a statistically significant effect of price, with a $10 increase in monthly premium contributions leading to a 2 to 3 percentage point decrease in a plan's market share. Copyright © 2012 John Wiley & Sons, Ltd.

A Comparative Analysis of the Financial Incentives of Two Distinct Experience-Rating Programs.

PubMed

Tompa, Emile; McLeod, Chris; Mustard, Cam

2016-07-01

The aim of this study was to compare the association between insurance premium incentives and claim outcomes in two different workers' compensation programs. Regression models were run for claim outcomes using data from two Canadian jurisdictions with different experience-rating programs-one with prospective (British Columbia) and another with retrospective (Ontario) adjustment of premiums. Key explanatory variables were past premium adjustments. For both programs, past premium adjustments were significantly associated with claim outcomes, suggesting adjustments provided incentives for claims reduction. The magnitudes of effects in the prospective program were smaller than the retrospective one, though relative persistence of effects over time was larger. Having large and immediate employer responses to incentives may appear desirable, but insurers should consider the time required for employers to improve and sustain good practices, and create incentives that parallel such time lines.

The effects of premium changes on ALL Kids, Alabama's CHIP program.

PubMed

Morrisey, Michael A; Blackburn, Justin; Sen, Bisakha; Becker, David; Kilgore, Meredith L; Caldwell, Cathy; Menachemi, Nir

2012-01-01

Describe the trends in enrollment and renewal in the Alabama Children's Health Insurance Plan (CHIP), ALL Kids, since its creation in 1998, and to estimate the effect that an annual premium increase, along with coincident increases in service copays, had on the decision to renew participation. Unlike many other CHIP programs, ALL Kids is a standalone program that provides year long enrollment and contracts with the state's Blue Cross and Blue Shield program for its network of providers and its provider fee structure. In October 2003 premiums for individual coverage were increased by $50 per year and copays by $1 to $3 per visit. This study is based upon a sample of 569,650 person-year observations of 230,255 children enrolled in the ALL Kids program between 1999 and 2009. The study models enrollment as a time series of cross section renewal decisions and specifies a series of linear probability regression models to estimate the effect of changes in the premium shift on the decision to renew. A second analysis includes interaction effects of the premiums shift with demographics, health status, income and previous enrollment to estimate differential response across subgroups. The increases in premiums and copays are estimated to have reduced program renewals by 6.1 to 8.3 percent depending upon how much time one allows for families to renew. Families with a child who has a chronic condition were more likely to renew coverage. However, those with chronic conditions, African-Americans and those with lower family incomes were more price-sensitive. An increase in annual premiums and visit copays had a modest impact on program reenrollment with effects comparable to those found in Florida, New Hampshire, Kansas and Arizona, but smaller than those in Kentucky and Georgia.

Premium Rebates and the Quiet Consensus on Market Reform for Medicare

PubMed Central

Feldman, Roger; Dowd, Bryan E.; Coulam, Robert; Nichols, Len; Mutti, Anne

2001-01-01

Premium rebates allow beneficiaries who choose more efficient Medicare options to receive cash rebates, rather than extra benefits. That simple idea has been controversial. Without fanfare, however, premium rebates have become a key area of agreement in the debate on Medicare reform. Moreover, in legislation in late 2000, it became official policy: Medicare+Choice (M+C) plans will be allowed to offer rebates beginning in 2003. This article explores the economic rationale for premium rebates, provides a historical perspective on the rebate debate, discusses some of the implementation issues that need to be addressed before 2003, and reviews the implications of premium rebates for current legislative proposals for Medicare reform. PMID:12500336

48 CFR 1632.170 - Recurring premium payments to carriers.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Recurring premium payments to carriers. 1632.170 Section 1632.170 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT...

48 CFR 1632.170 - Recurring premium payments to carriers.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Recurring premium payments to carriers. 1632.170 Section 1632.170 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT...

Impact of the Minimum Pricing Policy and introduction of brand (generic) substitution into the Pharmaceutical Benefits Scheme in Australia.

PubMed

McManus, P; Birkett, D J; Dudley, J; Stevens, A

2001-01-01

To describe the effects of introducing the Minimum Pricing Policy (MPP) and generic (brand) substitution in 1990 and 1994 respectively on the dispensing of Pharmaceutical Benefits Scheme (PBS) prescriptions both at the aggregate and individual patient level. The relative proportion of prescriptions with a brand premium and those at benchmark was examined 4 years after introduction of the MPP and again 5 years later after generic substitution by pharmacists was permitted. To determine the impact of a price signal at the individual level, case studies involving a patient tracking methodology were conducted on two drugs (fluoxetine and ranitidine) that received a brand premium. From a zero base when the MPP was introduced in 1990, there were 5.4 million prescriptions (17%) dispensed for benchmark products 4 years later in 1994. At this stage generic (brand) substitution by pharmacists was then permitted and the market share of benchmark brands increased to 45% (25.2 million) by 1999. In the patient tracking studies, a significantly lower proportion of patients was still taking the premium brand of fluoxetine 3 months after the introduction of a price signal compared with patients taking paroxetine which did not have a generic competitor. This was also the case for the premium brand of ranitidine when compared to famotidine. The size of the price signal also had a marked effect on dispensing behaviour with the drug with the larger premium (fluoxetine) showing a significantly greater switch away from the premium brand to the benchmark product. The introduction in 1990 of the Minimum Pricing Policy without allowing generic substitution had a relatively small impact on the selection of medicines within the Pharmaceutical Benefits Scheme. However the effect of generic substitution at the pharmacist level, which was introduced in December 1994, resulted in a marked increase in the percentage of eligible PBS items dispensed at benchmark. Case studies showed a larger premium resulted in a greater shift of patients from drugs with a brand premium to the benchmark alternative.

Using Medicaid/SCHIP to insure working families: the Massachusetts experience.

PubMed

Mitchell, Janet B; Osber, Deborah S

2002-01-01

Massachusetts was the first State to implement a premium subsidy program for employer-sponsored health insurance, using both Medicaid and State Children's Health Insurance Program (SCHIP) funding. The Insurance Partnership (IP) provides subsidies directly to small employers, and the Premium Assistance Program provides subsidies to their low-income employees. Approximately 3,500 small firms currently participate, most of them offering health insurance coverage for the first time. Approximately 10,000 adults and children are covered through the program, the majority of whom had been uninsured prior to enrolling. Massachusetts' successful experience with premium subsidies offers important lessons for other States wishing to implement similar programs.

24 CFR 4001.122 - Fees and closing costs.

Code of Federal Regulations, 2010 CFR

2010-04-01

... originating the Program mortgage; (3) Premium pricing by the mortgagee providing the Program mortgage; (4... loan-to-value ratio does not exceed 90 percent (including the up-front premium required under § 4001...

Financial competitiveness of organic agriculture on a global scale.

PubMed

Crowder, David W; Reganold, John P

2015-06-16

To promote global food and ecosystem security, several innovative farming systems have been identified that better balance multiple sustainability goals. The most rapidly growing and contentious of these systems is organic agriculture. Whether organic agriculture can continue to expand will likely be determined by whether it is economically competitive with conventional agriculture. Here, we examined the financial performance of organic and conventional agriculture by conducting a meta-analysis of a global dataset spanning 55 crops grown on five continents. When organic premiums were not applied, benefit/cost ratios (-8 to -7%) and net present values (-27 to -23%) of organic agriculture were significantly lower than conventional agriculture. However, when actual premiums were applied, organic agriculture was significantly more profitable (22-35%) and had higher benefit/cost ratios (20-24%) than conventional agriculture. Although premiums were 29-32%, breakeven premiums necessary for organic profits to match conventional profits were only 5-7%, even with organic yields being 10-18% lower. Total costs were not significantly different, but labor costs were significantly higher (7-13%) with organic farming practices. Studies in our meta-analysis accounted for neither environmental costs (negative externalities) nor ecosystem services from good farming practices, which likely favor organic agriculture. With only 1% of the global agricultural land in organic production, our findings suggest that organic agriculture can continue to expand even if premiums decline. Furthermore, with their multiple sustainability benefits, organic farming systems can contribute a larger share in feeding the world.

77 FR 58359 - TRICARE, Formerly Known as the Civilian Health and Medical Program of the Uniformed Services...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-20

... Medical Program of the Uniformed Services; Calendar Year 2013 TRICARE Young Adult Program Premium Update... Young Adult Premiums for Calendar Year 2013. SUMMARY: This notice provides the updated TRICARE Young... to implement the TRICARE Young Adult (TYA) program as required by Title 10, United States Code...

Medicaid and CHIP Premiums and Access to Care: A Systematic Review.

PubMed

Saloner, Brendan; Hochhalter, Stephanie; Sabik, Lindsay

2016-03-01

Premiums are required in Medicaid and the Children's Health Insurance Program in many states. Effects of premiums are raised in policy debates. Our objective was to review effects of premiums on children's coverage and access. PubMed was used to search academic literature from 1995 to 2014. Two reviewers initially screened studies by using abstracts and titles, and 1 additional reviewer screened proposed studies. Included studies focused on publicly insured children, evaluated premium changes in at least 1 state/local program, and used longitudinal or repeated cross-sectional data with pre/postchange measures. We identified 263 studies of which 17 met inclusion criteria. Four studies examined population-level coverage effects by using national survey data, 11 studies examined trends in disenrollment and reenrollment by using administrative data, and 2 studies measured additional outcomes. No eligible studies evaluated health status effects. Increases in premiums were associated with increased disenrollment rates in 7 studies that permitted comparison. Larger premium increases and stringent enforcement tended to have larger effects on disenrollment. At a population level, premiums reduce public insurance enrollment and may increase the uninsured rate for lower-income children. Little is known about effects of premiums on spending or access to care, but 1 study reveals premiums are unlikely to yield substantial revenue. Effect sizes were difficult to compare across studies with administrative data. Public insurance premiums often increase disenrollment from public insurance and may have unintended consequences on overall coverage for low-income children. Copyright © 2016 by the American Academy of Pediatrics.

Determinants of Medicare plan choices: are beneficiaries more influenced by premiums or benefits?

PubMed

Jacobs, Paul D; Buntin, Melinda B

2015-07-01

To evaluate the sensitivity of Medicare beneficiaries to premiums and benefits when selecting healthcare plans after the introduction of Part D. We matched respondents in the 2008 Medicare Current Beneficiary Survey to the Medicare Advantage (MA) plans available to them using the Bid Pricing Tool and previously unavailable data on beneficiaries' plan choices. We estimated a 2-stage nested logit model of Medicare plan choice decision making, including the decision to choose traditional fee-for-service (FFS) Medicare or an MA plan, and for those choosing MA, which specific plan they chose. Beneficiaries living in areas with higher average monthly rebates available from MA plans were more likely to choose MA rather than FFS. When choosing MA plans, beneficiaries are roughly 2 to 3 times more responsive to dollars spent to reduce cost sharing than reductions in their premium. We calculated an elasticity of plan choice with respect to the monthly MA premium of -0.20. Beneficiaries with lower incomes are more sensitive to plan premiums and cost sharing than higher-income beneficiaries. MA plans appear to have a limited incentive to aggressively price their products, and seem to compete primarily over reduced beneficiary cost sharing. Given the limitations of the current plan choice environment, policies designed to encourage the selection of lower-cost plans may require increasing premium differences between plans and providing the tools to enable beneficiaries to easily assess those differences.

Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2018; Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program. Final rule.

PubMed

2016-12-22

This final rule sets forth payment parameters and provisions related to the risk adjustment program; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges and State-based Exchanges on the Federal platform. It also provides additional guidance relating to standardized options; qualified health plans; consumer assistance tools; network adequacy; the Small Business Health Options Programs; stand-alone dental plans; fair health insurance premiums; guaranteed availability and guaranteed renewability; the medical loss ratio program; eligibility and enrollment; appeals; consumer-operated and oriented plans; special enrollment periods; and other related topics.

The Effects of Premium Changes on ALL Kids, Alabama's CHIP Program

PubMed Central

Morrisey, Michael A.; Blackburn, Justin; Sen, Bisakha; Becker, David; Kilgore, Meredith L.; Caldwell, Cathy; Menachemi, Nir

2012-01-01

Objective Describe the trends in enrollment and renewal in the Alabama Children's Health Insurance Plan (CHIP), ALL Kids, since its creation in 1998, and to estimate the effect that an annual premium increase, along with coincident increases in service copays, had on the decision to renew participation. Background: Unlike many other CHIP programs, ALL Kids is a standalone program that provides year long enrollment and contracts with the state's Blue Cross and Blue Shield program for its network of providers and its provider fee structure. In October 2003 premiums for individual coverage were increased by $50 per year and copays by $1 to $3 per visit. Population Studied This study is based upon a sample of 569,650 person-year observations of 230,255 children enrolled in the ALL Kids program between 1999 and 2009. Study Design The study models enrollment as a time series of cross section renewal decisions and specifies a series of linear probability regression models to estimate the effect of changes in the premium shift on the decision to renew. A second analysis includes interaction effects of the premiums shift with demographics, health status, income and previous enrollment to estimate differential response across subgroups. Principal Findings The increases in premiums and copays are estimated to have reduced program renewals by 6.1 to 8.3 percent depending upon how much time one allows for families to renew. Families with a child who has a chronic condition were more likely to renew coverage. However, those with chronic conditions, African-Americans and those with lower family incomes were more price-sensitive. Conclusions An increase in annual premiums and visit copays had a modest impact on program reenrollment with effects comparable to those found in Florida, New Hampshire, Kansas and Arizona, but smaller than those in Kentucky and Georgia. PMID:24800149

Patient Protection and Affordable Care Act; third party payment of qualified health plan premiums. Interim final rule with comment period.

PubMed

2014-03-19

This interim final rule requires issuers of qualified health plans (QHPs), including stand-alone dental plans (SADPs), to accept premium and cost-sharing payments made on behalf of enrollees by the Ryan White HIV/AIDS Program, other Federal and State government programs that provide premium and cost sharing support for specific individuals, and Indian tribes, tribal organizations, and urban Indian organizations.

Making Medicare advantage a middle-class program.

PubMed

Glazer, Jacob; McGuire, Thomas G

2013-03-01

This paper studies the role of Medicare's premium policy in sorting beneficiaries between traditional Medicare (TM) and managed care plans in the Medicare advantage (MA) program. Beneficiaries vary in their demand for care. TM fully accommodates demand but creates a moral hazard inefficiency. MA rations care but disregards some elements of the demand. We describe an efficient assignment of beneficiaries to these two options, and argue that efficiency requires an MA program oriented to serve the large middle part of the distribution of demand: the "middle class." Current Medicare policy of a "single premium" for MA plans cannot achieve efficient sorting. We characterize the demand-based premium policy that can implement the efficient assignment of enrollees to plans. If only a single premium is feasible, the second-best policy involves too many of the low-demand individuals in MA and a too low level of services relative to the first best. We identify approaches to using premium policy to revitalize MA and improve the efficiency of Medicare. Copyright © 2012 Elsevier B.V. All rights reserved.

Estimating organic, local, and other price premiums in the Hawaii fluid milk market.

PubMed

Loke, Matthew K; Xu, Xun; Leung, PingSun

2015-04-01

With retail scanner data, we applied hedonic price modeling to explore price premiums for organic, local, and other product attributes of fluid milk in Hawaii. Within the context of revealed preference, this analysis of organic and local attributes, under a single unified framework, is significant, as research in this area is deficient in the existing literature. This paper finds both organic and local attributes delivered price premiums over imported, conventional, whole fluid milk. However, the estimated price premium for organic milk (24.6%) is significantly lower than findings in the existing literature. Likewise, the price premium for the local attribute is estimated at 17.4%, again substantially lower compared with an earlier, stated preference study in Hawaii. Beyond that, we estimated a robust price premium of 19.7% for nutritional benefits claimed. The magnitude of this estimated coefficient reinforces the notion that nutrition information on food is deemed beneficial and valuable. Finally, package size measures the influence of product weight. With each larger package size, the estimate led to a corresponding larger price discount. This result is consistent with the practice of weight discounting that retailers usually offer with fresh packaged food. Additionally, we estimated a fairly high Armington elasticity of substitution, which suggests a relatively high degree of substitution between local and imported fluid milk when their relative price changes. Overall, this study establishes price premiums for organic, local, and nutrition benefits claimed for fluid milk in Hawaii. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

7 CFR 2201.23 - Funding for the Program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the Program and operate the Program accordingly. (b) Credit Risk Premium—(1) Establishment and approval. The Board may establish and approve the acceptance of credit risk premiums with respect to a..., credit risk premiums shall be accepted from a non-Federal source on behalf of a Borrower. (2) Credit risk...

Analyses of Military Healthcare Benefit Design and Delivery: Study in Support of the Military Compensation and Retirement Modernization Commission

DTIC Science & Technology

2015-01-01

Health Sciences , and other specialized skill training and professional development education programs; • Base Operations/Communications – DoD medical and... Actuary lowered its estimate of future per capita medical spending for dual-eligible beneficiaries (i.e., beneficiaries eligible for both TRICARE and...of the covered population into account. While advanced actuarial modeling would be required to determine each plan’s actual premiums, here we

A new, but old business model for family physicians: cash.

PubMed

Weber, J Michael

2013-01-01

The following study is an exploratory investigation into the opportunity identification, opportunity analysis, and strategic implications of implementing a cash-only family physician practice. The current market dynamics (i.e., increasing insurance premiums, decreasing benefits, more regulations and paperwork, and cuts in federal and state programs) suggest that there is sufficient motivation for these practitioners to change their current business model. In-depth interviews were conducted with office managers and physicians of family physician practices. The results highlighted a variety of issues, including barriers to change, strategy issues, and opportunities/benefits. The implications include theory applications, strategic marketing applications, and managerial decision-making.

Income Eligibility Thresholds, Premium Contributions, and Children's Coverage Outcomes: A Study of CHIP Expansions

PubMed Central

Gresenz, Carole Roan; Edgington, Sarah E; Laugesen, Miriam J; Escarce, José J

2013-01-01

Objective To understand the effects of Children's Health Insurance Program (CHIP) income eligibility thresholds and premium contribution requirements on health insurance coverage outcomes among children. Data Sources 2002–2009 Annual Social and Economic Supplements of the Current Population Survey linked to data from multiple secondary data sources. Study Design We use a selection correction model to simultaneously estimate program eligibility and coverage outcomes conditional upon eligibility. We simulate the effects of three premium schedules representing a range of generosity levels and the effects of income eligibility thresholds ranging from 200 to 400 percent of the federal poverty line. Principal Findings Premium contribution requirements decrease enrollment in public coverage and increase enrollment in private coverage, with larger effects for greater contribution levels. Our simulation results suggest minimal changes in coverage outcomes from eligibility expansions to higher income families under premium schedules that require more than a modest contribution (medium or high schedules). Conclusions Our simulation results are useful counterpoints to previous research that has estimated the average effect of program expansions as they were implemented without disentangling the effects of premiums or other program features. The sensitivity to premiums observed suggests that although contribution requirements may be effective in reducing crowd-out, they also have the potential, depending on the level of contribution required, to nullify the effects of CHIP expansions entirely. The persistence of uninsurance among children under the range of simulated scenarios points to the importance of Affordable Care Act provisions designed to make the process of obtaining coverage transparent and navigable. PMID:23398477

Income eligibility thresholds, premium contributions, and children's coverage outcomes: a study of CHIP expansions.

PubMed

Gresenz, Carole Roan; Edgington, Sarah E; Laugesen, Miriam J; Escarce, José J

2013-04-01

To understand the effects of Children's Health Insurance Program (CHIP) income eligibility thresholds and premium contribution requirements on health insurance coverage outcomes among children. 2002-2009 Annual Social and Economic Supplements of the Current Population Survey linked to data from multiple secondary data sources. We use a selection correction model to simultaneously estimate program eligibility and coverage outcomes conditional upon eligibility. We simulate the effects of three premium schedules representing a range of generosity levels and the effects of income eligibility thresholds ranging from 200 to 400 percent of the federal poverty line. Premium contribution requirements decrease enrollment in public coverage and increase enrollment in private coverage, with larger effects for greater contribution levels. Our simulation results suggest minimal changes in coverage outcomes from eligibility expansions to higher income families under premium schedules that require more than a modest contribution (medium or high schedules). Our simulation results are useful counterpoints to previous research that has estimated the average effect of program expansions as they were implemented without disentangling the effects of premiums or other program features. The sensitivity to premiums observed suggests that although contribution requirements may be effective in reducing crowd-out, they also have the potential, depending on the level of contribution required, to nullify the effects of CHIP expansions entirely. The persistence of uninsurance among children under the range of simulated scenarios points to the importance of Affordable Care Act provisions designed to make the process of obtaining coverage transparent and navigable. © Health Research and Educational Trust.

5 CFR 892.302 - Will the Government contribution continue?

Code of Federal Regulations, 2011 CFR

2011-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS... employer will still pay the same share of your premium as provided in the Federal Employees Health Benefits...

5 CFR 892.203 - When will my premium conversion begin?

Code of Federal Regulations, 2013 CFR

2013-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS...)), your salary reduction (through a Federal allotment) and pre-tax benefit will be effective on the 1st...

5 CFR 892.302 - Will the Government contribution continue?

Code of Federal Regulations, 2014 CFR

2014-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS... employer will still pay the same share of your premium as provided in the Federal Employees Health Benefits...

5 CFR 892.302 - Will the Government contribution continue?

Code of Federal Regulations, 2013 CFR

2013-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS... employer will still pay the same share of your premium as provided in the Federal Employees Health Benefits...

5 CFR 892.203 - When will my premium conversion begin?

Code of Federal Regulations, 2014 CFR

2014-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS...)), your salary reduction (through a Federal allotment) and pre-tax benefit will be effective on the 1st...

5 CFR 892.302 - Will the Government contribution continue?

Code of Federal Regulations, 2010 CFR

2010-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS... employer will still pay the same share of your premium as provided in the Federal Employees Health Benefits...

Small businesses and the Affordable Care Act of 2010.

PubMed

Collins, Sara R; Davis, Karen; Nicholson, Jennifer L; Stremikis, Kristof

2010-09-01

The Patient Protection and Affordable Care Act (ACA) includes several short- and long-term provisions designed to help small businesses pay for and maintain health insurance for their workers, and to allow workers without employer coverage to gain access to affordable, comprehensive health insurance. Provisions include a small business tax credit to offset premium costs for firms that offer coverage starting this taxable year, establishment of state-based insurance exchanges that promise to lower administrative costs and pool risk more broadly, and creation of new market rules and an essential benefit standard to protect small firms and their workers. Analysis shows that up to 16.6 million workers are in firms that would be eligible for the tax credit in 2010 to 2013. Over the next 10 years, small businesses and organizations could receive an estimated $40 billion in federal support through the premium credit program.

Worth of Geophysical Data in Natural-Disaster-Insurance Rate Setting.

NASA Astrophysics Data System (ADS)

Attanasi, E. D.; Karlinger, M. R.

1982-04-01

Insurance firms that offer natural-disaster insurance base their rates on available information. The benefits from collecting additional data and incorporating this information to improve parameter estimates of probability distributions that are used to characterize natural-disaster events can be determined by computing changes in premiums as a function of additional data. Specifically, the worth of data can be measured by changes in consumer's surplus (the widely applied measure of benefits to consumers used in benefit-cost analysis) brought about when the premiums are adjusted. In this paper, a formal model of the process for setting insurance rates is hypothesized in which the insurance firm sets rates so as to trade off penalties of overestimation and underestimation of expected damages estimated from currently available hydrologic data. A Bayesian preposterior analysis is performed which permits the determination of the expected benefits of collecting additional geophysical data by examining the changes in expected premium rates as a function of the longer record before the data are actually collected. An estimate of the expected benefits associated with collecting more data for the representative consumer is computed using an assumed demand function for insurance. In addition, a sensitivity analysis of expected benefits to changes in insurance demand and firm rate-setting procedures is carried out. From these results, conclusions are drawn regarding aggregate benefits to all flood insurance purchasers.

42 CFR 457.810 - Premium assistance programs: Required protections against substitution.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., must provide the protections against substitution of CHIP coverage for coverage under group health... assistance programs must not be greater than the cost of other CHIP coverage for these children; and (2) The... children under premium assistance programs to the cost of other CHIP coverage for these children, done on a...

Financial competitiveness of organic agriculture on a global scale

PubMed Central

Crowder, David W.; Reganold, John P.

2015-01-01

To promote global food and ecosystem security, several innovative farming systems have been identified that better balance multiple sustainability goals. The most rapidly growing and contentious of these systems is organic agriculture. Whether organic agriculture can continue to expand will likely be determined by whether it is economically competitive with conventional agriculture. Here, we examined the financial performance of organic and conventional agriculture by conducting a meta-analysis of a global dataset spanning 55 crops grown on five continents. When organic premiums were not applied, benefit/cost ratios (−8 to −7%) and net present values (−27 to −23%) of organic agriculture were significantly lower than conventional agriculture. However, when actual premiums were applied, organic agriculture was significantly more profitable (22–35%) and had higher benefit/cost ratios (20–24%) than conventional agriculture. Although premiums were 29–32%, breakeven premiums necessary for organic profits to match conventional profits were only 5–7%, even with organic yields being 10–18% lower. Total costs were not significantly different, but labor costs were significantly higher (7–13%) with organic farming practices. Studies in our meta-analysis accounted for neither environmental costs (negative externalities) nor ecosystem services from good farming practices, which likely favor organic agriculture. With only 1% of the global agricultural land in organic production, our findings suggest that organic agriculture can continue to expand even if premiums decline. Furthermore, with their multiple sustainability benefits, organic farming systems can contribute a larger share in feeding the world. PMID:26034271

24 CFR 213.256 - Premiums; insurance upon completion.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Premiums; insurance upon completion... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES COOPERATIVE HOUSING MORTGAGE INSURANCE Contract Rights and Obligations-Projects § 213.256 Premiums...

Estimating Premium Sensitivity for Children's Public Health Insurance Coverage: Selection but No Death Spiral

PubMed Central

Marton, James; Ketsche, Patricia G; Snyder, Angela; Adams, E Kathleen; Zhou, Mei

2015-01-01

Objective To estimate the effect of premium increases on the probability that near-poor and moderate-income children disenroll from public coverage. Data Sources Enrollment, eligibility, and claims data for Georgia's PeachCare for Kids™ (CHIP) program for multiple years. Study Design We exploited policy-induced variation in premiums generated by cross-sectional differences and changes over time in enrollee age, family size, and income to estimate the duration of enrollment as a function of the effective (per child) premium. We classify children as being of low, medium, or high illness severity. Principal Findings A dollar increase in the per-child premium is associated with a slight increase in a typical child's monthly probability of exiting coverage from 7.70 to 7.83 percent. Children with low illness severity have a significantly higher monthly baseline probability of exiting than children with medium or high illness severity, but the enrollment response to premium increases is similar across all three groups. Conclusions Success in achieving coverage gains through public programs is tempered by persistent problems in maintaining enrollment, which is modestly affected by premium increases. Retention is subject to adverse selection problems, but premium increases do not appear to significantly magnify the selection problem in this case. PMID:25130764

Plan-provider integration, premiums, and quality in the Medicare Advantage market.

PubMed

Frakt, Austin B; Pizer, Steven D; Feldman, Roger

2013-12-01

To investigate how integration between Medicare Advantage plans and health care providers is related to plan premiums and quality ratings. We used public data from the Centers for Medicare and Medicaid Services (CMS) and the Area Resource File and private data from one large insurer. Premiums and quality ratings are from 2009 CMS administrative files and some control variables are historical. We estimated ordinary least-squares models for premiums and plan quality ratings, with state fixed effects and firm random effects. The key independent variable was an indicator of plan-provider integration. With the exception of Medigap premium data, all data were publicly available. We ascertained plan-provider integration through examination of plans' websites and governance documents. We found that integrated plan-providers charge higher premiums, controlling for quality. Such plans also have higher quality ratings. We found no evidence that integration is associated with more generous benefits. Current policy encourages plan-provider integration, although potential effects on health insurance products and markets are uncertain. Policy makers and regulators may want to closely monitor changes in premiums and quality after integration and consider whether quality improvement (if any) justifies premium increases (if they occur). © Health Research and Educational Trust.

Demystifying first-cost green building premiums in healthcare.

PubMed

Houghton, Adele; Vittori, Gail; Guenther, Robin

2009-01-01

This study assesses the extent of "first-cost green building construction premiums" in the healthcare sector based on data submitted by and interviews with 13 current LEED-certified and LEED-registered healthcare project teams, coupled with a literature survey of articles on the topics of actual and perceived first-cost premiums associated with green building strategies. This analysis covers both perceived and realized costs across a range of projects in this sector, leading to the following conclusions: Construction first-cost premiums may be lower than is generally perceived, and they appear to be independent of both building size and level of "green" achievement; projects are using financial incentives and philanthropy to drive higher levels of achievement; premiums are decreasing over time; and projects are benefiting from improvements in health and productivity which, although difficult to monetize, are universally valued.

National trends in the cost of employer health insurance coverage, 2003-2013.

PubMed

Collins, Sara R; Radley, David C; Schoen, Cathy; Beutel, Sophie

2014-12-01

Looking at trends in private employer-based health insurance from 2003 to 2013, this issue brief finds that premiums for family coverage increased 73 percent over the past decade--faster than median family income. Employees' contributions to their premiums climbed by 93 percent over that time frame. At the same time, deductibles more than doubled in both large and small firms. Workers are thus paying more but getting less protective benefits. However, the study also finds that while premiums continued to rise through 2013, the rate of growth slowed between 2010 and 2013, following implementation of the Affordable Care Act. While families experienced slower growth in premium contributions and deductibles over this period, sluggish growth in median family income means families are paying more in premiums and deductibles as a share of their income than ever before.

The German Long-Term Care Insurance Program: Evolution and Recent Developments.

PubMed

Nadash, Pamela; Doty, Pamela; von Schwanenflügel, Matthias

2018-05-08

Since 1995, Germany has operated one of the longest-running public programs providing universal support for the cost of long term services and supports (LTSS). Its self-funding, social insurance approach provides basic supports to nearly all Germans. We discuss its design and development, including recent reforms expanding the program and ensuring its ongoing sustainability. The study reviews legislative and programmatic changes, using program data, as well as legislative documents and program reports. The program is widely accepted among citizens and has achieved many of its original goals: ensuring access to LTSS and reducing reliance on the locally-funded safety-net social assistance program, which can be used to cover nursing home costs. It also strengthened the LTSS provider infrastructure and expanded access to home care. Recent reforms have addressed some of the program's key issues: the benefit's decreasing value, the eligibility and benefit structure that largely excluded cognitive impairment, and the program's longer-term financial sustainability-particularly its ability to sustain newly expanded benefits, which provide stronger protections to caregivers, index-link benefits, and more systematically incorporate cognitive impairment via a new assessment system. It has addressed financing issues by increasing premiums, introducing subsidies for the purchase of private insurance, and creating a "demographic reserve fund." The reforms constitute a significant strengthening of the program, remarkable in an era of retrenchment. Overall, the program provides evidence for the financial viability of a social insurance model, although longer-term challenges may yet arise.

Covering bariatric surgery has minimal effect on insurance premium costs within the Affordable Care Act.

PubMed

English, Wayne; Williams, Brandon; Scott, John; Morton, John

2016-06-01

Currently, of the 51 state health exchanges operating under the Affordable Care Act, only 23 include benchmark plans that cover bariatric surgery coverage. Bariatric surgery coverage is not considered an essential health benefit in 28 state exchanges, and this lack of coverage has a discriminatory and detrimental impact on millions of Americans participating in state exchanges that do not provide bariatric surgery coverage. We examined 3 state exchanges in which a portion of their plans provided coverage for bariatric surgery to determine if bariatric surgery coverage is correlated with premium costs. State health exchanges; United States. Data from the 2015 state exchange plans were analyzed using information from the Centers for Medicare & Medicaid Services' Individual Market Landscape file and Benefits and Cost Sharing public use files. Only 3 states (Oklahoma, Oregon, and Virginia) in the analysis have 1 or more rating regions in which a portion of the plans cover bariatric surgery. In Oklahoma and Oregon, the average monthly premiums for all bronze, silver, and gold coverage levels are higher for plans covering bariatric surgery. Only 1 of these states included platinum plans that cover bariatric surgery. The average difference in premiums was between $1 to $45 higher in Oklahoma, and $18 to $32 higher in Oregon. Conversely, in Virginia, the average monthly premiums are between $2 and $21 lower for each level for plans covering bariatric surgery. Monthly premiums for plans covering versus not covering bariatric surgery ranged from 6% lower to 15% higher in the same geographic rating region. Across all 3 states in the sample, the average monthly premiums do not differ consistently on the basis of whether the state exchange plans cover bariatric surgery. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

20 CFR 255.9 - Individual enrolled under supplementary medical insurance plan.

Code of Federal Regulations, 2010 CFR

2010-04-01

... supplementary medical insurance premiums will be applied toward payment of such premiums, and the balance of the... medical insurance plan. 255.9 Section 255.9 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS... supplementary medical insurance plan. Where recovery of the overpayment is by setoff as provided for in § 255.6...

20 CFR 255.9 - Individual enrolled under supplementary medical insurance plan.

Code of Federal Regulations, 2011 CFR

2011-04-01

... supplementary medical insurance premiums will be applied toward payment of such premiums, and the balance of the... medical insurance plan. 255.9 Section 255.9 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS... supplementary medical insurance plan. Where recovery of the overpayment is by setoff as provided for in § 255.6...

42 CFR 422.252 - Terminology.

Code of Federal Regulations, 2012 CFR

2012-10-01

... supplemental benefit, as described at § 422.266(b)(1). MA-PD plan means an MA local or regional plan that...). MA monthly prescription drug beneficiary premium is the MA-PD plan base beneficiary premium, defined... and the national average bid (as described in § 422.256(c)) less the amount of rebate the MA-PD plan...

42 CFR 422.252 - Terminology.

Code of Federal Regulations, 2014 CFR

2014-10-01

... supplemental benefit, as described at § 422.266(b)(1). MA-PD plan means an MA local or regional plan that...). MA monthly prescription drug beneficiary premium is the MA-PD plan base beneficiary premium, defined... and the national average bid (as described in § 422.256(c)) less the amount of rebate the MA-PD plan...

42 CFR 422.252 - Terminology.

Code of Federal Regulations, 2013 CFR

2013-10-01

... supplemental benefit, as described at § 422.266(b)(1). MA-PD plan means an MA local or regional plan that...). MA monthly prescription drug beneficiary premium is the MA-PD plan base beneficiary premium, defined... and the national average bid (as described in § 422.256(c)) less the amount of rebate the MA-PD plan...

42 CFR 406.28 - End of entitlement.

Code of Federal Regulations, 2012 CFR

2012-10-01

... application for hospital insurance benefits in his or her first month of eligibility under that section. (c... individual fails to pay the premium bill, entitlement will end on the last day of the third month after the... individual enrolled on the basis of § 406.20(c), entitlement to premium hospital insurance ends on the last...

42 CFR 406.28 - End of entitlement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... application for hospital insurance benefits in his or her first month of eligibility under that section. (c... individual fails to pay the premium bill, entitlement will end on the last day of the third month after the... individual enrolled on the basis of § 406.20(c), entitlement to premium hospital insurance ends on the last...

42 CFR 406.28 - End of entitlement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... application for hospital insurance benefits in his or her first month of eligibility under that section. (c... individual fails to pay the premium bill, entitlement will end on the last day of the third month after the... individual enrolled on the basis of § 406.20(c), entitlement to premium hospital insurance ends on the last...

42 CFR 406.28 - End of entitlement.

Code of Federal Regulations, 2014 CFR

2014-10-01

... application for hospital insurance benefits in his or her first month of eligibility under that section. (c... individual fails to pay the premium bill, entitlement will end on the last day of the third month after the... individual enrolled on the basis of § 406.20(c), entitlement to premium hospital insurance ends on the last...

42 CFR 406.28 - End of entitlement.

Code of Federal Regulations, 2013 CFR

2013-10-01

... application for hospital insurance benefits in his or her first month of eligibility under that section. (c... individual fails to pay the premium bill, entitlement will end on the last day of the third month after the... individual enrolled on the basis of § 406.20(c), entitlement to premium hospital insurance ends on the last...

77 FR 2761 - Exemptions From Certain Prohibited Transaction Restrictions

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-19

... the Act shall not apply to the reinsurance of risks, and receipt of premiums related therefrom, by... requires that an actuarial review of reserves be conducted annually by an independent firm of actuaries and... increased benefits; (e) In subsequent years, the formula used to calculate premiums by Unum or any successor...

42 CFR 447.66 - General alternative premium protections.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false General alternative premium protections. 447.66 Section 447.66 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing Under Sectio...

42 CFR 447.66 - General alternative premium protections.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false General alternative premium protections. 447.66 Section 447.66 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing Under Sectio...

42 CFR 447.66 - General alternative premium protections.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false General alternative premium protections. 447.66 Section 447.66 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing Under Sectio...

42 CFR 447.66 - General alternative premium protections.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false General alternative premium protections. 447.66 Section 447.66 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing Under Sectio...

24 CFR 203.288 - Discontinuance of adjusted premium charge.

Code of Federal Regulations, 2010 CFR

2010-04-01

... instrument, there shall be no adjusted mortgage insurance premium due the Commissioner on account of the... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Discontinuance of adjusted premium... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER...

24 CFR 203.288 - Discontinuance of adjusted premium charge.

Code of Federal Regulations, 2011 CFR

2011-04-01

... instrument, there shall be no adjusted mortgage insurance premium due the Commissioner on account of the... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Discontinuance of adjusted premium... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER...

Assessing potential enrollment and budgetary effects of SCHIP premiums: findings from Arizona and Kentucky.

PubMed

Kenney, Genevieve; Marton, James; McFeeters, Joshua; Costich, Julia

2007-12-01

To assess whether new premiums in SCHIP affect rates of disenrollment and reenrollment in SCHIP and whether they have spillover enrollment effects on Medicaid. We used SCHIP administrative enrollment data from Arizona and Kentucky. The enrollment data covered July 2001 to December 2005 in Arizona and November 2001 to August 2004 in Kentucky. We used administrative data from two states, Arizona and Kentucky, which introduced new premiums for certain income categories in their SCHIP programs in 2004 and 2003, respectively. We used multivariate hazard models to study rates of disenrollment and re-enrollment for the recipients who had been enrolled in the categories of SCHIP in which the new premiums were implemented. Competing hazard models were used to determine if recipients leaving SCHIP following the introduction of the premium were obtaining other public coverage or exiting public insurance entirely at higher rates. We also used time-series models to measure the effect of premiums on changes in caseloads in premium-paying SCHIP and other categories of public coverage and we assessed the budgetary implications of imposing premiums. In both states, the new premiums increased the rate of disenrollment and decreased the rate of re-enrollment in premium-paying SCHIP among the children who were enrolled in those categories before the premiums were implemented. The competing hazard models indicated that almost all of the increased disenrollment is caused by recipients leaving public insurance entirely. The time-series models indicated that the new premium reduced caseloads in premium-paying SCHIP, but that it might have increased caseloads for other types of public coverage. The amount of premiums collected net of the costs associated with administering premiums is small in both states. Estimating the full budgetary effects with certainty was not possible given the imprecision of the key time-series estimates. These results suggest that the new premium reduced enrollment in the premium-paying group by 18 percent (over 3,000 children) in Kentucky and by 5 percent (over 1,000 children) in Arizona, with some of these children apparently leaving public coverage altogether. While most children enrolled in these categories did not appear to be directly affected by the imposition of $10-$20 monthly premiums, the premiums may have caused some children to go without health insurance coverage, which in turn could have adverse effects on their access to care. Imposing nominal premiums may reduce state spending, but projected savings appear to be small relative to total state SCHIP spending and resulting increases in enrollment in other public programs and in uninsurance rates could offset those savings.

44 CFR 61.7 - Risk premium rate determinations.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE... estimate the risk premium rates necessary to provide flood insurance in accordance with accepted actuarial... flood insurance made available under the Program. Such rates are referred to in this subchapter as...

44 CFR 61.7 - Risk premium rate determinations.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE... estimate the risk premium rates necessary to provide flood insurance in accordance with accepted actuarial... flood insurance made available under the Program. Such rates are referred to in this subchapter as...

44 CFR 61.7 - Risk premium rate determinations.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE... estimate the risk premium rates necessary to provide flood insurance in accordance with accepted actuarial... flood insurance made available under the Program. Such rates are referred to in this subchapter as...

44 CFR 61.7 - Risk premium rate determinations.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE... estimate the risk premium rates necessary to provide flood insurance in accordance with accepted actuarial... flood insurance made available under the Program. Such rates are referred to in this subchapter as...

Premium Assistance Programs under SCHIP: Not for the Faint of Heart. Assessing the New Federalism: An Urban Institute Program To Assess Changing Social Policies. Occasional Paper.

ERIC Educational Resources Information Center

Lutzky, Amy Westpfahl; Hill, Ian

Under the State Childrens Health Insurance Program (SCHIP), states have the option to subsidize employer premiums for low-income workers with children. Given the potential for subsidized employer-sponsored insurance (ESI) programs to reduce the number of uninsured children, this study examined SCHIPs regulations and state experiences with premium…

Medicaid and Children's Health Insurance Programs: Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Other Provisions Related to Eligibility and Enrollment for Medicaid and CHIP. Final rule.

PubMed

2016-11-30

This final rule implements provisions of the Affordable Care Act that expand access to health coverage through improvements in Medicaid and coordination between Medicaid, CHIP, and Exchanges. This rule finalizes most of the remaining provisions from the "Medicaid, Children's Health Insurance Programs, and Exchanges: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Exchange Eligibility Appeals and Other Provisions Related to Eligibility and Enrollment for Exchanges, Medicaid and CHIP, and Medicaid Premiums and Cost Sharing; Proposed Rule" that we published in the January 22, 2013, Federal Register. This final rule continues our efforts to assist states in implementing Medicaid and CHIP eligibility, appeals, and enrollment changes required by the Affordable Care Act.

How low can you go? The impact of reduced benefits and increased cost sharing.

PubMed

Lee, Jason S; Tollen, Laura

2002-01-01

Amid escalating health care costs and a managed care backlash, employers are considering traditional cost control methods from the pre-managed care era. We use an actuarial model to estimate the premium-reducing effects of two such methods: increasing employee cost sharing and reducing benefits. Starting from a baseline plan with rich benefits and low cost sharing, estimated premium savings as a result of eliminating five specific benefits were about 22 percent. The same level of savings was also achieved by increasing cost sharing from a 15 dollars copayment with no deductible to 20 percent coinsurance and a 250 dollars deductible. Further increases in cost sharing produced estimated savings of up to 50 percent. We discuss possible market- and individual-level effects of the proliferation of plans with high cost sharing and low benefits.

24 CFR 252.6 - Method of payment of mortgage insurance premiums.

Code of Federal Regulations, 2010 CFR

2010-04-01

... insurance premiums. 252.6 Section 252.6 Housing and Urban Development Regulations Relating to Housing and..., AND BOARD AND CARE HOMES § 252.6 Method of payment of mortgage insurance premiums. The provisions of..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT...

24 CFR 203.18c - One-time or up-front mortgage insurance premium excluded from limitations on maximum mortgage...

Code of Federal Regulations, 2010 CFR

2010-04-01

... insurance premium excluded from limitations on maximum mortgage amounts. 203.18c Section 203.18c Housing and...-front mortgage insurance premium excluded from limitations on maximum mortgage amounts. After... LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE...

24 CFR 255.6 - Method of payment of mortgage insurance premiums.

Code of Federal Regulations, 2011 CFR

2011-04-01

... insurance premiums. 255.6 Section 255.6 Housing and Urban Development Regulations Relating to Housing and... PROJECTS § 255.6 Method of payment of mortgage insurance premiums. The provisions of 24 CFR 251.6 shall..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT...

24 CFR 252.6 - Method of payment of mortgage insurance premiums.

Code of Federal Regulations, 2011 CFR

2011-04-01

... insurance premiums. 252.6 Section 252.6 Housing and Urban Development Regulations Relating to Housing and..., AND BOARD AND CARE HOMES § 252.6 Method of payment of mortgage insurance premiums. The provisions of..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT...

24 CFR 203.18c - One-time or up-front mortgage insurance premium excluded from limitations on maximum mortgage...

Code of Federal Regulations, 2011 CFR

2011-04-01

... insurance premium excluded from limitations on maximum mortgage amounts. 203.18c Section 203.18c Housing and...-front mortgage insurance premium excluded from limitations on maximum mortgage amounts. After... LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE...

42 CFR 408.42 - Deduction from railroad retirement benefits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Deduction from railroad retirement benefits. 408.42... § 408.42 Deduction from railroad retirement benefits. (a) Responsibility for deductions. If an enrollee is entitled to railroad retirement benefits, his or her SMI premiums are deducted from those benefits...

42 CFR 408.43 - Deduction from social security benefits.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Deduction from social security benefits. 408.43... § 408.43 Deduction from social security benefits. SSA, acting as CMS's agent, deducts the premiums from the monthly social security benefits if the enrollee is not entitled to railroad retirement benefits...

42 CFR 408.43 - Deduction from social security benefits.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Deduction from social security benefits. 408.43... § 408.43 Deduction from social security benefits. SSA, acting as CMS's agent, deducts the premiums from the monthly social security benefits if the enrollee is not entitled to railroad retirement benefits...

42 CFR 408.43 - Deduction from social security benefits.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Deduction from social security benefits. 408.43... § 408.43 Deduction from social security benefits. SSA, acting as CMS's agent, deducts the premiums from the monthly social security benefits if the enrollee is not entitled to railroad retirement benefits...

42 CFR 408.43 - Deduction from social security benefits.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Deduction from social security benefits. 408.43... § 408.43 Deduction from social security benefits. SSA, acting as CMS's agent, deducts the premiums from the monthly social security benefits if the enrollee is not entitled to railroad retirement benefits...

42 CFR 408.43 - Deduction from social security benefits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Deduction from social security benefits. 408.43... § 408.43 Deduction from social security benefits. SSA, acting as CMS's agent, deducts the premiums from the monthly social security benefits if the enrollee is not entitled to railroad retirement benefits...

Market niche analysis in the casino gaming industry.

PubMed

Dandurand, L

1990-03-01

This article discusses the nature of market niche analysis in the casino gaming industry. It presents four approaches for conducting market niche analysis. An an example of one approach, the Las Vegas Visitor Profile Study is used to identify a premium niche in the Las Vegas Slot Target Market. A detailed examination of the premium niche profile provides a description of the typical premium slot player. The description of the typical premium player leads to hypotheses regarding needs (the unique preference set) of the premium player. An analysis of the unique preference set suggests an appropriate enhanced marketing program.

CHIP premiums, health status, and the insurance coverage of children.

PubMed

Marton, James; Talbert, Jeffery C

2010-01-01

This study uses the introduction of premiums into Kentucky's Children's Health Insurance Program (KCHIP) to examine whether the enrollment impact of new premiums varies by child health type. We also examine the extent to which children find alternative coverage after premium nonpayment. Public insurance claims data suggest that those with chronic health conditions are less likely to leave public coverage. We find little evidence of a differential impact of premiums on enrollment among the chronically ill. Our survey of nonpayers shows that 56% of responding families found alternative private or public health coverage for their children after losing CHIP.

Demand for a Medicare prescription drug benefit: exploring consumer preferences under a managed competition framework.

PubMed

Cline, Richard R; Mott, David A

2003-01-01

Several proposals for adding a prescription drug benefit to the Medicare program rely on consumer choice and market forces to promote efficiency. However, little information exists regarding: 1) the extent of price sensitivity for such plans among Medicare beneficiaries, or 2) the extent to which drug-only insurance plans using various cost-control mechanisms might experience adverse selection. Using data from a survey of elderly Wisconsin residents regarding their likely choices from a menu of hypothetical drug plans, we show that respondents are likely to be price sensitive with respect to both premiums and out-of-pocket costs but that selection problems may arise in these markets. Outside intervention may be necessary to ensure the feasibility of a market-based approach to a Medicare drug benefit.

Employment transitions and continuity of health insurance: implications for premium assistance programs.

PubMed

Marquis, M Susan; Kapur, Kanika

2003-01-01

We use data from two nationwide panel surveys to explore whether premium assistance programs can provide stable insurance for low-income children. We estimate that low-income children who are newly enrolled in an employer-group plan would keep that coverage longer than similar children keep newly acquired public insurance. We conclude that group coverage could provide a source of insurance for eligible low-income children that is more stable than public insurance. However, only one-third of low-income uninsured children have access to group insurance, and most low-income children with access to a group plan are enrolled in it. Thus, premium assistance programs are difficult to target effectively, and other programs are necessary to reach the majority of uninsured children.

Prospects for Reducing Uninsured Rates among Children: How Much Can Premium Assistance Programs Help? Timely Analysis of Immediate Health Policy Issues

ERIC Educational Resources Information Center

Kenney, Genevieve; Cook, Allison; Pelletier, Jennifer

2009-01-01

With the reauthorization of the State Children's Health Insurance Program (SCHIP) under consideration in early 2009, an important question is the extent to which uninsured children could be covered under employer-sponsored insurance through premium assistance programs, which use public funding under Medicaid and SCHIP to subsidize…

42 CFR 460.186 - PACE premiums.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false PACE premiums. 460.186 Section 460.186 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE...

Plan–Provider Integration, Premiums, and Quality in the Medicare Advantage Market

PubMed Central

Frakt, Austin B; Pizer, Steven D; Feldman, Roger

2013-01-01

Objective. To investigate how integration between Medicare Advantage plans and health care providers is related to plan premiums and quality ratings. Data Source. We used public data from the Centers for Medicare and Medicaid Services (CMS) and the Area Resource File and private data from one large insurer. Premiums and quality ratings are from 2009 CMS administrative files and some control variables are historical. Study Design. We estimated ordinary least-squares models for premiums and plan quality ratings, with state fixed effects and firm random effects. The key independent variable was an indicator of plan–provider integration. Data Collection. With the exception of Medigap premium data, all data were publicly available. We ascertained plan–provider integration through examination of plans’ websites and governance documents. Principal Findings. We found that integrated plan–providers charge higher premiums, controlling for quality. Such plans also have higher quality ratings. We found no evidence that integration is associated with more generous benefits. Conclusions. Current policy encourages plan–provider integration, although potential effects on health insurance products and markets are uncertain. Policy makers and regulators may want to closely monitor changes in premiums and quality after integration and consider whether quality improvement (if any) justifies premium increases (if they occur). PMID:23800017

A demand-side view of risk adjustment.

PubMed

Feldman, R; Dowd, B E; Maciejewski, M

2001-01-01

This paper analyzes the efficient allocation of consumers to health plans. Specifically, we address the question of why employers that offer multiple health plans often make larger contributions to the premiums of the high-cost plans. Our perspective is that the subsidy for high-cost plans represents a form of demand-side risk adjustment that improves efficiency. Without such subsidies (and in the absence of formal risk adjustment), too few employees would choose the high-cost plans preferred by high-risk workers. We test the theory by estimating a model of the employer premium subsidy, using data from a survey of large public employers in 1994. Our empirical analysis shows that employers are more likely to subsidize high-cost plans when the benefits of risk adjustment are greater. The findings suggest that the premium subsidy can accomplish some of the benefits of formal risk adjustment.

Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013-15 Study.

PubMed

Patel, Mitesh S; Asch, David A; Troxel, Andrea B; Fletcher, Michele; Osman-Koss, Rosemary; Brady, Jennifer; Wesby, Lisa; Hilbert, Victoria; Zhu, Jingsan; Wang, Wenli; Volpp, Kevin G

2016-01-01

Employers commonly use adjustments to health insurance premiums as incentives to encourage healthy behavior, but the effectiveness of those adjustments is controversial. We gave 197 obese participants in a workplace wellness program a weight loss goal equivalent to 5 percent of their baseline weight. They were randomly assigned to a control arm, with no financial incentive for achieving the goal, or to one of three intervention arms offering an incentive valued at $550. Two intervention arms used health insurance premium adjustments, beginning the following year (delayed) or in the first pay period after achieving the goal (immediate). A third arm used a daily lottery incentive separate from premiums. At twelve months there were no statistically significant differences in mean weight change either between the control group (whose members had a mean gain of 0.1 pound) and any of the incentive groups (delayed premium adjustment, -1.2 pound; immediate premium adjustment, -1.4 pound; daily lottery incentive, -1.0 pound) or among the intervention groups. The apparent failure of the incentives to promote weight loss suggests that employers that encourage weight reduction through workplace wellness programs should test alternatives to the conventional premium adjustment approach by using alternative incentive designs, larger incentives, or both. Project HOPE—The People-to-People Health Foundation, Inc.

Assessing Potential Enrollment and Budgetary Effects of SCHIP Premiums: Findings from Arizona and Kentucky

PubMed Central

Kenney, Genevieve; Marton, James; McFeeters, Joshua; Costich, Julia

2007-01-01

Objective To assess whether new premiums in SCHIP affect rates of disenrollment and reenrollment in SCHIP and whether they have spillover enrollment effects on Medicaid. Data Source We used SCHIP administrative enrollment data from Arizona and Kentucky. The enrollment data covered July 2001 to December 2005 in Arizona and November 2001 to August 2004 in Kentucky. Study Design We used administrative data from two states, Arizona and Kentucky, which introduced new premiums for certain income categories in their SCHIP programs in 2004 and 2003, respectively. We used multivariate hazard models to study rates of disenrollment and re-enrollment for the recipients who had been enrolled in the categories of SCHIP in which the new premiums were implemented. Competing hazard models were used to determine if recipients leaving SCHIP following the introduction of the premium were obtaining other public coverage or exiting public insurance entirely at higher rates. We also used time-series models to measure the effect of premiums on changes in caseloads in premium-paying SCHIP and other categories of public coverage and we assessed the budgetary implications of imposing premiums. Principal Findings In both states, the new premiums increased the rate of disenrollment and decreased the rate of re-enrollment in premium-paying SCHIP among the children who were enrolled in those categories before the premiums were implemented. The competing hazard models indicated that almost all of the increased disenrollment is caused by recipients leaving public insurance entirely. The time-series models indicated that the new premium reduced caseloads in premium-paying SCHIP, but that it might have increased caseloads for other types of public coverage. The amount of premiums collected net of the costs associated with administering premiums is small in both states. Estimating the full budgetary effects with certainty was not possible given the imprecision of the key time-series estimates. Conclusion These results suggest that the new premium reduced enrollment in the premium-paying group by 18 percent (over 3,000 children) in Kentucky and by 5 percent (over 1,000 children) in Arizona, with some of these children apparently leaving public coverage altogether. While most children enrolled in these categories did not appear to be directly affected by the imposition of $10–$20 monthly premiums, the premiums may have caused some children to go without health insurance coverage, which in turn could have adverse effects on their access to care. Imposing nominal premiums may reduce state spending, but projected savings appear to be small relative to total state SCHIP spending and resulting increases in enrollment in other public programs and in uninsurance rates could offset those savings. PMID:17995547

Behavioral economics holds potential to deliver better results for patients, insurers, and employers.

PubMed

Loewenstein, George; Asch, David A; Volpp, Kevin G

2013-07-01

Many programs being implemented by US employers, insurers, and health care providers use incentives to encourage patients to take better care of themselves. We critically review a range of these efforts and show that many programs, although well-meaning, are unlikely to have much impact because they require information, expertise, and self-control that few patients possess. As a result, benefits are likely to accrue disproportionately to patients who already are taking adequate care of their health. We show how these programs could be made more effective through the use of insights from behavioral economics. For example, incentive programs that offer patients small and frequent payments for behavior that would benefit the patients, such as medication adherence, can be more effective than programs with incentives that are far less visible because they are folded into a paycheck or used to reduce a monthly premium. Deploying more-nuanced insights from behavioral economics can lead to policies with the potential to increase patient engagement and deliver dividends for patients and favorable cost-effectiveness ratios for insurers, employers, and other relevant commercial entities.

Effects of public premiums on children's health insurance coverage: evidence from 1999 to 2003.

PubMed

Kenney, Genevieve; Hadley, Jack; Blavin, Fredric

This study uses 2000 to 2004 Current Population Survey data to examine the effects of public premiums on the insurance coverage of children whose family incomes are between 100% and 300% of the federal poverty level. The analysis employs multinomial logistic models that control for factors other than premium costs. While the magnitude of the estimated effects varies across models, the results consistently indicate that raising public premiums reduces enrollment in public programs, with some children who forgo public coverage having private coverage instead and others being uninsured. The results indicate that public premiums have larger effects when applied to lower-income families.

Factors influencing buyers' willingness to offer price premiums for carbon credits sourced from urban forests

Treesearch

N.C. Poudyal; J.M. Bowker; J.P. Siry

2015-01-01

Marketing carbon offset credits generated by urban forest projects could help cities and local governments achieve their financial self-sufficiency and environmental sustainability goals. Understanding the value of carbon credits sourced from urban forests, and the factors that determine buyers’ willingness to pay a premium for such credits could benefit cities in...

Estimating local, organic, and other price premiums of shell eggs in Hawaii.

PubMed

Loke, Matthew K; Xu, Xun; Leung, PingSun

2016-05-01

Hedonic modeling and retail scanner data were utilized to investigate the influence of local, organic, nutrition benefits, and other attributes of shell eggs on retail price premium in Hawaii. Within a revealed preference framework, the analysis of local and organic attributes, simultaneously, under a single unified setting is important, as such work is highly deficient in the published literature. This paper finds high to moderate price premiums in four key attributes of shell eggs - organic (64%), local (40%), nutrition benefits claimed (33%), and brown shell (18.4%). Large and extra-large sized eggs also experience price premiums over medium sized eggs. With each larger packing size, the estimated coefficients were negative, indicating a price discount, relative to the baseline packing size. However, there is no evidence to support the overwhelming influence of "local" over "organic", as hypothesized in other research work. Overall, the findings in this paper suggest industry producers and retailers should highlight and market effusively the primary attributes of their shell eggs, including "local", to remain competitive in the marketplace. Effective communication channels are crucial to delivering the product information, capturing the attention of consumers, and securing retail sales. © 2016 Poultry Science Association Inc.

Making Medicare Advantage a Middle-Class Program

PubMed Central

Glazer, Jacob; McGuire, Thomas

2013-01-01

This paper studies the role of Medicare's premium policy in sorting beneficiaries between traditional Medicare (TM) and managed care plans in the Medicare Advantage (MA) program. Beneficiaries vary in their demand for care. TM fully accommodates demand but creates a moral hazard inefficiency. MA rations care but disregards some elements of the demand. We describe an efficient assignment of beneficiaries to these two options, and argue that efficiency requires an MA program oriented to serve the large middle part of the distribution of demand: the “middle class.” Current Medicare policy of a “single premium” for MA plans cannot achieve efficient sorting. We characterize the demand-based premium policy that can implement the efficient assignment of enrollees to plans. If only a single premium is feasible, the second-best policy involves too many of the low-demand individuals in MA and a too low level of services relative to the first best. We identify approaches to using premium policy to revitalize MA and improve the efficiency of Medicare. PMID:23454916

78 FR 42159 - Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-15

...This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act. This final rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and amends requirements for benchmark and benchmark- equivalent benefit packages consistent with sections 1937 of the Social Security Act (which we refer to as ``alternative benefit plans'') to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also updates and simplifies the complex Medicaid premium and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. It includes transition policies for 2014 as applicable.

Economic feasibility of converting cow manure to electricity: a case study of the CVPS Cow Power program in Vermont.

PubMed

Wang, Q; Thompson, E; Parsons, R; Rogers, G; Dunn, D

2011-10-01

A case study of the Central Vermont Public Service Corporation (CVPS) Cow Power program examines the economic feasibility for dairy farms to convert cow manure into electricity via anaerobic methane digestion. The study reviews the mechanism for CVPS, dairy farms, electricity customers, and government agencies to develop and operate the program since 2004, examines the costs and returns for the participating dairy farms, and assesses their cash flow over a period of 7 yr under different scenarios. With 6 dairy farms generating about 12 million kilowatt-hours of electricity per year and more than 4,600 CVPS electricity customers voluntarily paying premiums of $0.04 per kilowatt-hour, or a total of about $470,000 per year, the CVPS Cow Power program represents a successful and locally sourced renewable energy project with many environmental and economic benefits. Factors for the successful development and operation of the program include significant grants from government agencies and other organizations, strong consumer support, timely adjustments to the basic electricity price paid to the farms, and close collaboration among the participating parties. This study confirms that it is technically feasible to convert cow manure to electricity on farms, but the economic returns depend highly on the base electricity price, premium rate, financial supports from government agencies and other organizations, and sales of the byproducts of methane generation. Copyright © 2011 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Means to an End: Collective Bargaining and Teacher Benefits

ERIC Educational Resources Information Center

Graham, Larry A.

1976-01-01

The intent of this investigation was to determine if and to what extent collective bargaining has influenced attainment of salary and economic benefits such as teacher salary, insurance premiums, and sick leave. (MM)

Analysis of farmers' willingness to participate in pasture grazing programs: Results from a discrete choice experiment with German dairy farmers.

PubMed

Danne, M; Musshoff, O

2017-09-01

Over the last decades, the usage of pasture for grazing of dairy cows has decreased considerably. Pasture grazing programs initiated by dairy companies try to counteract this trend. The present paper investigates farmers' willingness to participate in such grazing programs. A special aim was to quantify the price premiums farmers require for program participation and to identify determinants influencing the premium level. The empirical analysis is based on a discrete choice experiment with 293 German dairy farmers. Models are estimated in terms of willingness to accept. It was found that farmers have no substantial preference for whether the pasture grazing program is financed by the food industry, a governmental scheme, or the dairy company. However, an extension of the annual or daily grazing period results in a decreasing willingness of farmers to participate in a pasture grazing program. In addition, farmers decline the option of a feeding standard prescribing the use of only green fodder when offered an alternative program that merely reduces the amount of concentrated feed or maize silage in the diet. Farmers' with an aversion toward program participation have a significant higher price demand for fulfilling the program requirements. Furthermore, the required price premiums increase with growing milk yields and a greater number of cows kept on the farm. However, if the availability of pasture is high, farmers are more likely to participate. The estimated price premiums and factors influencing farmers' willingness to participate found by this study should be considered by dairies and policymakers to gain insights into the design of possible pasture grazing programs from the perspective of farmers. Thereby, paying price premiums to farmers may increase the attractiveness of pasture grazing, which could finally result in an extended usage of pasture grazing. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

State trends in premiums and deductibles, 2003-2011: eroding protection and rising costs underscore need for action.

PubMed

Schoen, Cathy; Lippa, Jacob; Collins, Sara; Radley, David

2012-12-01

Rapidly rising health insurance premiums and higher cost-sharing continue to strain the budgets of U.S. working families and employers. Analysis of state trends in private employer-based health insurance from 2003 to 2011 reveals that premiums for family coverage increased 62 percent across states--rising far faster than income for middle- and low-income families. At the same time, deductibles more than doubled in large and small firms. Workers are thus paying more but getting less-protective benefits. If trends continue at their historical rate, the average premium for family coverage will reach nearly $25,000 by 2020. The Affordable Care Act's reforms should begin to moderate costs while improving coverage. But with private insurance costs projected to increase faster than incomes over the next decade, further efforts are needed. If annual premium growth slowed by one percentage point, by 2020 employers and families would save $2,029 annually for family coverage.

State trends in premiums and deductibles, 2003-2009: how building on the Affordable Care Act will help stem the tide of rising costs and eroding benefits.

PubMed

Schoen, Cathy; Stremikis, Kristof; How, Sabrina K H; Collins, Sara R

2010-12-01

Rapidly rising health insurance costs have strained U.S. families and employers in recent years. This issue brief examines data for all states on changes in private employer premiums and deductibles for 2003 and 2009. The analysis finds that premiums for businesses and their employees increased 41 percent across states from 2003 to 2009, while per-person deductibles jumped 77 percent in large as well as small firms. If these trends continue at the rate prior to enactment of the Affordable Care Act, the average premium for family coverage will rise 79 percent by 2020, to more than $23,000. The authors describe how health reform offers the potential to reduce insurance cost growth while improving value and protection. If reforms succeed in slowing premium growth by 1 percentage point annually in all states, by 2020 employers and families together will save $2,323 annually for family coverage, compared with projected trends.

Delaware's Wellness Program: Motivating Employees Improves Health and Saves Money

PubMed Central

Davis, Jennifer “J. J.”

2008-01-01

Background Every year, employers around the country evaluate their company benefits package in the hopes of finding a solution to the ever-rising cost of health insurance premiums. For many business executives, the only logical choice is to pass along those costs to the employee. Objectives As an employer, our goal in Delaware has always been to come up with innovative solutions to drive down the cost of health insurance premiums while encouraging our employees to take responsibility for their own health and wellness by living a healthy and active lifestyle, and provide them with the necessary tools. Methods The DelaWELL program (N = 68,000) was launched in 2007, after being tested in initial (N = 100) and expanded (N = 1500) pilot programs from 2004 to 2006 in which 3 similar groups were compared before and after the pilot. Employee health risk assessment, education, and incentives provided employees the necessary tools we had assumed would help them make healthier lifestyle choices. Results In the first pilot, fewer emergency department visits and lower blood pressure levels resulted in direct savings of more than $62,000. In the expanded pilot, in all 3 groups blood pressure was significantly reduced (P <.001) from preprogram to postprogram; body fat reduction was also significant (P <.001); and glucose levels dropped (P <.001) in 2 groups. The overall saving was about $450,000. And in only about 4 months this year, 729 employees participating in DelaWELL had a combined weight loss of 5162 lb. Conclusions Decision makers in the State of Delaware have come up with an innovative solution to controlling costs while offering employees an attractive benefits package. The savings from its employee benefit program have allowed the state to pass along the savings to employees by maintaining employee-paid health insurance contributions at the same level for the past 3 years. DelaWELL has already confirmed our motto, “Although it may seem an unusual business investment to pay for healthcare before the need arises, in Delaware we concluded that this makes perfect sense.” This promising approach to improving health and reducing healthcare costs could potentially be applied to other employer groups. PMID:25126247

Delaware's Wellness Program: Motivating Employees Improves Health and Saves Money.

PubMed

Davis, Jennifer J J

2008-09-01

Every year, employers around the country evaluate their company benefits package in the hopes of finding a solution to the ever-rising cost of health insurance premiums. For many business executives, the only logical choice is to pass along those costs to the employee. As an employer, our goal in Delaware has always been to come up with innovative solutions to drive down the cost of health insurance premiums while encouraging our employees to take responsibility for their own health and wellness by living a healthy and active lifestyle, and provide them with the necessary tools. The DelaWELL program (N = 68,000) was launched in 2007, after being tested in initial (N = 100) and expanded (N = 1500) pilot programs from 2004 to 2006 in which 3 similar groups were compared before and after the pilot. Employee health risk assessment, education, and incentives provided employees the necessary tools we had assumed would help them make healthier lifestyle choices. In the first pilot, fewer emergency department visits and lower blood pressure levels resulted in direct savings of more than $62,000. In the expanded pilot, in all 3 groups blood pressure was significantly reduced (P <.001) from preprogram to postprogram; body fat reduction was also significant (P <.001); and glucose levels dropped (P <.001) in 2 groups. The overall saving was about $450,000. And in only about 4 months this year, 729 employees participating in DelaWELL had a combined weight loss of 5162 lb. Decision makers in the State of Delaware have come up with an innovative solution to controlling costs while offering employees an attractive benefits package. The savings from its employee benefit program have allowed the state to pass along the savings to employees by maintaining employee-paid health insurance contributions at the same level for the past 3 years. DelaWELL has already confirmed our motto, "Although it may seem an unusual business investment to pay for healthcare before the need arises, in Delaware we concluded that this makes perfect sense." This promising approach to improving health and reducing healthcare costs could potentially be applied to other employer groups.

Patient Protection and Affordable Care Act; HHS notice of benefit and payment parameters for 2015. Final rule.

PubMed

2014-03-11

This final rule sets forth payment parameters and oversight provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also provides additional standards with respect to composite premiums, privacy and security of personally identifiable information, the annual open enrollment period for 2015, the actuarial value calculator, the annual limitation in cost sharing for stand-alone dental plans, the meaningful difference standard for qualified health plans offered through a Federally-facilitated Exchange, patient safety standards for issuers of qualified health plans, and the Small Business Health Options Program.

76 FR 65755 - Proposed Submission of Information Collection for OMB Review; Comment Request; Survey of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-24

... PENSION BENEFIT GUARANTY CORPORATION Proposed Submission of Information Collection for OMB Review; Comment Request; Survey of Nonparticipating Single Premium Group Annuity Rates AGENCY: Pension Benefit... Collection. SUMMARY: The Pension Benefit Guaranty Corporation (``PBGC'') intends to request that the Office...

Fiscal Year 2014: Military Retirement Fund Audited Financial Report

DTIC Science & Technology

2014-11-07

Reserve Retirement ................................................................................................................. 7 Survivor...benefits for military members’ retirement from active duty and the reserves , disability retirement benefits, and survivor benefits. The MRF accumulates... premium /discount amortization and accrued inflation compensation. In comparison, in FY 2013 the MRF received approximately $20.5 billion in normal cost

42 CFR 408.44 - Deduction from civil service annuities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... not entitled to railroad retirement benefits or social security benefits, and is receiving a civil... service annuity or to social security or railroad retirement benefits, and the annuitant gives written consent, OPM also deducts the spouse's premium from the annuitant's monthly check. (c) Withdrawal of...

How Medicare Could Provide Dental, Vision, and Hearing Care for Beneficiaries.

PubMed

Willink, Amber; Shoen, Cathy; Davis, Karen

2018-01-01

The Medicare program specifically excludes coverage of dental, vision, and hearing services. As a result, many beneficiaries do not receive necessary care. Those that do are subject to high out-of-pocket costs. Examine gaps in access to dental, vision, and hearing services for Medicare beneficiaries and design a voluntary dental, vision, and hearing benefit plan with cost estimates. Uses the Medicare Current Beneficiary Survey, Cost and Use File, 2012, with population and costs projected to 2016 values. Among Medicare beneficiaries, 75 percent of people who needed a hearing aid did not have one; 70 percent of people who had trouble eating because of their teeth did not go to the dentist in the past year; and 43 percent of people who had trouble seeing did not have an eye exam in the past year. Lack of access was particularly acute for poor beneficiaries. Because few people have supplemental insurance covering these additional services, among people who received care, three-fourths of their costs of dental and hearing services and 60 percent of their costs of vision services were paid out of pocket. We propose a basic benefit package for dental, vision, and hearing services offered as a premium-financed voluntary insurance option under Medicare. Assuming the benefit package could be offered for $25 per month, we estimate the total coverage costs would be $1.924 billion per year, paid for by premiums. Subsidies to reach low-income beneficiaries would follow the same design as the Part D subsidy.

Generosity and adjusted premiums in job-based insurance: Hawaii is up, Wyoming is down.

PubMed

Gabel, Jon; McDevitt, Roland; Gandolfo, Laura; Pickreign, Jeremy; Hawkins, Samantha; Fahlman, Cheryl

2006-01-01

This paper reports national and state findings on the generosity or actuarial value of U.S. employer-based plans and adjusted premiums in 2002. The basis for our calculations is simulated bill paying for a large standardized population. After adjusting for the quality of benefits, we find from regression analysis that adjusted premiums are 18 percent higher in the nation's smallest firms than in firms with 1,000 or more workers. They are 25 percent higher in indemnity plans and 18 percent higher in preferred provider organizations than in health maintenance organizations. The generosity of coverage increased from 1997 to 2002.

Health benefits in 2005: premium increases slow down, coverage continues to erode.

PubMed

Gabel, Jon; Claxton, Gary; Gil, Isadora; Pickreign, Jeremy; Whitmore, Heidi; Finder, Benjamin; Hawkins, Samantha; Rowland, Diane

2005-01-01

This paper reports findings on the state of job-based health insurance in spring 2005 and how it has changed during recent years. Premiums rose 9.2 percent, the first year of single-digit increases since 2000. The percentage of firms offering health benefits has fallen from 69 percent in 2000 to 60 percent in 2005. Cost sharing did not grow appreciably in the past year. Enrollment in preferred provider organizations (PPOs) grew from 55 percent in 2004 to 61 percent in 2005, while enrollment in health maintenance organizations (HMOs) fell from 25 percent to 21 percent of the total.

Job-based health insurance: costs climb at a moderate pace.

PubMed

Claxton, Gary; DiJulio, Bianca; Whitmore, Heidi; Pickreign, Jeremy; McHugh, Megan; Finder, Benjamin; Osei-Anto, Awo

2009-01-01

Each year the Kaiser/HRET Survey of Employer Health Benefits takes a snapshot of the state of employee benefits in the United States, based on interviews with public and private employers. Our findings for 2009 show that families continue to face higher premiums, up about 5 percent from last year, and that cost sharing in the form of deductibles and copayments for office visits is greater as well. Average annual premiums in 2009 were $4,824 for single coverage and $13,375 for family coverage. Enrollment in high-deductible health plans held steady. We offer new insights about health risk assessments and how firms responded to the economic downturn.

42 CFR 447.64 - Alternative premiums, enrollment fees, or similar fees: State plan requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR... cost sharing under Medicaid, defined at § 447.78, track beneficiaries' incurred premiums and cost...

42 CFR 447.64 - Alternative premiums, enrollment fees, or similar fees: State plan requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR... cost sharing under Medicaid, defined at § 447.78, track beneficiaries' incurred premiums and cost...

Changes in premiums of cancelled nongroup plans under the Affordable Care Act.

PubMed

Maeda, Jared Lane L K; Chen, Jersey; Plemons, Brent R

2016-07-01

To examine the effect of the Affordable Care Act (ACA) on changes in premiums for subscribers of nongrandfathered, nongroup insurance plans that were "cancelled." Retrospective multivariate analyses. Changes in annual premiums post ACA were evaluated across subgroups of subscriber and health plan characteristics. Data was derived from databases containing information on premiums, plan benefit, and demographics for subscribers aged 18 to 64 years within Kaiser Permanente of the Mid-Atlantic States. A linear regression model was used to examine the independent association between subscriber and health plan characteristics on the relative change in premiums. In 2013, 4169 nongroup subscribers were enrolled in plans that were cancelled as a result of the ACA. The median pre-ACA premium was $3240 (range = $780-$39,492), which increased by a median of 21.3% (range = -77.4% to 193.6%), or $685 (range = -$27,464 to $8676), post ACA in 2014. Premiums increased more for high-deductible plans (median = 63.7%) than standard-deductible plans (median = 8.4%). Due to shifts in the age curve, premiums decreased for more than half of women aged 18 to 44 years, but increased by 35.2% for women aged 55 to 64 years. Premiums fell by 15.5% for subscribers who did not pass standard medical underwriting due to preexisting conditions. Changes in premiums in the nongroup market post ACA, varied substantially across subgroups, primarily due to differences in the amount of coverage, changes in rating criteria, shifts in the age curve, and anticipated differences in risk selection and composition of the risk pool. Given the extent of this variation, it would be incorrect to conclude the ACA as being uniformly beneficial or detrimental to subscribers of these cancelled plans.

Risky business: when mom and pop buy health insurance for their employees.

PubMed

Gabel, Jon R; Pickreign, Jeremy D

2004-04-01

The economics of small group insurance makes offering health benefits to employees a risky business. Surveys of employers from 1989 to 2003 reveal that more rapid premium increases are forcing small firms to impose higher cost-sharing. In 2003, premiums for small firms (3-199 workers) increased 15.5 percent, outpacing the 13.2 percent increase for large firms (200+ workers). From 2000 to 2003, deductibles among small firms increased 100 percent in PPO plans when employees use in-network providers and 131 percent when they use out-of-network providers; among large firms, deductibles in PPO plans increased 33 percent and 44 percent, respectively. And in 2003, 40.3 percent of employees in the smallest firms contributed 41 percent or more of the total family premium, compared with only 11.2 percent of employees in large firms. Clearly, fundamental change in the small employer market is necessary, including new options for helping small firms gain access to the advantages large firms have in purchasing health benefits.

Relative Affordability of Health Insurance Premiums under CHIP Expansion Programs and the ACA.

PubMed

Gresenz, Carole Roan; Laugesen, Miriam J; Yesus, Ambeshie; Escarce, José J

2011-10-01

Affordability is integral to the success of health care reforms aimed at ensuring universal access to health insurance coverage, and affordability determinations have major policy and practical consequences. This article describes factors that influenced the determination of affordability benchmarks and premium-contribution requirements for Children's Health Insurance Program (CHIP) expansions in three states that sought to universalize access to coverage for youth. It also compares subsidy levels developed in these states to the premium subsidy schedule under the Affordable Care Act (ACA) for health insurance plans purchased through an exchange. We find sizeable variability in premium-contribution requirements for children's coverage as a percentage of family income across the three states and in the progressivity and regressivity of the premium-contribution schedules developed. These findings underscore the ambiguity and subjectivity of affordability standards. Further, our analyses suggest that while the ACA increases the affordability of family coverage for families with incomes below 400 percent of the federal poverty level, the evolution of CHIP over the next five to ten years will continue to have significant implications for low-income families.

Employee responses to health insurance premium increases.

PubMed

Goldman, Dana P; Leibowitz, Arleen A; Robalino, David A

2004-01-01

To determine the sensitivity of employees' health insurance decisions--including the decision to not choose health maintenance organization or fee-for-service coverage--during periods of rapidly escalating healthcare costs. A retrospective cohort study of employee plan choices at a single large firm with a "cafeteria-style" benefits plan wherein employees paid all the additional cost of purchasing more generous insurance. We modeled the probability that an employee would drop coverage or switch plans in response to employee premium increases using data from a single large US company with employees across 47 states during the 3-year period of 1989 through 1991, a time of large premium increases within and across plans. Premium increases induced substantial plan switching. Single employees were more likely to respond to premium increases by dropping coverage, whereas families tended to switch to another plan. Premium increases of 10% induced 7% of single employees to drop or severely cut back on coverage; 13% to switch to another plan; and 80% to remain in their existing plan. Similar figures for those with family coverage were 11%, 12%, and 77%, respectively. Simulation results that control for known covariates show similar increases. When faced with a dramatic increase in premiums--on the order of 20%--nearly one fifth of the single employees dropped coverage compared with 10% of those with family coverage. Employee coverage decisions are sensitive to rapidly increasing premiums, and single employees may be likely to drop coverage. This finding suggests that sustained premium increases could induce substantial increases in the number of uninsured individuals.

20 CFR 422.602 - Terms used in this subpart.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 422.602 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ORGANIZATION AND PROCEDURES Administrative Review Process Under the Coal Industry Retiree Health Benefit Act of 1992 § 422.602 Terms used in this... responsibility of paying the annual health and death benefit premiums of certain coal miners and their eligible...

The impact of CHIP premium increases on insurance outcomes among CHIP eligible children

PubMed Central

2014-01-01

Background Within the United States, public insurance premiums are used both to discourage private health policy holders from dropping coverage and to reduce state budget costs. Prior research suggests that the odds of having private coverage and being uninsured increase with increases in public insurance premiums. The aim of this paper is to test effects of Children’s Health Insurance Program (CHIP) premium increases on public insurance, private insurance, and uninsurance rates. Methods The fact that families just below and above a state-specific income cut-off are likely very similar in terms of observable and unobservable characteristics except the premium contribution provides a natural experiment for estimating the effect of premium increases. Using 2003 Medical Expenditure Panel Survey (MEPS) merged with CHIP premiums, we compare health insurance outcomes for CHIP eligible children as of January 2003 in states with a two-tier premium structure using a cross-sectional regression discontinuity methodology. We use difference-in-differences analysis to compare longitudinal insurance outcomes by December 2003. Results Higher CHIP premiums are associated with higher likelihood of private insurance. Disenrollment from CHIP in response to premium increases over time does not increase the uninsurance rate. Conclusions When faced with higher CHIP premiums, private health insurance may be a preferable alternative for CHIP eligible families with higher incomes. Therefore, competition in the insurance exchanges being formed under the Affordable Care Act could enhance choice. PMID:24589197

The impact of CHIP premium increases on insurance outcomes among CHIP eligible children.

PubMed

Nikolova, Silviya; Stearns, Sally

2014-03-03

Within the United States, public insurance premiums are used both to discourage private health policy holders from dropping coverage and to reduce state budget costs. Prior research suggests that the odds of having private coverage and being uninsured increase with increases in public insurance premiums. The aim of this paper is to test effects of Children's Health Insurance Program (CHIP) premium increases on public insurance, private insurance, and uninsurance rates. The fact that families just below and above a state-specific income cut-off are likely very similar in terms of observable and unobservable characteristics except the premium contribution provides a natural experiment for estimating the effect of premium increases. Using 2003 Medical Expenditure Panel Survey (MEPS) merged with CHIP premiums, we compare health insurance outcomes for CHIP eligible children as of January 2003 in states with a two-tier premium structure using a cross-sectional regression discontinuity methodology. We use difference-in-differences analysis to compare longitudinal insurance outcomes by December 2003. Higher CHIP premiums are associated with higher likelihood of private insurance. Disenrollment from CHIP in response to premium increases over time does not increase the uninsurance rate. When faced with higher CHIP premiums, private health insurance may be a preferable alternative for CHIP eligible families with higher incomes. Therefore, competition in the insurance exchanges being formed under the Affordable Care Act could enhance choice.

SCHIP premiums, enrollment, and expenditures: a two state, competing risk analysis.

PubMed

Marton, James; Ketsche, Patricia G; Zhou, Mei

2010-07-01

Faced with state budget troubles, policymakers may introduce or increase State Children's Health Insurance Program (SCHIP) premiums for children in the highest program income eligibility categories. In this paper we compare the responses of SCHIP recipients in a state (Kentucky) that introduced SCHIP premiums for the first time at the end of 2003 with the responses of recipients in a state (Georgia) that increased existing SCHIP premiums in mid-2004. We start with a theoretical examination of how these different policies create different changes to family budget constraints and produce somewhat different financial incentives for recipients. Next we empirically model the impact of these policies using a competing risk approach to differentiate exits due to transfers to other eligibility categories of public coverage from exiting the public health insurance system. In both states we find a short-run increase in the likelihood that children transfer to lower- income eligibility/lower-premium categories of SCHIP. We also find a short-run increase in the rate at which children transfer from SCHIP to Medicaid in Kentucky, which is consistent with our theoretical model. These findings have important financial implications for state budgets, as the matching rates and premium levels are different for different eligibility categories of public coverage. Copyright (c) 2009 John Wiley & Sons, Ltd.

Medicare prescription drug coverage: Consumer information and preferences

PubMed Central

Winter, Joachim; Balza, Rowilma; Caro, Frank; Heiss, Florian; Jun, Byung-hill; Matzkin, Rosa; McFadden, Daniel

2006-01-01

We investigate prescription drug use, and information and enrollment intentions for the new Medicare Part D drug insurance program, using a sample of Medicare-eligible subjects surveyed before open enrollment began for this program. We find that, despite the complexity of competing plans offered by private insurers under Part D, a majority of the Medicare population had information on this program and a substantial majority planned to enroll. We find that virtually all elderly, even those with no current prescription drug use, can expect to benefit from enrollment in a Part D Standard plan at the low premiums available in the current market. However, there is a significant risk that many eligible seniors, particularly low-income elderly with poor health or cognitive impairment, will make poor enrollment and plan choices. PMID:16682629

20 CFR 404.1592e - How do we determine provisional benefits?

Code of Federal Regulations, 2010 CFR

2010-04-01

... equal to the higher of the benefits payable. (4) If you request reinstatement for more than one benefit..., but are not limited to— (1) If you are a prisoner under § 404.468; (2) If you have been removed... your provisional benefits unless you give us permission. We can recover Medicare premiums you owe from...

Having it all: national benefit equity and local payment parity in Medicare.

PubMed

Dowd, Bryan; Feldman, Roger

2002-01-01

The Medicare Payment Advisory Commission (MedPAC) has identified two important problems with the Medicare+Choice (M+C) program: nationwide geographic inequity in government-financed benefits, and unequal government payments for M+C plans versus fee-for-service (FFS) Medicare in the same market area. MedPAC concludes that both problems cannot be solved simultaneously. We argue that both problems could be solved if Congress discontinued its policy of underwriting the cost of FFS Medicare. Instead, Congress should define a national entitlement benefit package and have all health plans submit bids on the package in each market area. The government's premium contribution should be equal to the lowest bid submitted by a qualified health plan in each market area. The contribution could be adjusted for health risk, the special obligations of FFS Medicare, and welfare enhancements associated with FFS Medicare that are valued by both beneficiaries and taxpayers but unrelated to beneficiaries' health status.

5 CFR 892.208 - Can I change my enrollment from self and family to self only at any time?

Code of Federal Regulations, 2013 CFR

2013-01-01

... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.208 Can I change my enrollment from...

5 CFR 892.208 - Can I change my enrollment from self and family to self only at any time?

Code of Federal Regulations, 2014 CFR

2014-01-01

... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.208 Can I change my enrollment from...

5 CFR 892.208 - Can I change my enrollment from self and family to self only at any time?

Code of Federal Regulations, 2011 CFR

2011-01-01

... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.208 Can I change my enrollment from...

5 CFR 892.208 - Can I change my enrollment from self and family to self only at any time?

Code of Federal Regulations, 2010 CFR

2010-01-01

... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.208 Can I change my enrollment from...

42 CFR 408.205 - Application procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Application procedures. 408.205 Section 408.205 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Supplementary Medical Insurance Premium Surcharge...

24 CFR 200.53 - Initial operating funds.

Code of Federal Regulations, 2010 CFR

2010-04-01

... standards established by the Commissioner for: (a) Accruals for taxes, ground rates, mortgage insurance premiums, and property insurance premiums, during the course of construction; (b) Meeting the cost of... Endorsement Generally Applicable to Multifamily and Health Care Facility Mortgage Insurance Programs; and...

24 CFR 200.53 - Initial operating funds.

Code of Federal Regulations, 2011 CFR

2011-04-01

... standards established by the Commissioner for: (a) Accruals for taxes, ground rates, mortgage insurance premiums, and property insurance premiums, during the course of construction; (b) Meeting the cost of... Endorsement Generally Applicable to Multifamily and Health Care Facility Mortgage Insurance Programs; and...

42 CFR 408.205 - Application procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Application procedures. 408.205 Section 408.205 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Supplementary Medical Insurance Premium Surcharge...

44 CFR 61.16 - Probation additional premium.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Probation additional premium. 61.16 Section 61.16 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE...

44 CFR 61.16 - Probation additional premium.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Probation additional premium. 61.16 Section 61.16 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE...

44 CFR 61.16 - Probation additional premium.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Probation additional premium. 61.16 Section 61.16 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE...

44 CFR 61.16 - Probation additional premium.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Probation additional premium. 61.16 Section 61.16 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE...

44 CFR 61.16 - Probation additional premium.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Probation additional premium. 61.16 Section 61.16 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE...

29 CFR 4006.6 - Definition of “participant.”

Code of Federal Regulations, 2010 CFR

2010-07-01

... of $5,000 or less leaves employment, the benefit will be immediately cashed out. On December 30, 2013... treated as not having an accrued benefit on December 31, 2013 (the participant count date for the 2014 premium), because Jane's benefit is treated as having been paid on December 30, 2013. Thus, Jane is not...

42 CFR 422.100 - General requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... in the service area of the MA plan; (2) At a uniform premium, with uniform benefits and level of cost... review and approval of MA benefits and associated cost sharing. CMS reviews and approves MA benefits and... 42 Public Health 3 2010-10-01 2010-10-01 false General requirements. 422.100 Section 422.100...

In Second Year Of Marketplaces, New Entrants, ACA 'Co-Ops,' And Medicaid Plans Restrain Average Premium Growth Rates.

PubMed

Gabel, Jon R; Whitmore, Heidi; Green, Matthew; Stromberg, Sam T; Weinstein, Daniel S; Oran, Rebecca

2015-12-01

Premiums for health insurance plans offered through the federally facilitated and state-based Marketplaces remained steady or increased only modestly from 2014 to 2015. We used data from the Marketplaces, state insurance departments, and insurer websites to examine patterns of premium pricing and the factors behind these patterns. Our data came from 2,964 unique plans offered in 2014 and 4,153 unique plans offered in 2015 in forty-nine states and the District of Columbia. Using descriptive and multivariate analysis, we found that the addition of a carrier in a rating area lowered average premiums for the two lowest-cost silver plans and the lowest-cost bronze plan by 2.2 percent. When all plans in a rating area were included, an additional carrier was associated with an average decline in premiums of 1.4 percent. Plans in the Consumer Operated and Oriented Plan Program and Medicaid managed care plans had lower premiums and average premium increases than national commercial and Blue Cross and Blue Shield plans. On average, premiums fell by an appreciably larger amount for catastrophic and bronze plans than for gold plans, and premiums for platinum plans increased. This trend of low premium increases overall is unlikely to continue, however, as insurers are faced with mounting medical claims. Project HOPE—The People-to-People Health Foundation, Inc.

[Provide comprehensive service for state policy].

PubMed

Wu, X

1991-04-01

In recent years, Chinese insurance companies introduced family planning (FP) insurance series. These schemes originated from the "one child" and life insurance and accident insurance of the early 1980s, which were established in response to the need that came with the "one child" policy. In order to help relieve the difficulties of rural FP work, the People's Insurance Corporation extended these programs to a series of schemes. These schemes included e.g., and old age security program for the families with 1 daughter only, old age security for families with an only child, and the program for FP workers' personal safety. The purpose of these schemes was to guarantee security in old age for families with few children, to ensure compensation if accident occurs during delivery or as a result of birth control operations; and compensation for FP workers for physical assaults they encountered. As FP organizations have been directly involved in advertising the insurance programs, there has been support from local governments with human and financial resources, and these insurance programs have been expanding every year. The payment of the policy has been either entirely or partially borne by the employers of the insured. In the process of the development of the insurance program, some problems have occurred. 1st, competition between FP organizations and insurance companies have evolved in sponsoring the program for its profit. 2nd, some media reports have confused the payment of premiums with the compulsory levy of undue fees, which in a way, hindered the expansion of program enrollment. 3rd, some local administrations are short of funds to pay for the insurance premiums. 4th, the accrued income from the premiums is lower than the expected sum of the principle and interest if the same funds were deposited in a bank at current interest rate. Therefore, some schemes lack appeal. FP series insurance is a longer term program which will have an important impact on the realization of the aim of population policy, and on the welfare of the population. The government should give adequate emphasis to the management of the program. The fund from the policy premiums could be used in high return and low risk investment in order to increase the appeal of the insurance schemes. Besides the current resources for the payment of premiums, funds from government allocation, penalty payment from those who have birth above the quota, one-child allowance, donations from communities or individuals, and income from special lotteries could also be used to pay the premiums.

More choice in health insurance marketplaces may reduce the value of the subsidies available to low-income enrollees.

PubMed

Taylor, Erin A; Saltzman, Evan; Bauhoff, Sebastian; Pacula, Rosalie L; Eibner, Christine

2015-01-01

Federal subsidies available to enrollees in health insurance Marketplaces are pegged to the premium of the second-lowest-cost silver plan available in each rating area (as defined by each state). People who qualify for the subsidy contribute a percentage of their income to purchase coverage, and the federal government covers the remaining cost up to the price of that premium. Because the number of plans offered and plan premiums vary substantially across rating areas, the effective value of the subsidy may vary geographically. We found that the availability of more plans in a rating area was associated with lower premiums but higher deductibles for enrollees in the second-lowest-cost silver plan. In rating areas with more than twenty plans, the average deductible in the second-lowest-cost silver plan was nearly $1,000 higher than it was in rating areas with fewer than thirteen plans. Because premium costs for second-lowest-cost silver plans are capped, deductibles may be a more salient measure of plan value for enrollees than premiums are. Greater standardization of plans or an alternative approach to calculating the subsidy could provide a more consistent benefit to enrollees across various rating areas. Project HOPE—The People-to-People Health Foundation, Inc.

Flood Catastrophe Model for Designing Optimal Flood Insurance Program: Estimating Location-Specific Premiums in the Netherlands.

PubMed

Ermolieva, T; Filatova, T; Ermoliev, Y; Obersteiner, M; de Bruijn, K M; Jeuken, A

2017-01-01

As flood risks grow worldwide, a well-designed insurance program engaging various stakeholders becomes a vital instrument in flood risk management. The main challenge concerns the applicability of standard approaches for calculating insurance premiums of rare catastrophic losses. This article focuses on the design of a flood-loss-sharing program involving private insurance based on location-specific exposures. The analysis is guided by a developed integrated catastrophe risk management (ICRM) model consisting of a GIS-based flood model and a stochastic optimization procedure with respect to location-specific risk exposures. To achieve the stability and robustness of the program towards floods with various recurrences, the ICRM uses stochastic optimization procedure, which relies on quantile-related risk functions of a systemic insolvency involving overpayments and underpayments of the stakeholders. Two alternative ways of calculating insurance premiums are compared: the robust derived with the ICRM and the traditional average annual loss approach. The applicability of the proposed model is illustrated in a case study of a Rotterdam area outside the main flood protection system in the Netherlands. Our numerical experiments demonstrate essential advantages of the robust premiums, namely, that they: (1) guarantee the program's solvency under all relevant flood scenarios rather than one average event; (2) establish a tradeoff between the security of the program and the welfare of locations; and (3) decrease the need for other risk transfer and risk reduction measures. © 2016 Society for Risk Analysis.

Dental Care And Medicare Beneficiaries: Access Gaps, Cost Burdens, And Policy Options.

PubMed

Willink, Amber; Schoen, Cathy; Davis, Karen

2016-12-01

Despite the wealth of evidence that oral health is related to physical health, Medicare explicitly excludes dental care from coverage, leaving beneficiaries at risk for tooth decay and periodontal disease and exposed to high out-of-pocket spending. To profile these risks, we examined access to dental care across income groups and types of insurance coverage in 2012. High-income beneficiaries were almost three times as likely to have received dental care in the previous twelve months, compared to low-income beneficiaries-74 percent of whom received no dental care. We also describe two illustrative policies that would expand access, in part by providing income-related subsidies. One would offer a voluntary, premium-financed benefit similar to those offered by Part D prescription drug plans, with an estimated premium of $29 per month. The other would cover basic dental care in core Medicare Part B benefits, financed in part by premiums ($7 or $15 per month, depending on whether premiums covered 25 percent or 50 percent of the cost) and in part by general revenues. The fact that beneficiaries are forgoing dental care and are exposed to significant costs if they seek care underscores the need for action. The policies offer pathways for improving health and financial independence for older adults. Project HOPE—The People-to-People Health Foundation, Inc.

CPI revision provides more accuracy in the medical care services component.

PubMed

Ford, I K; Sturm, P

1988-04-01

This revision, as in the past, enabled the Bureau to update medical care service expenditure weights in the CPI, including a more complete allocation of health insurance premiums. Instead of keeping the portion of premiums that go to benefits under health insurance, the expenditure weight for each benefit category has been added to the appropriate out-of-pocket expense. The unpublished health insurance item represents only the retained earnings portion of premiums paid by households. The specific item categories included in medical care services have also been updated and expanded. A study conducted during the developmental phase of the revision indicated that the Bureau should expand the eligible priced rates for physicians in the CPI to include not only the "self-pay" rate, but also other categories of payment as well. Another study indicated that the direct pricing of health insurance is not feasible because of the difficulty of factoring out from premium changes the effect of utilization levels and modified coverage. In pricing medical care service items, as with other item categories in the CPI, BLS attempts to exclude from price movement the effect of quality changes. However, some quality changes are difficult to assess or are not readily identified, for example, a change in the ratio of nurses to patients, and such changes may be reflected as part of the price change movement in the CPI.

24 CFR 203.281 - Calculation of one-time MIP.

Code of Federal Regulations, 2010 CFR

2010-04-01

... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums-One-Time Payment § 203.281 Calculation of one-time MIP. (a) The applicable premium percentage determined...

24 CFR 206.109 - Amount of mortgagee share of premium.

Code of Federal Regulations, 2010 CFR

2010-04-01

... premium. 206.109 Section 206.109 Housing and Urban Development Regulations Relating to Housing and Urban... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES HOME EQUITY CONVERSION MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance...

24 CFR 203.281 - Calculation of one-time MIP.

Code of Federal Regulations, 2011 CFR

2011-04-01

... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums-One-Time Payment § 203.281 Calculation of one-time MIP. (a) The applicable premium percentage determined...

24 CFR 206.109 - Amount of mortgagee share of premium.

Code of Federal Regulations, 2011 CFR

2011-04-01

... premium. 206.109 Section 206.109 Housing and Urban Development Regulations Relating to Housing and Urban... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES HOME EQUITY CONVERSION MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance...

Impact of Hearing Aid Technology on Outcomes in Daily Life I: the Patients’ Perspective

PubMed Central

Cox, Robyn M; Johnson, Jani A; Xu, Jingjing

2016-01-01

Objectives One of the challenges facing hearing care providers when recommending hearing aids is the choice of device technology level. Major manufacturers market families of hearing aids that are described as spanning the range from basic technology to premium technology. Premium technology hearing aids include acoustical processing capabilities (features) that are not found in basic technology instruments. These premium features are intended to yield improved hearing in daily life compared to basic-feature devices. However, independent research that establishes the incremental effectiveness of premium-feature devices compared to basic-feature devices is lacking. This research was designed to explore reported differences in hearing abilities for adults using premium-feature and basic-feature hearing aids in their daily lives. Design This was a single-blinded, repeated, crossover trial in which the participants were blinded. All procedures were carefully controlled to limit researcher bias. Forty-five participants used carefully fitted bilateral hearing aids for one month and then provided data to describe the hearing improvements or deficiencies noted in daily life. Typical participants were 70 years old with mild to moderate adult-onset hearing loss bilaterally. Each participant used 4 pairs of hearing aids: premium- and basic-feature devices from brands marketed by each of two major manufacturers. Participants were blinded about the devices they used and about the research questions. Results All of the outcomes were designed to capture the participant’s point of view about the benefits of the hearing aids. Three types of data were collected: change in hearing-related quality of life, extent of agreement with six positively worded statements about everyday hearing with the hearing aids, and reported preferences between the premium- and basic-feature devices from each brand as well as across all four research hearing aids combined. None of these measures yielded a statistically significant difference in outcomes between premium- and basic-feature devices. Participants did not report better outcomes with premium processing with any measure. Conclusions It could reasonably be asserted that the patient’s perspective is the gold standard for hearing aid effectiveness. While the acoustical processing provided by premium features can potentially improve scores on tests conducted in contrived conditions in a laboratory, or on specific items in a questionnaire, this does not ensure that the processing will be of noteworthy benefit when the hearing aid is used in the real world challenges faced by the patient. If evidence suggests the patient cannot detect that premium features yield improvements over basic features in daily life, what is the responsibility of the provider in recommending hearing aid technology level? In the current research, there was no evidence to suggest that premium-feature devices yielded better outcomes than basic-feature devices from the patient’s point of view. All of the research hearing aids were substantially, but equally, helpful. Further research is needed on this topic with other hearing aids and other manufacturers. In the meantime, providers should insist on scientifically credible independent evidence to support effectiveness claims for any hearing help devices. PMID:26881981

20 CFR 410.561c - Defeat the purpose of title IV.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Section 410.561c Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY..., accident, and health insurance including premiums for supplementary medical insurance benefits under title XVIII of the Social Security Act), taxes, installment payments, etc.; (2) Medical, hospitalization, and...

NOAA Workforce Management Office

Science.gov Websites

Home Careers at NOAA Search Criteria Click to Search WORKFORCE MANAGEMENT OFFICE NATIONAL OCEANIC Federal Employees Health (FEHB) Life (FEGLI) Life Insurance and Active Duty Information Long Term Care (FLTCIP) New Employee Benefit Information OPM Retirement Information Premium Conversion - Health Benefits

NOAA Workforce Management Office

Science.gov Websites

Federal Employees Health (FEHB) Life (FEGLI) Life Insurance and Active Duty Information Long Term Care (FLTCIP) New Employee Benefit Information OPM Retirement Information Premium Conversion - Health Benefits and FERS Handbook Military Service Deposit Information Non-foreign Area Retirement Equity Assurance

20 CFR 422.602 - Terms used in this subpart.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Review Process Under the Coal Industry Retiree Health Benefit Act of 1992 § 422.602 Terms used in this... responsibility of paying the annual health and death benefit premiums of certain coal miners and their eligible... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Terms used in this subpart. 422.602 Section...

20 CFR 422.602 - Terms used in this subpart.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Review Process Under the Coal Industry Retiree Health Benefit Act of 1992 § 422.602 Terms used in this... responsibility of paying the annual health and death benefit premiums of certain coal miners and their eligible... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Terms used in this subpart. 422.602 Section...

20 CFR 422.602 - Terms used in this subpart.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Review Process Under the Coal Industry Retiree Health Benefit Act of 1992 § 422.602 Terms used in this... responsibility of paying the annual health and death benefit premiums of certain coal miners and their eligible... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Terms used in this subpart. 422.602 Section...

HMO market penetration and costs of employer-sponsored health plans.

PubMed

Baker, L C; Cantor, J C; Long, S H; Marquis, M S

2000-01-01

Using two employer surveys, we evaluate the role of increased health maintenance organization (HMO) market share in containing costs of employer-sponsored coverage. Total costs for employer health plans are about 10 percent lower in markets in which HMOs' market share is above 45 percent than they are in markets with HMO enrollments of below 25 percent. This is the result of lower premiums for HMOs than for non-HMO plans, as well as the competitive effect of HMOs that leads to lower non-HMO premiums for employers that continue to offer these benefits. Slower growth in premiums in areas with high HMO enrollments suggests that expanded HMO market share may also lower the long-run growth in costs.

Estimated value of insurance premium due to Citarum River flood by using Bayesian method

NASA Astrophysics Data System (ADS)

Sukono; Aisah, I.; Tampubolon, Y. R. H.; Napitupulu, H.; Supian, S.; Subiyanto; Sidi, P.

2018-03-01

Citarum river flood in South Bandung, West Java Indonesia, often happens every year. It causes property damage, producing economic loss. The risk of loss can be mitigated by following the flood insurance program. In this paper, we discussed about the estimated value of insurance premiums due to Citarum river flood by Bayesian method. It is assumed that the risk data for flood losses follows the Pareto distribution with the right fat-tail. The estimation of distribution model parameters is done by using Bayesian method. First, parameter estimation is done with assumption that prior comes from Gamma distribution family, while observation data follow Pareto distribution. Second, flood loss data is simulated based on the probability of damage in each flood affected area. The result of the analysis shows that the estimated premium value of insurance based on pure premium principle is as follows: for the loss value of IDR 629.65 million of premium IDR 338.63 million; for a loss of IDR 584.30 million of its premium IDR 314.24 million; and the loss value of IDR 574.53 million of its premium IDR 308.95 million. The premium value estimator can be used as neither a reference in the decision of reasonable premium determination, so as not to incriminate the insured, nor it result in loss of the insurer.

42 CFR 403.253 - Calculation of benefits.

Code of Federal Regulations, 2011 CFR

2011-10-01

... calculated on a net level reserve basis, using appropriate values to account for lapse, mortality, morbidity, and interest, that on the valuation date represents— (A) The present value of expected incurred benefits over the loss ratio calculation period; less— (B) The present value of expected net premiums over...

42 CFR 403.253 - Calculation of benefits.

Code of Federal Regulations, 2014 CFR

2014-10-01

... calculated on a net level reserve basis, using appropriate values to account for lapse, mortality, morbidity, and interest, that on the valuation date represents— (A) The present value of expected incurred benefits over the loss ratio calculation period; less— (B) The present value of expected net premiums over...

42 CFR 403.253 - Calculation of benefits.

Code of Federal Regulations, 2013 CFR

2013-10-01

... calculated on a net level reserve basis, using appropriate values to account for lapse, mortality, morbidity, and interest, that on the valuation date represents— (A) The present value of expected incurred benefits over the loss ratio calculation period; less— (B) The present value of expected net premiums over...

42 CFR 403.253 - Calculation of benefits.

Code of Federal Regulations, 2012 CFR

2012-10-01

... calculated on a net level reserve basis, using appropriate values to account for lapse, mortality, morbidity, and interest, that on the valuation date represents— (A) The present value of expected incurred benefits over the loss ratio calculation period; less— (B) The present value of expected net premiums over...

42 CFR 417.594 - Computation of adjusted community rate (ACR).

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS... aggregate premium for all its enrollees and weights the aggregate by the size of the various enrolled groups... groups or other bodies of subscribers that enroll in the HMO or CMP through payment of premiums.) (2...

42 CFR 417.594 - Computation of adjusted community rate (ACR).

Code of Federal Regulations, 2011 CFR

2011-10-01

... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS... aggregate premium for all its enrollees and weights the aggregate by the size of the various enrolled groups... groups or other bodies of subscribers that enroll in the HMO or CMP through payment of premiums.) (2...

5 CFR 894.403 - Are FEDVIP premiums paid on a pre-tax basis?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Are FEDVIP premiums paid on a pre-tax basis? 894.403 Section 894.403 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Cost of Coverage...

5 CFR 894.401 - How do I pay premiums?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false How do I pay premiums? 894.401 Section 894.401 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Cost of Coverage § 894.401 How do I pay...

5 CFR 894.401 - How do I pay premiums?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false How do I pay premiums? 894.401 Section 894.401 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Cost of Coverage § 894.401 How do I pay...

5 CFR 894.403 - Are FEDVIP premiums paid on a pre-tax basis?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Are FEDVIP premiums paid on a pre-tax basis? 894.403 Section 894.403 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Cost of Coverage...

42 CFR 408.8 - Grace period and termination date.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE General Provisions § 408.8 Grace period and termination date. (a) Grace period. (1) For all initial premium payments (monthly or quarterly), and subsequent monthly or quarterly payments, the grace period ends with the last day of the third month after...

Public and private health insurance premiums: how do they affect the health insurance status of low-income childless adults?

PubMed

Guy, Gery P; Adams, E Kathleen; Atherly, Adam

2012-01-01

The Patient Protection and Affordable Care Act (ACA) will substantially increase public health insurance eligibility and alter the costs of insurance coverage. Using Current Population Survey (CPS) data from the period 2000-2008, we examine the effects of public and private health insurance premiums on the insurance status of low-income childless adults, a population substantially affected by the ACA. Results show higher public premiums to be associated with a decrease in the probability of having public insurance and an increase in the probability of being uninsured, while increased private premiums decrease the probability of having private insurance. Eligibility for premium assistance programs and increased subsidy levels are associated with lower rates of uninsurance. The magnitudes of the effects are quite modest and provide important implications for insurance expansions for childless adults under the ACA.

26 CFR 54.9812-1T - Parity in the application of certain limits to mental health benefits (temporary).

Code of Federal Regulations, 2010 CFR

2010-04-01

... benefits that may be paid under a group health plan for an individual (or for a group of individuals...-month period under a plan for an individual (or for a group of individuals considered a single unit in... groups individuals for purposes of determining benefits, or premiums or contributions. For example...

Children's health insurance program premiums adversely affect enrollment, especially among lower-income children.

PubMed

Abdus, Salam; Hudson, Julie; Hill, Steven C; Selden, Thomas M

2014-08-01

Both Medicaid and the Children's Health Insurance Program (CHIP), which are run by the states and funded by federal and state dollars, offer health insurance coverage for low-income children. Thirty-three states charged premiums for children at some income ranges in CHIP or Medicaid in 2013. Using data from the 1999-2010 Medical Expenditure Panel Surveys, we show that the relationship between premiums and coverage varies considerably by income level and by parental access to employer-sponsored insurance. Among children with family incomes above 150 percent of the federal poverty level, a $10 increase in monthly premiums is associated with a 1.6-percentage-point reduction in Medicaid or CHIP coverage. In this income range, the increase in uninsurance may be higher among those children whose parents lack an offer of employer-sponsored insurance than among those whose parents have such an offer. Among children with family incomes of 101-150 percent of poverty, a $10 increase in monthly premiums is associated with a 6.7-percentage-point reduction in Medicaid or CHIP coverage and a 3.3-percentage-point increase in uninsurance. In this income range, the increase in uninsurance is even larger among children whose parents lack offers of employer coverage. Project HOPE—The People-to-People Health Foundation, Inc.

Employee Health and Optional Benefits | Alaska Division of Retirement and

Science.gov Websites

Categories Health Information Life Disability DCAP Forms/Publications Features Empower Retirement Account RIN DRB Home Retirement Benefits Employer Services AlaskaCare Easy Navigation Employee Health Gym Discount Health Plan FAQs Overview What Plan am I in? Information Enrollment Information FAQs Premiums

Employee Health Plan Details | Alaska Division of Retirement and Benefits

Science.gov Websites

Health Information Life Disability DCAP Forms/Publications Features Empower Retirement Account Info Home Retirement Benefits Employer Services AlaskaCare Easy Navigation Employee Health Gym Discount Health Plan FAQs Overview What Plan am I in? Information Enrollment Information FAQs Premiums Qualified

7 CFR 1767.41 - Accounting methods and procedures required of all RUS borrowers.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Premium on Life of a Borrower Employee 606 Pension Costs 607 Unproductive Time 608 Training Costs... 612 Special Power Cost Study 613 Mapping Costs 614 Member Relations Costs 615 Statewide Fees 616 Power... Benefits 628 Postretirement Benefits 627 Power Cost Study 612 Power Supply/Distribution Cooperative...

7 CFR 1767.41 - Accounting methods and procedures required of all RUS borrowers.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Premium on Life of a Borrower Employee 606 Pension Costs 607 Unproductive Time 608 Training Costs... 612 Special Power Cost Study 613 Mapping Costs 614 Member Relations Costs 615 Statewide Fees 616 Power... Benefits 628 Postretirement Benefits 627 Power Cost Study 612 Power Supply/Distribution Cooperative...

7 CFR 1767.41 - Accounting methods and procedures required of all RUS borrowers.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Premium on Life of a Borrower Employee 606 Pension Costs 607 Unproductive Time 608 Training Costs... 612 Special Power Cost Study 613 Mapping Costs 614 Member Relations Costs 615 Statewide Fees 616 Power... Benefits 628 Postretirement Benefits 627 Power Cost Study 612 Power Supply/Distribution Cooperative...

20 CFR 418.2105 - What is the threshold?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false What is the threshold? 418.2105 Section 418.2105 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE SUBSIDIES Income-Related Monthly Adjustments to Medicare Prescription Drug Coverage Premiums Determination of the Income-Related Monthly Adjustment Amount § 418.2105 What is the...

20 CFR 418.2105 - What is the threshold?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false What is the threshold? 418.2105 Section 418.2105 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE SUBSIDIES Income-Related Monthly Adjustments to Medicare Prescription Drug Coverage Premiums Determination of the Income-Related Monthly Adjustment Amount § 418.2105 What is the...

20 CFR 418.2105 - What is the threshold?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false What is the threshold? 418.2105 Section 418.2105 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE SUBSIDIES Income-Related Monthly Adjustments to Medicare Prescription Drug Coverage Premiums Determination of the Income-Related Monthly Adjustment Amount § 418.2105 What is the...

How Do Health Insurer Market Concentration and Bargaining Power with Hospitals Affect Health Insurance Premiums?

PubMed Central

Trish, Erin E.; Herring, Bradley J.

2017-01-01

The US health insurance industry is highly concentrated, and health insurance premiums are high and rising rapidly. Policymakers have focused on the possible link between the two, leading to ACA provisions to increase insurer competition. However, while market power may enable insurers to include higher profit margins in their premiums, it may also result in stronger bargaining leverage with hospitals to negotiate lower payment rates to partially offset these higher premiums. We empirically examine the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006–2011 KFF/HRET Employer Health Benefits Survey. We exploit a unique feature of employer-sponsored insurance, in which self-insured employers purchase only administrative services from managed care organizations, to disentangle these different effects on insurer concentration by constructing one concentration measure representing fully-insured plans’ transactions with employers and the other concentration measure representing insurers’ bargaining with hospitals. As expected, we find that premiums are indeed higher for plans sold in markets with higher levels of concentration relevant to insurer transactions with employers, lower for plans in markets with higher levels of insurer concentration relevant to insurer bargaining with hospitals, and higher for plans in markets with higher levels of hospital market concentration. PMID:25910690

How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?

PubMed

Trish, Erin E; Herring, Bradley J

2015-07-01

The US health insurance industry is highly concentrated, and health insurance premiums are high and rising rapidly. Policymakers have focused on the possible link between the two, leading to ACA provisions to increase insurer competition. However, while market power may enable insurers to include higher profit margins in their premiums, it may also result in stronger bargaining leverage with hospitals to negotiate lower payment rates to partially offset these higher premiums. We empirically examine the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006-2011 KFF/HRET Employer Health Benefits Survey. We exploit a unique feature of employer-sponsored insurance, in which self-insured employers purchase only administrative services from managed care organizations, to disentangle these different effects on insurer concentration by constructing one concentration measure representing fully-insured plans' transactions with employers and the other concentration measure representing insurers' bargaining with hospitals. As expected, we find that premiums are indeed higher for plans sold in markets with higher levels of concentration relevant to insurer transactions with employers, lower for plans in markets with higher levels of insurer concentration relevant to insurer bargaining with hospitals, and higher for plans in markets with higher levels of hospital market concentration. Copyright © 2015 Elsevier B.V. All rights reserved.

Iowa's Medicaid Expansion Promoted Healthy Behaviors But Was Challenging To Implement And Attracted Few Participants.

PubMed

Askelson, Natoshia M; Wright, Brad; Bentler, Suzanne; Momany, Elizabeth T; Damiano, Peter

2017-05-01

As part of Iowa's Medicaid expansion, the Healthy Behaviors Program was designed to provide members with incentives to complete specified healthy activities in return for waiving monthly premiums. We used claims data and interviews to document the first year (2014) of the program's implementation. Healthy activities completion rates did not exceed 17 percent. Interviews with members and clinic managers revealed low levels of awareness of the program's existence, deficits in knowledge about how the program works, and a variety of barriers to activity completion. Our findings suggest that the lack of knowledge hindered the state's ability to incentivize activities and that it subjected beneficiaries to premium expenses and potential disenrollment. These results should guide federal and state policy makers in devising more effective ways of educating Medicaid beneficiaries and providers about programs that incentivize responsibility for healthy behaviors. The results suggest that efforts by federal and state governments to reform Medicaid by shifting responsibility onto program members for healthy behaviors are unlikely to succeed, especially without careful thought and design of premiums, penalties, and incentives for participants. Project HOPE—The People-to-People Health Foundation, Inc.

Utilization and costs of home-based and community-based care within a social HMO: trends over an 18-year period

PubMed Central

Leutz, Walter; Nonnenkamp, Lucy; Dickinson, Lynn; Brody, Kathleen

2005-01-01

Abstract Purpose Our objective was to describe the utilization and costs of services from 1985 to 2002 of a Social Health Maintenance Organization (SHMO) demonstration project providing a benefit for home-based and community-based as well as short-term institutional (HCB) care at Kaiser Permanente Northwest (KPNW), serving the Portland, Oregon area. The HCB care benefit was offered by KPNW as a supplement to Medicare's acute care medical benefits, which KPNW provides in an HMO model. KPNW receives a monthly per capita payment from Medicare to provide medical benefits, and Medicare beneficiaries who choose to join pay a supplemental premium that covers prescription drugs, HCB care benefits, and other services. A HCB care benefit of up to $12,000 per year in services was available to SHMO members meeting requirement for nursing home certification (NHC). Methods We used aggregate data to track temporal changes in the period 1985 to 2002 on member eligibility, enrollment in HCB care plans, age, service utilization and co-payments. Trends in the overall costs and financing of the HCB care benefit were extracted from quarterly reports, management data, and finance data. Results During the time period, 14,815 members enrolled in the SHMO and membership averaged 4,531. The proportion of SHMO members aged 85 or older grew from 12 to 25%; proportion meeting requirements for NHC rose from 4 to 27%; and proportion with HCB care plans rose from 4 to 18%. Costs for the HCB care benefit rose from $21 per SHMO member per month in 1985 to $95 in 2002. The HCB care costs were equivalent to 12% to 16% of Medicare reimbursement. The HCB program costs were covered by member premiums (which rose from $49 to $180) and co-payments from members with care plans. Over the 18-year period, spending shifted from nursing homes to a range of community services, e.g. personal care, homemaking, member reimbursement, lifeline, equipment, transportation, shift care, home nursing, adult day care, respite care, and dentures. Rising costs per month per SHMO member reflected increasing HCB eligibility rather than costs per member with HCB care, which actually fell from $6,164 in 1989 to $4,328 in 2002. Care management accounted for about one-quarter of community care costs since 1992. Conclusions The Kaiser Permanente Northwest SHMO served an increasingly aged and disabled membership by reducing costs per HCB member care plan and shifting utilization to a broad range of community care services. Supported by a disability-based Medicare payment formula and by SHMO beneficiaries willing to pay increasing premiums, KPNW has been able to offer comprehensive community care. The model could be replicated by other HMOs with the support of favorable federal policies. PMID:16773166

Deductibles in health insurance

NASA Astrophysics Data System (ADS)

Dimitriyadis, I.; Öney, Ü. N.

2009-11-01

This study is an extension to a simulation study that has been developed to determine ruin probabilities in health insurance. The study concentrates on inpatient and outpatient benefits for customers of varying age bands. Loss distributions are modelled through the Allianz tool pack for different classes of insureds. Premiums at different levels of deductibles are derived in the simulation and ruin probabilities are computed assuming a linear loading on the premium. The increase in the probability of ruin at high levels of the deductible clearly shows the insufficiency of proportional loading in deductible premiums. The PH-transform pricing rule developed by Wang is analyzed as an alternative pricing rule. A simple case, where an insured is assumed to be an exponential utility decision maker while the insurer's pricing rule is a PH-transform is also treated.

Medicare Part D: Are Insurers Gaming the Low Income Subsidy Design?

PubMed

Decarolis, Francesco

2015-04-01

This paper shows how in Medicare Part D insurers' gaming of the subsidy paid to low-income enrollees distorts premiums and raises the program cost. Using plan-level data from the first five years of the program, I find multiple instances of pricing strategy distortions for the largest insurers. Instrumental variable estimates indicate that the changes in a concentration index measuring the manipulability of the subsidy can explain a large share of the premium growth observed between 2006 and 2011. Removing this distortion could reduce the cost of the program without worsening consumer welfare.

42 CFR 406.32 - Monthly premiums.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Monthly premiums. 406.32 Section 406.32 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM... at least the previous one year period to a worker who has 30 or more QCs; (3) Had been married to a...

5 CFR 894.404 - May I opt out of premium conversion?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false May I opt out of premium conversion? 894.404 Section 894.404 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Cost of Coverage § 894.404 May I...

5 CFR 894.404 - May I opt out of premium conversion?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false May I opt out of premium conversion? 894.404 Section 894.404 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Cost of Coverage § 894.404 May I...

7 CFR 91.39 - Premium hourly fee rates for overtime and legal holiday service.

Code of Federal Regulations, 2013 CFR

2013-01-01

... overtime work. When analytical testing in a Science and Technology facility requires the services of... (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Fees and Charges § 91.39 Premium hourly fee rates for overtime and legal holiday service. (a) When analytical testing in a Science...

7 CFR 91.39 - Premium hourly fee rates for overtime and legal holiday service.

Code of Federal Regulations, 2014 CFR

2014-01-01

... overtime work. When analytical testing in a Science and Technology facility requires the services of... (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Fees and Charges § 91.39 Premium hourly fee rates for overtime and legal holiday service. (a) When analytical testing in a Science...

7 CFR 91.39 - Premium hourly fee rates for overtime and legal holiday service.

Code of Federal Regulations, 2012 CFR

2012-01-01

... overtime work. When analytical testing in a Science and Technology facility requires the services of... (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Fees and Charges § 91.39 Premium hourly fee rates for overtime and legal holiday service. (a) When analytical testing in a Science...

7 CFR 91.39 - Premium hourly fee rates for overtime and legal holiday service.

Code of Federal Regulations, 2011 CFR

2011-01-01

... overtime work. When analytical testing in a Science and Technology facility requires the services of... (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Fees and Charges § 91.39 Premium hourly fee rates for overtime and legal holiday service. (a) When analytical testing in a Science...

Damages Caps in Medical Malpractice Cases

PubMed Central

Nelson, Leonard J; Morrisey, Michael A; Kilgore, Meredith L

2007-01-01

This article reviews the empirical literature on the effects of damages caps and concludes that the better-designed studies show that damages caps reduce liability insurance premiums. The effects of damages caps on defensive medicine, physicians’ location decisions, and the cost of health care to consumers are less clear. The only study of whether consumers benefit from lower health insurance premiums as a result of damages caps found no impact. Some state courts have based decisions declaring damages caps legislation unconstitutional on the lack of evidence of their effectiveness, thereby ignoring the findings of conflicting research studies or discounting their relevance. Although courts should be cautious in rejecting empirical evidence that caps are effective, legislators should consider whether they benefit consumers enough to justify limiting tort recoveries for those most seriously injured by malpractice. PMID:17517115

Integrating smoking control policies into employee benefits: a survey of large California corporations.

PubMed Central

Schauffler, H H

1993-01-01

OBJECTIVES. Public health policy promotes the use of risk-rating health insurance and payment for smoking cessation as economic incentives to encourage smoking cessation. This study was undertaken to learn more about the adoption of these policies in large corporations. METHODS. A random sample survey of 280 private California corporations with more than 500 employees was undertaken to document the prevalence of policies integrating smoking control into employee benefit designs. RESULTS. Only 8.6% of large corporations had ever considered risk-rating health insurance premiums using smoking status and only 2.15% had implemented a risk-rating policy. Nearly 20% of the companies offered health insurance plans that covered smoking cessation services. Subsidization or payment for smoking cessation outside health insurance was provided by over 37% of the companies surveyed, and 87% had adopted formal work-site smoking policies. CONCLUSION. Benefit policies that provide financial support to smokers to participate in smoking cessation services are much more prevalent and are viewed more positively by the benefits managers in large corporations than are policies to risk-rate health insurance premiums on the basis of smoking. PMID:8362996

The Affordable Care Act and health insurance exchanges: effects on the pediatric dental benefit.

PubMed

Orynich, C Ashley; Casamassimo, Paul S; Seale, N Sue; Reggiardo, Paul; Litch, C Scott

2015-01-01

To examine the relationship between state health insurance Exchange selection and pediatric dental benefit design, regulation and cost. Medical and dental plans were analyzed across three types of state health insurance Exchanges: State-based (SB), State-partnered (SP), and Federally-facilitated (FF). Cost-analysis was completed for 10,427 insurance plans, and health policy expert interviews were conducted. One-way ANOVA compared the cost-sharing structure of stand-alone dental plans (SADP). T-test statistics compared differences in average total monthly pediatric premium costs. No causal relationships were identified between Exchange selection and the pediatric dental benefit's design, regulation or cost. Pediatric medical and dental coverage offered through the embedded plan design exhibited comparable average total monthly premium costs to aggregate cost estimates for the separately purchased SADP and traditional medical plan (P=0.11). Plan designs and regulatory policies demonstrated greater correlation between the SP and FF Exchanges, as compared to the SB Exchange. Parameters defining the pediatric dental benefit are complex and vary across states. Each state Exchange was subject to barriers in improving the quality of the pediatric dental benefit due to a lack of defined, standardized policy parameters and further legislative maturation is required.

Medicare essential: an option to promote better care and curb spending growth.

PubMed

Davis, Karen; Schoen, Cathy; Guterman, Stuart

2013-05-01

Medicare's core benefit design reflects private insurance as of 1965, with separate coverage for hospital and physician services (and now prescription drugs) and no protection against catastrophic costs. Modernizing Medicare's benefit design to offer comprehensive benefits, financial protection, and incentives to choose high-value care could improve coverage and lower beneficiary costs. We describe a new option we call Medicare Essential, which would combine Medicare's hospital, physician, and prescription drug coverage into an integrated benefit with an annual limit on out-of-pocket expenses for covered benefits. Cost sharing would be reduced for enrollees who seek care from high-quality low-cost providers. Out-of-pocket savings from lower premiums and health care costs for a Medicare Essential enrollee could be $173 per month, compared to what an enrollee would pay with traditional Medicare, prescription drug and private supplemental coverage. Financed by a budget-neutral premium, we estimate that this new plan choice could reduce total health spending relative to current projections by $180 billion and reduce employer retiree spending by $90 billion during 2014-23. Given its potential, such an alternative should be a part of the debate over the future of Medicare.

Patient Protection and Affordable Care Act; program integrity: exchange, premium stabilization programs, and market standards; amendments to the HHS notice of benefit and payment parameters for 2014. Final rule.

PubMed

2013-10-30

This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, this final rule outlines financial integrity and oversight standards with respect to Affordable Insurance Exchanges, qualified health plan (QHP) issuers in Federally-facilitated Exchanges (FFEs), and States with regard to the operation of risk adjustment and reinsurance programs. It also establishes additional standards for special enrollment periods, survey vendors that may conduct enrollee satisfaction surveys on behalf of QHP issuers, and issuer participation in an FFE, and makes certain amendments to definitions and standards related to the market reform rules. These standards, which include financial integrity provisions and protections against fraud and abuse, are consistent with Title I of the Affordable Care Act. This final rule also amends and adopts as final interim provisions set forth in the Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 interim final rule, published in the Federal Register on March 11, 2013, related to risk corridors and cost-sharing reduction reconciliation.

76 FR 15316 - Medicaid Program; State Allotments for Payment of Medicare Part B Premiums for Qualifying...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-21

... expenditure in any one year by State, local, or tribal governments, in the aggregate, or by the private sector... private sector. Executive Order 13132 establishes certain requirements that an agency must meet when it... allotments available to pay the Medicare Part B premiums for Qualifying Individuals (QIs) for the Federal...

78 FR 53766 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-30

... did not have the premium paid for by a state, a political subdivision of a state, or an agency or instrumentality of one or more states or political subdivisions) may have the Part A premium reduced to zero... in Medicaid & Children's Health Insurance Program (CHIP); Use: The Improper Payments Information Act...

24 CFR 203.284 - Calculation of up-front and annual MIP on or after July 1, 1991.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Obligations Calculation of Mortgage Insurance Premium on Or After July 1, 1991 § 203.284 Calculation of up... refund all of the unearned premium charges paid on a mortgage upon termination of insurance by voluntary... HOUSING COMMISSIONER, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS...

24 CFR 203.284 - Calculation of up-front and annual MIP on or after July 1, 1991.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Obligations Calculation of Mortgage Insurance Premium on Or After July 1, 1991 § 203.284 Calculation of up... refund all of the unearned premium charges paid on a mortgage upon termination of insurance by voluntary... HOUSING COMMISSIONER, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS...

75 FR 21329 - Medicaid Program; State Allotments for Payment of Medicare Part B Premiums for Qualifying...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-23

... includes payment for premiums for Medicare Part B. Section 4732 of the Balanced Budget Act of 1997 (BBA... formula for determining State allotments. However, since certain States projected a deficit in their... minimize the impact on States with FY QI allotments that might be greater than their QI expenditures for...

Medicare Part D: successes and continuing challenges. Impact of Medicare Part D on Massachusetts health programs and beneficiaries.

PubMed

Thomas, Cindy Parks; Sussman, Jeffrey

2007-05-30

On January 1, 2006, the Centers for Medicare and Medicaid Services (CMS) implemented the Medicare Drug Benefit, or "Medicare Part D." The program offers prescription drug coverage for the one million Medicare beneficiaries in Massachusetts. Part D affects Massachusetts state health programs and beneficiaries in a number of ways. The program: (1) provides prescription drug insurance, including catastrophic coverage, through a choice of private prescription drug plans (PDPs) or integrated Medicare Advantage (MA-PD) health plans; (2) shifts prescription drug coverage for dual-eligible Medicare / Medicaid beneficiaries from Medicaid to Medicare Part D drug plans; (3) requires a maintenance-of-effort, or "clawback" payments from states to CMS designed to capture a portion of states' Medicaid savings to help finance the benefit; (4) offers additional help for premiums and cost sharing to low income beneficiaries through the Low Income Subsidy (LIS); and (5) provides a subsidy to employer groups that maintain their own prescription drug coverage for retired beneficiaries. This paper summarizes the activities involved in implementing Medicare Part D, the impact it has had on Massachusetts health programs, and the experiences of beneficiaries and others conducting outreach and enrollment. The data are drawn from interviews with officials and documents provided by state health programs, CMS and the Social Security Administration, and representatives of provider and advocacy groups involved in the enrollment and ongoing support of Medicare beneficiaries.

Cutting back but not cutting out: small employers respond to premium increases.

PubMed

Short, Ashley C; Lesser, Cara S

2002-10-01

Rising premiums and a weak economy are generating questions about the potential erosion of health insurance coverage, particularly for the more than 46 million Americans who work for small firms. People working in small firms typically have less access to coverage than those in large firms. In 2000 and early 2001, the Center for Studying Health System Change (HSC) conducted its third round of site visits to 12 nationally representative metropolitan areas and found that while few small employers actually dropped coverage, many increased the employee share of premiums, raised copayments and deductibles, switched products and carriers and/or reduced benefits. With the U.S. economy now in rougher shape, small employers may pare back coverage even more, putting affordable health care further out of the reach of workers and their families.

After CLASS--Is a voluntary public insurance program a realistic way to meet the long-term support and service needs of adults with disabilities?

PubMed

Kennedy, Jae; Gimm, Gilbert; Glazier, Raymond

2016-04-01

The CLASS Act, which was part of the Affordable Care Act of 2010, established a voluntary personal assistance services (PAS) insurance program. However, concerns about enrollment and adverse selection led to repeal of the CLASS Act in 2013. To estimate the number of middle-aged adults interested in purchasing PAS insurance, the sociodemographic, socioeconomic and disability attributes of this population, and the maximum monthly premium they would be willing to pay for such coverage. A total of 13,384 adults aged 40-65 answered questions about their interest in PAS insurance in the 2011 Sample Adult National Health Interview Survey. We applied survey weights for the U.S. population and conducted logistic regression analyses to identify personal factors associated with interest in paying for the CLASS program. An estimated 25.8 million adults aged 40-65 (26.7%) said they would be interested in paying for a public insurance program to cover PAS benefits. However, interest in PAS insurance varied by age, race, ethnicity, region, income, disability status, and family experience with ADL assistance. Only 1.6 million adults aged 40-65 (1.8%) said they would be willing to pay $100 per month or more for coverage. While more than a quarter of the middle-aged adult population said they were interested in PAS insurance, actual participation would be highly dependent on premium rates. The current lack of publicly subsidized insurance for long-term care and personal assistance services remains a serious gap in the disability service system. Copyright © 2016 Elsevier Inc. All rights reserved.

Appraising into the Sun: Six-State Solar Home Paired-Sale Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lawrence Berkeley National Laboratory

Although residential solar photovoltaic (PV) installations have proliferated, PV systems on some U.S. homes still receive no value during an appraisal because comparable home sales are lacking. To value residential PV, some previous studies have employed paired-sales appraisal methods to analyze small PV home samples in depth, while others have used statistical methods to analyze large samples. Our first-of-its-kind study connects the two approaches. It uses appraisal methods to evaluate sales price premiums for owned PV systems on single-unit detached houses that were also evaluated in a large statistical study. Independent appraisers evaluated 43 recent home sales pairs in sixmore » states: California, Oregon, Florida, Maryland, North Carolina, and Pennsylvania. We compare these results with contributory-value estimates—based on income (using the PV Value® tool), gross cost, and net cost—as well as hedonic modeling results from the recent statistical study. The results provide strong, appraisal-based evidence of PV premiums in all states. More importantly, the results support the use of cost- and incomebased PV premium estimates when paired-sales analysis is impossible. PV premiums from the paired-sales analysis are most similar to net PV cost estimates. PV Value® income results generally track the appraised premiums, although conservatively. The appraised premiums are in agreement with the hedonic modeling results as well, which bolsters the suitability of both approaches for estimating PV home premiums. Therefore, these results will benefit valuation professionals and mortgage lenders who increasingly are encountering homes equipped with PV and need to understand the factors that can both contribute to and detract from market value.« less

State-based Marketplaces using 'clearinghouse' plan management models are associated with lower premiums.

PubMed

Krinn, Kelly; Karaca-Mandic, Pinar; Blewett, Lynn A

2015-01-01

The state-based and federally facilitated health insurance Marketplaces, or exchanges, enrolled more than eight million people during the first open enrollment period, which ended March 31, 2014. There is significant variation in how states have designed and implemented their Marketplaces. We examined how premiums varied with states' involvement in the Marketplaces through governance, plan management authority, and strategy during the first year that the exchanges have been open. State-based Marketplaces using "clearinghouse" plan management models had significantly lower adjusted average premiums for all plans within each metal level compared to state-based Marketplaces using "active purchaser" models and the federally facilitated and partnership Marketplaces. Clearinghouse management models are those in which all health plans that meet published criteria are accepted. Active purchaser models are those in which states negotiate premiums, provider networks, number of plans, and benefits. Our baseline estimates provide valuable benchmarks for evaluating future performance of states' involvement in governance, plan management, and regulatory authority of the insurance Marketplaces. Project HOPE—The People-to-People Health Foundation, Inc.

Employer-sponsored health insurance in New York: findings from the 2003 Commonwealth Fund/HRET survey.

PubMed

Edwards, Jennifer N; How, Sabrina; Whitmore, Heidi; Gabel, Jon R; Hawkins, Samantha; Pickreign, Jeremy D

2004-05-01

A 2003 Commonwealth Fund/Health Research and Educational Trust survey of 576 New York State firms found that, in order to manage rising health costs, employers are increasing the share of the insurance premium that employees pay, delaying the start of benefits, and increasing cost-sharing at the point of service. This has enabled employers to preserve health benefits, but has raised costs for workers and their families. On average, workers' contributions for family coverage rose 54 percent, from $1,392 per year in 2001 to $2,148 per year in 2003. During that time period, fewer workers selected family coverage. Employers are receptive to a wide range of approaches to make coverage more available and affordable for their employees, but they have limited familiarity with public programs that could cover their lower-wage workers, such as Healthy New York, Family Health Plus, or Child Health Plus.

National trends in occupational injuries before and after 1992 and predictors of workers' compensation costs.

PubMed

Bhushan, Abhinav; Leigh, J Paul

2011-01-01

Numbers and costs of occupational injuries and illnesses are significant in terms of morbidity and dollars, yet our understanding of time trends is minimal. We investigated trends and addressed some common hypotheses regarding causes of fluctuations. We pulled data on incidence rates (per 100 full-time employed workers) for injuries and illnesses from the U.S. Bureau of Labor Statistics and on costs and benefits from the National Academy of Social Insurance for 1973 through 2007. Rates reflected all injury and illness cases, lost work-time cases, and cases resulting in at least 31 days away from work. We adjusted dollar costs (premiums) and benefits for inflation and measured them per employed worker. We plotted data in time-trend charts and ran linear regressions. From 1973 to 1991, there was a weak to nonexistent downward trend for injury and illness rates, and rates were strongly and negatively correlated with the unemployment rate. From 1992 to 2007, there were strong, consistent downward trends, but no longer were there statistically significant correlations with unemployment. Significant predictors (and signs) of workers' compensation premiums for 1973-2007 included medical price inflation (positive), number of lost-time injuries (positive), the Dow Jones Industrial Average (negative), and inflation-adjusted interest rate on U.S. Treasury bonds (negative). Dollars of benefits were positively and significantly predicted by medical inflation and number of lost-time cases. For 1992-2007, the Dow Jones variable was the only robust predictor of premiums; the number of injuries was not a significant positive predictor. We had two major conclusions. First, the year 1992 marked a sharp contrast in trends and correlations between unemployment and incidence rates for occupational injuries and illnesses. Second, for the entire time period (1973-2007), insurance carriers' premiums were strongly associated with returns on investments.

National Trends in Occupational Injuries Before and After 1992 and Predictors of Workers' Compensation Costs

PubMed Central

Bhushan, Abhinav; Leigh, J. Paul

2011-01-01

Objective Numbers and costs of occupational injuries and illnesses are significant in terms of morbidity and dollars, yet our understanding of time trends is minimal. We investigated trends and addressed some common hypotheses regarding causes of fluctuations. Methods We pulled data on incidence rates (per 100 full-time employed workers) for injuries and illnesses from the U.S. Bureau of Labor Statistics and on costs and benefits from the National Academy of Social Insurance for 1973 through 2007. Rates reflected all injury and illness cases, lost work-time cases, and cases resulting in at least 31 days away from work. We adjusted dollar costs (premiums) and benefits for inflation and measured them per employed worker. We plotted data in time-trend charts and ran linear regressions. Results From 1973 to 1991, there was a weak to nonexistent downward trend for injury and illness rates, and rates were strongly and negatively correlated with the unemployment rate. From 1992 to 2007, there were strong, consistent downward trends, but no longer were there statistically significant correlations with unemployment. Significant predictors (and signs) of workers' compensation premiums for 1973–2007 included medical price inflation (positive), number of lost-time injuries (positive), the Dow Jones Industrial Average (negative), and inflation-adjusted interest rate on U.S. Treasury bonds (negative). Dollars of benefits were positively and significantly predicted by medical inflation and number of lost-time cases. For 1992–2007, the Dow Jones variable was the only robust predictor of premiums; the number of injuries was not a significant positive predictor. Conclusion We had two major conclusions. First, the year 1992 marked a sharp contrast in trends and correlations between unemployment and incidence rates for occupational injuries and illnesses. Second, for the entire time period (1973–2007), insurance carriers' premiums were strongly associated with returns on investments. PMID:21886322

A simple change to the Medicare Part D low-income subsidy program could save $5 billion.

PubMed

Zhang, Yuting; Zhou, Chao; Baik, Seo Hyon

2014-06-01

Medicare Part D provides a subsidy to beneficiaries with incomes below 150 percent of the federal poverty level. Enrollees with the low-income subsidy accounted for 75 percent of the $60 billion in total federal Part D spending in 2013. The government randomly assigns any new beneficiary who automatically qualifies for the subsidy, or who successfully applies for it without indicating a preferred plan, to a stand-alone Part D plan whose premium is equal to or below the average premium for the basic Part D benefit in the region. We used an intelligent reassignment algorithm and 2008-09 Part D drug use and spending data to match enrollees to available plans according to their medication needs. We found that such a reassignment approach could have saved the federal government over $5 billion in 2009, for mean government savings of $710 (median: $368) per enrollee with a low-income subsidy. Implementing that simple change to reassign beneficiaries would have also lowered the proportion of prescriptions that required utilization review from 29 percent to 20 percent, and the proportion of prescriptions with quantity limits from 27 percent to 19 percent. Project HOPE—The People-to-People Health Foundation, Inc.

48 CFR 1652.232-71 - Payments-experience-rated contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for error or fraud, the subscription charges received for the Plan by the Employees Health Benefits... accounting, OPM will place any surplus demonstration project premiums in the regular Contingency Reserves of...

48 CFR 1652.232-70 - Payments-community-rated contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for error or fraud, the subscription charges received for the plan by the Employees Health Benefits... Administrative Reserve. After the final accounting, OPM will place any surplus demonstration project premiums in...

The distributional consequences of a Medicare premium support proposal.

PubMed

Rice, Thomas; Desmond, Katherine A

2004-12-01

This article analyzes the distributional consequences of enacting a particular premium support proposal known as Breaux-Frist I. Under the proposal, the federal government would contribute a certain amount toward the purchase of Medicare coverage, based on the premiums charged by different health plans. Beneficiaries could choose something akin to the traditional fee-for-service option or a privately sponsored ealth plan such as a health maintenance organization. The article simulates the expected distributional impacts in three areas: among beneficiaries who choose to retain fee-for-service coverage, between different geographic areas, and according to various beneficiary characteristics. We find that the legislation would result in increased premiums for beneficiaries remaining in the Medicare fee-for-service program as a result of unfavorable selection; lead to a geographic redistribution in premium payments, with those living in areas with high levels of Medicare expenditures paying more; and a much lower financial burden than is the case now for near-poor beneficiaries who do not have full Medicaid coverage. Finally, the article discusses how these results compare to those that may occur under the premium support demonstration project, beginning in 2010, established under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

26 CFR 1.419-1T - Treatment of welfare benefit funds. (Temporary)

Code of Federal Regulations, 2011 CFR

2011-04-01

... welfare benefit funds with excess reserves. Q-2: When do the deduction rules of section 419, as enacted by... “funds” within section 419(e)(3)(C). A retired lives reserve or a premium stabilization reserve... employer and the employer has the right to have any amount in the reserve applied against its future years...

42 CFR 422.106 - Coordination of benefits with employer or union group health plans and Medicaid.

Code of Federal Regulations, 2014 CFR

2014-10-01

.... Jurisdiction regulating benefits under these circumstances is as follows: (1) All requirements of this part... the following: (1) Payment of a portion or all of the MA basic and supplemental premiums. (2) Payment... organizations. (1) MA organizations may request, in writing, from CMS, a waiver or modification of those...

42 CFR 422.106 - Coordination of benefits with employer or union group health plans and Medicaid.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... Jurisdiction regulating benefits under these circumstances is as follows: (1) All requirements of this part... the following: (1) Payment of a portion or all of the MA basic and supplemental premiums. (2) Payment... organizations. (1) MA organizations may request, in writing, from CMS, a waiver or modification of those...

42 CFR 422.106 - Coordination of benefits with employer or union group health plans and Medicaid.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... Jurisdiction regulating benefits under these circumstances is as follows: (1) All requirements of this part... the following: (1) Payment of a portion or all of the MA basic and supplemental premiums. (2) Payment... organizations. (1) MA organizations may request, in writing, from CMS, a waiver or modification of those...

Drug benefit decisions among older adults: a policy-capturing analysis.

PubMed

Cline, Richard R; Gupta, Kiran

2006-01-01

Under the Medicare Prescription Drug Improvement and Modernization Act, beneficiaries remaining in the traditional fee-for-service plan will face a variety of drug benefit options provided by private stand-alone prescription drug plans. Although these plans likely will differ with regard to a number of important attributes, little is known about older adults' judgment processes in this context. The objectives of this study were to 1) better understand the manner in which drug insurance attributes are weighted in older adults' judgments of drug benefit suitability, 2) explore variability in judgment strategies among seniors, and 3) assess seniors' insight into their judgment policies. Three focus groups were conducted with 19 older adults to elicit important drug plan attributes. A policy-capturing study with 32 seniors, none of whom had participated in the focus groups, then was employed to quantify the impacts of these attributes on judgments of plan suitability. Focus group participants reported that copayment, monthly premium, deductible, formulary use, and mail-order pharmacy use were important drug insurance attributes. The policy-capturing study showed that deductibles and premiums were weighted most heavily in judgment formation. However, significant variability in judgment policies was apparent, with 3 distinct groups emerging from cluster analysis. The first emphasized deductibles and copayments, the second premiums and deductibles, and the third use of a mail-order pharmacy and deductibles. Study volunteers exhibited insight into the role of some plan attributes in their judgments, but not others. Cost-sharing provisions appear to be most important in older adults' evaluations of drug benefit plans. However, significant heterogeneity in attribute preferences also was apparent in this study. Older adults may not be cognizant of the manner in which some plan attributes affect their evaluations, suggesting a role for decision aids in this process.

31 CFR 50.36 - Allocation of premium income associated with entities that do share profits and losses with...

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false Allocation of premium income associated with entities that do share profits and losses with private sector insurers. 50.36 Section 50.36 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM...

31 CFR 50.36 - Allocation of premium income associated with entities that do share profits and losses with...

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false Allocation of premium income associated with entities that do share profits and losses with private sector insurers. 50.36 Section 50.36 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM...

31 CFR 50.36 - Allocation of premium income associated with entities that do share profits and losses with...

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Allocation of premium income associated with entities that do share profits and losses with private sector insurers. 50.36 Section 50.36 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM...

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Reserve Select; TRICARE Dental Program; Early Eligibility for TRICARE for Certain Reserve Component Members. Final rule.

PubMed

2015-09-15

TRICARE Reserve Select (TRS) is a premium-based TRICARE health plan available for purchase worldwide by qualified members of the Ready Reserve and by qualified survivors of TRS members. TRICARE Dental Program (TDP) is a premium-based TRICARE dental plan available for purchase worldwide by qualified Service members. This final rule revises requirements and procedures for the TRS program to specify the appropriate actuarial basis for calculating premiums in addition to making other minor clarifying administrative changes. For a member who is involuntarily separated from the Selected Reserve under other than adverse conditions this final rule provides a time-limited exception that allows TRS coverage in effect to continue for up to 180 days after the date on which the member is separated from the Selected Reserve and TDP coverage in effect to continue for no less than 180 days after the separation date. It also expands early TRICARE eligibility for certain Reserve Component members from a maximum of 90 days to a maximum of 180 days prior to activation in support of a contingency operation for more than 30 days.

12 CFR 327.51 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Temporary Liquidity Guarantee Program. An eligible premium also does not include any emergency special... Temporary Liquidity Guarantee Program or for any other reason. (e) An insured depository institution's...

Evaluating the Impact of Health Insurance Industry Consolidation: Learning from Experience.

PubMed

Dafny, Leemore S

2015-11-01

Research shows consolidation in the private health insurance industry leads to premium increases, even though insurers with larger local market shares generally obtain lower prices from health care providers. Additional research is needed to understand how to protect against harms and unlock benefits from scale. Data on enrollment, premiums, and costs of commercial health insurance--by insurer, plan, customer segment, and local market--would help us understand whether, when, and for whom consolidation is harmful or beneficial. Such transparency is common where there is a strong public interest and substantial public regulation, both of which characterize this vital sector.

The US Medical Liability System: Evidence for Legislative Reform

PubMed Central

Guirguis-Blake, Janelle; Fryer, George E.; Phillips, Robert L.; Szabat, Ronald; Green, Larry A.

2006-01-01

BACKGROUND Despite state and federal efforts to implement medical malpractice reform, there is limited evidence on which to base policy decisions. The National Practitioner Data Bank (NPDB) offers an opportunity to evaluate the effects of previous malpractice tort reforms on malpractice payments and premiums. METHODS For every state and the District of Columbia, we calculated the number of malpractice payments, total amount paid, and average payment from NPDB data reported from 1999 through 2001. We analyzed 44,913 claims using logistic regression to study associations between payments, physician premiums, and 10 state statutory tort reforms. RESULTS Wide variations exist in malpractice payments among states. The reforms most associated with lower payments and premiums were total and noneconomic damage caps. Mean payments were 26% lower in states with total damage caps ($196,495.34 vs $265,554.50, P = .001). Mean payments were 22% less in states with noneconomic damage caps ($219,225.98 vs $279,849.86, P = .010). Total damage caps were associated with lower mean annual premiums, especially for obstetricians ($22,371.57 vs $42,728.68, P <.001). Hard noneconomic damage caps were associated with premium reductions for obstetricians (30,283.75 vs 45,740.88; P = .039). CONCLUSIONS Significant reductions in malpractice payments could be realized if total or noneconomic damage caps were operating nationally. Hard noneconomic damage and total damage caps could yield lower premiums. If tied to a comprehensive plan for reform, the money saved could be diverted to implement alternative approaches to patient compensation or be used to achieve other systems reform benefiting patients, employers, physicians, and hospitals. PMID:16735526

Patient-centered and visual quality outcomes of premium cataract surgery: a systematic review.

PubMed

Wang, Sophia Y; Stem, Maxwell S; Oren, Gale; Shtein, Roni; Lichter, Paul R

2017-06-26

Over 8 million cataract surgeries are performed in the United States and the European Union annually, with many patients choosing to pay out of pocket for premium options including premium intraocular lens implants (IOLs) or laser-assisted cataract surgery (LACS). This report provides a systematic review evaluating patient-centered and visual quality outcomes comparing standard monofocal IOLs to premium cataract surgery options. PubMed and EMBASE were searched for publications published between January 1, 1980, and September 18, 2016, on multifocal, accommodative, and toric IOLs, monovision, and LACS, which reported on 1) dysphotopsias, 2) contrast sensitivity, 3) spectacle independence, 4) vision-related quality of life or patient satisfaction, and 5) IOL exchange. Multifocal lenses achieved higher rates of spectacle independence compared to monofocal lenses but also had higher reported frequency of dysphotopsia and worse contrast sensitivity, especially with low light or glare. Accommodative lenses were not associated with reduced contrast sensitivity or more dysphotopsia but had only modest improvements in spectacle independence compared to monofocal lenses. Studies of monovision did not target a sufficiently myopic outcome in the near-vision eye to achieve the full potential for spectacle independence. Patients reported high levels of overall satisfaction regardless of implanted IOL. No studies correlated patient-reported outcomes with patient expectations. Studies are needed to thoroughly compare patient-reported outcomes with concomitant patient expectations. In light of the substantial patient costs for premium options, patients and their surgeons will benefit from a better understanding of which surgical options best meet patients' expectations and how those expectations can be impacted by premium versus monofocal-including monovision-options.

Effect of premium, copayments, and health status on the choice of health plans.

PubMed

Naessens, James M; Khan, Mahmud; Shah, Nilay D; Wagie, Amy; Pautz, Rebecca A; Campbell, Claudia R

2008-10-01

Explore effects of comorbidity and prior health care utilization on choice of employee health plans with different levels of cost sharing. Mayo Clinic employees in Rochester, Minnesota (MCR) under age 65 in January 2004; N = 20,379. Assessment of a natural experiment where self-funded medical care benefit options were changed to contain costs within a large medical group practice. Before the change, most employees were enrolled in a plan with first dollar coverage, while 18% had a plan with copays and deductibles. In 2004, 3 existing plans were replaced by 2 new options, one with lower premiums and higher out-of-pocket costs and the other with higher premiums, a lower coinsurance rate, and lower out-of-pocket maximums. Data on employees were merged across insurance claims, medical records, eligibility files, and employment files for 2003 and 2004. As the number of chronic comorbidities among family members increased, the probability of choosing high-premium option also increased. Seventy-two percent of employees with at least 1 family member with comorbidity chose the high-cost option versus 54.7% of employees with no comorbidities. High-premium and low-premium plans seem to subdivide population into discrete risk categories, which may adversely affect the future stability of the insurance plan options. Various factors affect decision making of employees regarding the choice of plan with different levels of cost-sharing. In a natural experiment setting where all options were redesigned, the health status of employees and their dependents played a very significant role in plan choice.

The US Medical Liability System: evidence for legislative reform.

PubMed

Guirguis-Blake, Janelle; Fryer, George E; Phillips, Robert L; Szabat, Ronald; Green, Larry A

2006-01-01

Despite state and federal efforts to implement medical malpractice reform, there is limited evidence on which to base policy decisions. The National Practitioner Data Bank (NPDB) offers an opportunity to evaluate the effects of previous malpractice tort reforms on malpractice payments and premiums. For every state and the District of Columbia, we calculated the number of malpractice payments, total amount paid, and average payment from NPDB data reported from 1999 through 2001. We analyzed 44,913 claims using logistic regression to study associations between payments, physician premiums, and 10 state statutory tort reforms. Wide variations exist in malpractice payments among states. The reforms most associated with lower payments and premiums were total and noneconomic damage caps. Mean payments were 26% lower in states with total damage caps (196,495.34 dollars vs 265,554.50 dollars, P = .001). Mean payments were 22% less in states with noneconomic damage caps (219,225.98 dollars vs 279,849.86 dollars, P = .010). Total damage caps were associated with lower mean annual premiums, especially for obstetricians (22,371.57 dollars vs 42,728.68 dollars, P <.001). Hard noneconomic damage caps were associated with premium reductions for obstetricians (30,283.75 vs 45,740.88; P = .039). Significant reductions in malpractice payments could be realized if total or noneconomic damage caps were operating nationally. Hard noneconomic damage and total damage caps could yield lower premiums. If tied to a comprehensive plan for reform, the money saved could be diverted to implement alternative approaches to patient compensation or be used to achieve other systems reform benefiting patients, employers, physicians, and hospitals.

The Impact of Location and Proximity on Consumers' Willingness to Pay for Green Electricity: The Case of West Virginia

NASA Astrophysics Data System (ADS)

Nkansah, Kofi

During the 2015 legislative session, West Virginia lawmakers passed a bill to repeal the Renewable and Alternative Energy Portfolio Standards Act of 2009 (ARPS). Legislators stated concerns about ARPS's impacts on coal industry related jobs in the state as the major factor driving this repeal. However, no comprehensive study on public acceptance, opinions, or willingness to pay (WTP) for renewable/and or alternative sources of electricity within West Virginia was used to inform this repeal decision. As the state of West Virginia struggles to find the right path to expand its renewable energy portfolio, public acceptance of renewable electricity is crucial to establishing a viable market for these forms of energy and also ensure the long-term sustainability of any RPS policy that may be enacted in the future. This study sought to assess consumers' preferences, attitudes and WTP for renewable and alternative electricity in West Virginia. The monetary values that consumers placed on proximity as an attribute of a renewable and alternative electricity generation source were also estimated. Two counties in West Virginia were selected as study areas based on the types of electricity generation facility that already exist in each county -one county with coal-fired power plants (Monongalia County) and another with both a coal-fired power plant and a wind farm (Grant County). A forced choice experiment survey was used with attributes that varied in source of energy (wind versus natural gas), proximity of the generation source relative to the respondent's residence (near, moderate or far) and an additional premium per month on the electric bill (varying from 1 to 15). Respondents were asked to choose between generating 10% of the electricity supplied to them from wind or natural gas. Random samples of 1500 residents from each county were sent surveys and response rates were 27.0% (Monongalia) and 35.3% (Grant). A Mixed logit econometric models were used to analyze consumer choices with utility models. WTP for energy source and proximity attribute levels were computed using parameter estimates from these utility models. Statistically different models were developed for each county. Results from the study showed that respondents in both counties had preferences for electricity generated from wind compared to natural gas. A majority of the sampled populations chose the wind option, 62.0% in Monongalia County and 60.0% in Grant County. The sampled populations in Monongalia and Grant Counties were willing to pay a weighted mean of 21.59 and 9.87 per month, respectively, for 10% of their electricity to be generated from wind over natural gas. Despite this large difference, county level means were not statistically different. On aggregate, a positive social benefit per year would be derived from generating 10% of electricity supplied to consumers in Monongalia County (2.5 million) and Grant County (186 thousand) from wind relative to natural gas. Similarly, the most social benefit would be derived from siting wind turbines at "far" locations from residents in both counties. Both county level sampled populations were willing to pay a higher premium to site wind turbines or a natural gas-fired power plant at the farthest location relative to the baseline location (near a respondent's current residence). Grant County respondents were willing to pay a slightly higher positive premium (mean of 11.71 per month) to site wind turbines at the farthest location than respondents in Monongalia County (mean of 10.14 per month). The mean WTP to site a natural gas-fired power plant at the farthest location in Monongalia County (13.06) and Grant County (13.47) were not statistically different from each other. Results from this study suggest that the decision for an outright repeal of the ARPS bill was flawed. Based on Monongalia and Grant County populations, there are social benefits derived from generating 10% of the electricity supplied to consumers in West Virginia from renewable and alternative energy sources, and wind is preferred to natural gas. This repeal implies there are few, if any, benefits. Given this repeal, I suggest that a voluntary green pricing program with a focus on wind energy serve as an alternative renewable energy policy in West Virginia. Under such a policy, consumers who are concerned about the environment and are willing to pay a positive premium for renewable electricity would be able to opt into the program. Premiums paid by participants of such a program can be used to increase the renewable energy share in West Virginia's energy portfolio.

42 CFR 408.4 - Payment obligations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... kidney donors. (1) No premiums are required for SMI benefits related to the donation of a kidney if the donor is not an enrollee. (2) A kidney donor who is an enrollee is not relieved of the obligation for...

42 CFR 408.4 - Payment obligations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... kidney donors. (1) No premiums are required for SMI benefits related to the donation of a kidney if the donor is not an enrollee. (2) A kidney donor who is an enrollee is not relieved of the obligation for...

Tax subsidies for private health insurance - july 2009 update.

PubMed

Burman, Len; Khitatrakun, Surachai; Goodell, Sarah

2009-07-01

Tax subsides for employer-sponsored health insurance are the largest subsidy for private health insurance and support key mechanisms of the U.S. insurance system, but they overwhelmingly benefit high-wage employees. When employers purchase or provide insurance for their employees, their contributions to the premium are excluded from income and payroll taxes. This tax exclusion provided more than $100 billion in income and payroll tax subsidies in 2002. High-income workers benefit more from these subsidies than those with lower incomes because of their higher marginal tax rate. Applying the tax exclusion in their respective tax brackets means high-income families (those earning more than $200,000) receive a subsidy worth one-third of the premium, while the lowest income families receive a subsidy worth just 10 percent. Despite these issues, ESI is a successful mechanism in many ways, covering a significant majority of Americans and providing a good pooling mechanism.

Spurring enrollment in Medicare savings programs through a substitute for the asset test focused on investment income.

PubMed

Dorn, Stan; Shang, Baoping

2012-02-01

Fewer than one-third of eligible Medicare beneficiaries enroll in Medicare savings programs, which pay premiums and, in some cases, eliminate out-of-pocket cost sharing for poor and near-poor enrollees. Many beneficiaries don't participate in savings programs because they must complete a cumbersome application process, including a burdensome asset test. We demonstrate that a streamlined alternative to the asset test-allowing seniors to qualify for Medicare savings programs by providing evidence of limited assets or showing a lack of investment income-would permit 78 percent of currently eligible seniors to bypass the asset test entirely. This simplified approach would increase the number of beneficiaries who qualify for Medicare savings programs from the current 3.6 million seniors to 4.6 million. Such an alternative would keep benefits targeted to people with low assets, eliminate costly administrative expenses and obstacles to enrollment associated with the asset test, and avoid the much larger influx of seniors that would occur if the asset test were eliminated entirely.

A functional model for monitoring equity and effectiveness in purchasing health insurance premiums for the poor: evidence from Cambodia and the Lao PDR.

PubMed

Annear, Peter Leslie; Bigdeli, Maryam; Jacobs, Bart

2011-10-01

To assess the impact on equity and effectiveness of introducing targeted subsidies for the poor into existing voluntary health insurance schemes in Low Income Countries with special reference to cross-subsidisation. A functional model was constructed using routine collected financial data to analyse changes in financial flows and resulting shifts in cross-subsidization between poor and non-poor. Data were collected from two sites, in Cambodia at Kampot operational health district and in the Lao People's Democratic Republic at Nambak district. Six key variables were identified as determining the financial flows between the subsidy and the insurance schemes and with health providers: population coverage, premium rate, facility contact rate, capitation rate, cost of treatment and changes in administration costs. Negative cross-subsidization was revealed where capitation was used as the payment mechanism and where utilisation rates of the poor were significantly below the non-poor. The same level of access for the poor could have been achieved with a lower Health Equity Fund subsidy if used as a direct reimbursement of user charges by the Health Equity Fund to the provider rather than through the Community Based Health Insurance scheme. Purchasing premiums for the poor under these conditions is more costly than direct reimbursement to the provider for the same level of service delivery. Negative cross-subsidization is a serious risk that must be managed appropriately and the benefits of a larger risk pool (cross-subsidization of the poor) are not evident. Benefits from combined coverage may accrue in the longer term with an expanded base of voluntary payers or when those with subsidized premiums are lifted out of poverty. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Risk-cost-benefit analysis of atrazine in drinking water from agricultural activities and policy implications

NASA Astrophysics Data System (ADS)

Tesfamichael, Aklilu A.; Caplan, Arthur J.; Kaluarachchi, Jagath J.

2005-05-01

This study provides an improved methodology for investigating the trade-offs between the health risks and economic benefits of using atrazine in the agricultural sector by incorporating public attitude to pesticide management in the analysis. Regression models are developed to predict finished water atrazine concentration in high-risk community water supplies in the United States. The predicted finished water atrazine concentrations are then used in a health risk assessment. The computed health risks are compared with the total economic surplus in the U.S. corn market for different atrazine application rates using estimated demand and supply functions developed in this work. Analysis of different scenarios with consumer price premiums for chemical-free and reduced-chemical corn indicate that if the society is willing to pay a price premium, risks can be reduced without a large reduction in the total economic surplus and net benefits may be higher. The results also show that this methodology provides an improved scientific framework for future decision making and policy evaluation in pesticide management.

Using contingent choice methods to assess consumer preferences about health plan design.

PubMed

Marquis, M Susan; Buntin, Melinda Beeuwkes; Kapur, Kanika; Yegian, Jill M

2005-01-01

American insurers are designing products to contain health care costs by making consumers financially responsible for their choices. Little is known about how consumers will view these new designs. Our objective is to examine consumer preferences for selected benefit designs. We used the contingent choice method to assess willingness to pay for six health plan attributes. Our sample included subscribers to individual health insurance products in California, US. We used fitted logistic regression models to explore how preferences for the more generous attributes varied with the additional premium and with the characteristics of the subscriber. High quality was the most highly valued attribute based on the amounts consumers report they are willing to pay. They were also willing to pay substantial monthly premiums to reduce their overall financial risk. Individuals in lower health were willing to pay more to reduce their financial risk than individuals in better health. Consumers may prefer tiered-benefit designs to those that involve overall increases in cost sharing. More consumer information is needed to help consumers better evaluate the costs and benefits of their insurance choices.

Assessment of insurance incentives for safety belt usage

DOT National Transportation Integrated Search

1983-05-12

This study assesses the feasibility of insurance companies to offer incentives, in the form of premium reductions or additional benefits, which would be effective in increasing safety belt usage. The insurance types considered in this report are auto...

Michigan's Public Educator Retirement System--On the Road to Bankruptcy: A Legal Analysis of Michigan

ERIC Educational Resources Information Center

Geier, Brett A.

2016-01-01

Since 1980, Michigan retirees have been afforded health care benefits for which they were required to pay 10 percent of the premium upon retirement--the remainder was paid for by the state. Recently, the Michigan Legislature reduced the financial obligation of the State for retiree health care benefits, placing it on the individual member. In…

Subsidies and the Demand for Individual Health Insurance in California

PubMed Central

Susan Marquis, M; Buntin, Melinda Beeuwkes; Escarce, José J; Kapur, Kanika; Yegian, Jill M

2004-01-01

Objective To estimate the effect of changes in premiums for individual insurance on decisions to purchase individual insurance and how this price response varies among subgroups of the population. Data Source Survey responses from the Current Population Survey (), the Survey of Income and Program Participation (), the National Health Interview Survey (), and data about premiums and plans offered in the individual insurance market in California, 1996–2001. Study Design A logit model was used to estimate the decisions to purchase individual insurance by families without access to group insurance. This was modeled as a function of premiums, controlling for family characteristics and other characteristics of the market. A multinomial model was used to estimate the choice between group coverage, individual coverage, and remaining uninsured for workers offered group coverage as a function of premiums for individual insurance and out-of-pocket costs of group coverage. Principal Findings The elasticity of demand for individual insurance by those without access to group insurance is about −.2 to −.4, as has been found in earlier studies. However, there are substantial differences in price responses among subgroups with low-income, young, and self-employed families showing the greatest response. Among workers offered group insurance, a decrease in individual premiums has very small effects on the choice to purchase individual coverage versus group coverage. Conclusions Subsidy programs may make insurance more affordable for some families, but even sizeable subsidies are unlikely to solve the problem of the uninsured. We do not find evidence that subsidies to individual insurance will produce an unraveling of the employer-based health insurance system. PMID:15333122

Converting unused vacation days to retiree medical benefits: a proposed partial solution to an emerging national crisis.

PubMed

Saxon, Donald R

2003-06-01

Costs for retiree medical benefits are spiraling upward. One way to help fund this area of compensation, with little or no additional financial burden to either employers or employees, could be using an employee benefit plan whereby each year's unused vacation days and sick days are transferred into an employee's tax-free account in a voluntary employee benefit association (VEBA) trust. On retirement, the account is used to purchase a (pre-Medicare) retiree medical plan, prescription drug benefit, a Medicare supplemental policy and/or simply make Medicare premium payments.

Some demographic issues affecting private health insurance.

PubMed

Hanning, Brian

2004-01-01

There will be significant changes in the demography of persons with Private Health Insurance (PHI). Two methods of projecting PHI coverage are discussed in this paper. The first assumes the only factors affecting PHI coverage are demographic change and mortality and facilitates comparisons between actual and projected PHI coverage. The second projects the percentage of the population insured in each five year age cohort, and makes allowance for changes in PHI coverage due to all factors. Demographic change will increase Registered Health Benefit Organization (RHBO) premiums by 1.7% per annum. The role of these projections in analysing the effect of future premium increases on PHI retention rates is also discussed.

Small employer perspectives on the Affordable Care Act's premiums, SHOP exchanges, and self-insurance.

PubMed

Gabel, Jon R; Whitmore, Heidi; Pickreign, Jeremy; Satorius, Jennifer L; Stromberg, Sam

2013-11-01

Beginning January 1, 2014, small businesses having no more than fifty full-time-equivalent workers will be able to obtain health insurance for their employees through Small Business Health Options Program (SHOP) exchanges in every state. Although the Affordable Care Act intended the exchanges to make the purchasing of insurance more attractive and affordable to small businesses, it is not yet known how they will respond to the exchanges. Based on a telephone survey of 604 randomly selected private firms having 3-50 employees, we found that both firms that offered health coverage and those that did not rated most features of SHOP exchanges highly but were also very price sensitive. More than 92 percent of nonoffering small firms said that if they were to offer coverage, it would be "very" or "somewhat" important to them that premium costs be less than they are today. Eighty percent of offering firms use brokers who commonly perform functions of benefit managers--functions that the SHOP exchanges may assume. Twenty-six percent of firms using brokers reported discussing self-insuring with their brokers. An increase in the number of self-insured small employers could pose a threat to SHOP exchanges and other small-group insurance reforms.

Encouraging vehicle-to-grid (V2G) participation through premium tariff rates

NASA Astrophysics Data System (ADS)

Richardson, David B.

2013-12-01

The provision of vehicle-to-grid (V2G) services to an electric grid by electric vehicles (EVs) can potentially reduce the cost of vehicle ownership through revenue generation. Recent studies indicate that yearly vehicle profit from V2G may not be sufficient to induce widespread participation. This paper investigates the feasibility of a premium tariff rate for V2G power, similar to current feed-in-tariff (FIT) programs for renewable energy. Using Ontario, Canada as a case study, an hourly time-series model for a fleet of commuter EVs is created. Tariff rates for V2G peak power are calculated based on the same return on investment as the current FIT for renewable energy in Ontario. The tariff rates are competitive with the renewable energy tariffs, especially when EVs are allowed to provide ancillary services to the grid in addition to peak power. Despite the guaranteed rate of return, yearly vehicle profit is low. Two variations are considered to increase vehicle profit, thereby enhancing the attractiveness of V2G. A higher return on investment is favored over direct benefits offered to EV owners. A higher return on investment may be justifiable based on the higher level of risk inherent in V2G when compared to renewable energy.

Employee choice of flexible spending account participation and health plan.

PubMed

Hamilton, Barton H; Marton, James

2008-07-01

Despite the fact that flexible spending accounts (FSAs) are becoming an increasingly popular employer-provided health benefit, there has been very little empirical study of FSA use among employees at the individual level. This study contributes to the literature on FSAs using a unique data set that provides three years of employee-level-matched benefits data. Motivated by the theoretical model of FSA choice presented in Cardon and Showalter (J. Health Econ. 2001; 20(6):935-954), we examine the determinants of FSA participation and contribution levels using cross-sectional and random-effect two-part models. FSA participation and health plan choice are also modeled jointly in each year using conditional logit models. We find that, even after controlling for a number of other demographic characteristics, non-whites are less likely to participate in the FSA program, have lower contributions conditional on participation, and have a lower probability of switching to new lower cost share, higher premium plans when they were introduced. We also find evidence that choosing health plans with more expected out-of-pocket expenses is correlated with participation in the FSA program. Copyright (c) 2007 John Wiley & Sons, Ltd.

Enhanced Tobacco Control Initiative at Johns Hopkins Health System: Employee Fairness Perception.

PubMed

Durrani, Shabnum; Lucik, Meg; Safeer, Richard

2018-02-01

Organizations often fail to establish a clear awareness of what employees consider fair when implementing changes to employee benefits in the workplace. In 2016, the Johns Hopkins Health System (JHHS) enhanced their tobacco control efforts. In addition to enhanced smoking cessation benefits, employees were offered an increased reduction in their insurance premiums if they were nonsmokers. To qualify for the reduction, employees participated in testing rather than relying on self-reporting as had been done in the past. The shift to testing prompted a concern by some senior management at JHHS who did not want employees to feel they were not trusted. As the program unfolded at JHHS, the four-component model of procedural justice was applied to provide a framework for reviewing the implementation of the new voluntary tobacco testing at JHHS from a fairness lens. The purpose of this article is to illustrate the application of the four-component procedural model of justice to the tobacco testing process at JHHS. As approximately 75% of employees participated in the program, the experience at JHHS can be instructive to other employers who are looking to implement changes in their workplaces and how to minimize unintended consequences with their employees.

Administrative costs for advance payment of health coverage tax credits: an initial analysis.

PubMed

Dorn, Stan

2007-03-01

Health Coverage Tax Credits (HCTCs), created under the Trade Act of 2002, pay 65 percent of health insurance premiums for certain workers displaced by international trade and early retirees. These credits can be paid directly to insurers when monthly premiums are due, in advance of annual tax return filing. While HCTC administrative costs have fallen significantly since program start-ups, they still comprise approximately 34 percent of total spending. Changes to the HCTC program could lower administrative costs, but the size of the resulting savings is unknown. These findings have important implications for any future tax credit plan intended to cover the uninsured.

Guaranteed Student Loans: Analysis of Insurance Premiums Charged by Guaranty Agencies. Briefing Report to the Chairman, Subcommittee on Postsecondary Education, Committee on Education and Labor, House of Representatives.

ERIC Educational Resources Information Center

Comptroller General of the U.S., Washington, DC.

The insurance premium rates that guaranty agencies charge student borrowers under the Guaranteed Student Loan program were analyzed by the U.S. General Accounting Office. The Higher Education Amendments of 1986 established a maximum rate (3% of the principal loan amount) that all agencies could charge student borrowers. Comparisons were made of…

Factors influencing the decision to drop out of health insurance enrolment among urban slum dwellers in Ghana.

PubMed

Atinga, Roger A; Abiiro, Gilbert Abotisem; Kuganab-Lem, Robert Bella

2015-03-01

To identify the factors influencing dropout from Ghana's health insurance scheme among populations living in slum communities. Cross-sectional data were collected from residents of 22 slums in the Accra Metropolitan Assembly. Cluster and systematic random sampling techniques were used to select and interview 600 individuals who had dropped out from the scheme 6 months prior to the study. Descriptive statistics and multivariate logistic regression models were computed to account for sample characteristics and reasons associated with the decision to dropout. The proportion of dropouts in the sample increased from the range of 6.8% in 2008 to 34.8% in 2012. Non-affordability of premium was the predominant reason followed by rare illness episodes, limited benefits of the scheme and poor service quality. Low-income earners and those with low education were significantly more likely to report premium non-affordability. Rare illness was a common reason among younger respondents, informal sector workers and respondents with higher education. All subgroups of age, education, occupation and income reported nominal benefits of the scheme as a reason for dropout. Interventions targeted at removing bottlenecks to health insurance enrolment are salient to maximising the size of the insurance pool. Strengthening service quality and extending the premium exemption to cover low-income families in slum communities is a valuable strategy to achieve universal health coverage. © 2014 John Wiley & Sons Ltd.

Willingness to Pay for Complementary Health Care Insurance in Iran.

PubMed

Nosratnejad, Shirin; Rashidian, Arash; Akbari Sari, Ali; Moradi, Najme

2017-09-01

Complementary health insurance is increasingly used to remedy the limitations and shortcomings of the basic health insurance benefit packages. Hence, it is essential to gather reliable information about the amount of Willingness to Pay (WTP) for health insurance. We assessed the WTP for health insurance in Iran in order to suggest an affordable complementary health insurance. The study sample consisted of 300 household heads all over provinces of Iran in 2013. The method applied was double bounded dichotomous choice and open-ended question approach of contingent valuation. The average WTP for complementary health insurance per person per month by double bounded dichotomous choice and open-ended question method respectively was 199000 and 115300 Rials (8 and 4.6 USD, respectively). Household's heads with higher levels of income and those who worked had more WTP for the health insurance. Besides, the WTP increased in direct proportion to the number of insured members of each household and in inverse proportion to the family size. The WTP value can be used as a premium in a society. As an important finding, the study indicated that the households were willing to pay higher premiums than currently collected for the complementary health insurance coverage in Iran. This offers the policy makers the opportunity to increase the premium and provide good benefits package for insured people of country then better risk pooling.

78 FR 32126 - VA Dental Insurance Program

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-29

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN99 VA Dental Insurance Program AGENCY... its regulations to establish rules and procedures for the VA Dental Insurance Program (VADIP), a pilot program that offers premium-based dental insurance to enrolled veterans and certain survivors and...

The Happy Meal® Effect: the impact of toy premiums on healthy eating among children in Ontario, Canada.

PubMed

Hobin, Erin P; Hammond, David G; Daniel, Samantha; Hanning, Rhona M; Manske, Steve

2012-05-24

"Toy premiums", offered with McDonald's Happy Meals®, are a prominent form of food marketing directed at children. Two California jurisdictions recently implemented policies that only permit offering fast-food toy premiums with meals that meet certain nutritional criteria. The primary objective of the current study was to examine elements of this policy in a Canadian context and determine if children select healthier food products if toy premiums are only offered with healthier food options. The study also examined if the impact of restricting toy premiums to healthier foods varied by gender and age. A between-groups experimental study was conducted with 337 children aged 6-12 years attending day camps in Ontario, Canada. Children were offered one of four McDonald's Happy Meals® as part of the camp lunch program: two "healthier" meals that met the nutritional criteria and two meals that did not. In the control condition, all four meals were offered with a toy premium. In the intervention condition, the toy was only offered with the two "healthier" meals. Children were significantly more likely to select the healthier meals when toys were only offered with meals that met nutritional criteria (OR=3.19, 95% CI: 1.89-5.40). The effect of pairing toys with healthier meals had a stronger effect on boys than girls (OR=1.90, 95% CI: 1.14-3.17). Policies that restrict toy premiums to food that meet nutritional criteria may promote healthier eating at fast-food restaurants.

19 CFR 351.520 - Export insurance.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Duties INTERNATIONAL TRADE ADMINISTRATION, DEPARTMENT OF COMMERCE ANTIDUMPING AND COUNTERVAILING DUTIES Identification and Measurement of Countervailable Subsidies § 351.520 Export insurance. (a) Benefit—(1) In general. In the case of export insurance, a benefit exists if the premium rates charged are inadequate to...

UnitedHealthcare experience illustrates how payers can enable patient engagement.

PubMed

Sandy, Lewis G; Tuckson, Reed V; Stevens, Simon L

2013-08-01

Patient engagement is crucial to better outcomes and a high-performing health system, but efforts to support it often focus narrowly on the role of physicians and other care providers. Such efforts miss payers' unique capabilities to help patients achieve better health. Using the experience of UnitedHealthcare, a large national payer, this article demonstrates how health plans can analyze and present information to both patients and providers to help close gaps in care; share detailed quality and cost information to inform patients' choice of providers; and offer treatment decision support and value-based benefit designs to help guide choices of diagnostic tests and therapies. As an employer, UnitedHealth Group has used these strategies along with an "earn-back" program that provides positive financial incentives through reduced premiums to employees who adopt healthful habits. UnitedHealth's experience provides lessons for other payers and for Medicare and Medicaid, which have had minimal involvement with demand-side strategies and could benefit from efforts to promote activated beneficiaries.

Do individuals respond to cost-sharing subsidies in their selections of marketplace health insurance plans?

PubMed

DeLeire, Thomas; Chappel, Andre; Finegold, Kenneth; Gee, Emily

2017-12-01

The Affordable Care Act (ACA) provides assistance to low-income consumers through both premium subsidies and cost-sharing reductions (CSRs). Low-income consumers' lack of health insurance literacy or information regarding CSRs may lead them to not take-up CSR benefits for which they are eligible. We use administrative data from 2014 to 2016 on roughly 22 million health insurance plan choices of low-income individuals enrolled in ACA Marketplace coverage to assess whether they behave in a manner consistent with being aware of the availability of CSRs. We take advantage of discontinuous changes in the schedule of CSR benefits to show that consumers are highly sensitive to the value of CSRs when selecting insurance plans and that a very low percentage select dominated plans. These findings suggest that CSR subsidies are salient to consumers and that the program is well designed to account for any lack of health insurance literacy among the low-income population it serves. Copyright © 2017 Elsevier B.V. All rights reserved.

76 FR 70510 - Federal Employees' Group Life Insurance Program: New Federal Employees' Group Life Insurance...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-14

... OFFICE OF PERSONNEL MANAGEMENT Federal Employees' Group Life Insurance Program: New Federal Employees' Group Life Insurance (FEGLI) Premiums AGENCY: Office of Personnel Management. ACTION: Notice... [[Page 70511

Insurance Benefit Preferences of the Low-income Uninsured

PubMed Central

Danis, Marion; Biddle, Andrea K; Goold, Susan Dorr

2002-01-01

OBJECTIVE A frequently cited obstacle to universal insurance is the lack of consensus about what benefits to offer in an affordable insurance package. This study was conducted to assess the feasibility of providing uninsured patients the opportunity to define their own benefit package within cost constraints. DESIGN Structured group exercises SETTING Community setting PARTICIPANTS Uninsured individuals recruited from clinical and community settings in central North Carolina. MEASUREMENTS Insurance choices were measured using a simulation exercise, CHAT (Choosing Healthplans All Together). Participants designed managed care plans, individually and as groups, by selecting from 15 service categories having varied levels of restriction (e.g., formulary, copayments) within the constraints of a fixed monthly premium comparable to the typical per member/per month managed care premium paid by U.S. employers. MAIN RESULTS Two hundred thirty-four individuals who were predominantly male (70%), African American (55%), and socioeconomically disadvantaged (53% earned <$15,000 annually) participated in 22 groups and were able to design health benefit packages individually and in groups. All 22 groups chose to cover hospitalization, pharmacy, dental, and specialty care, and 21 groups chose primary care and mental health. Although individuals' choices differed from their groups' selections, 86% of participants were willing to abide by group choices. CONCLUSIONS Groups of low-income uninsured individuals are able to identify acceptable benefit packages that are comparable in cost but differ in benefit design from managed care contracts offered to many U.S. employees today. PMID:11841528

Modeling Dr. Dynasaur 2.0 Coverage and Finance Proposals

PubMed Central

Dick, Andrew W.; Price, Carter C.; Woods, Dulani; Freund, Deborah Anne; McNamara, Martin; Schramm, Steven P.; Berkman, Elrycc; Dehner, Tom

2017-01-01

Abstract The authors assessed an expansion of Vermont's Dr. Dynasaur program that would cover all residents age 25 and younger. The current Dr. Dynasaur program combines Vermont's Medicaid program and Child Health Insurance Program for children ages 0 through 18 to provide a seamless insurance program for those with family incomes below 317 percent of the federal poverty level. The authors used RAND's COMPARE-VT microsimulation model with Vermont-specific demographic, economic, and actuarial data to estimate the effects on health insurance coverage, costs, and premiums. They also identified the new revenues required to fund the program expansion and explored three alternative financing strategies to raise those funds: (1) an increase in the Vermont income tax, (2) a Vermont payroll tax, and (3) a Vermont business enterprise tax. The authors found that enrollment would increase by more than 260 percent under the 100-percent enrollment scenario and by nearly 200 percent under the 70-percent enrollment scenario by 2019. Not surprisingly, the children and young adults who move off employer-sponsored insurance (ESI) and into Dr. Dynasaur 2.0 have considerably lower expected health care costs than those who remain on ESI, increasing the per-person premiums by nearly $1,000 for those remaining enrolled in ESI. Annual health care expenditures per person for children and young adults in 2019 are estimated at $4,325 with Medicare prices. The combination of increased reimbursement rates, large increases in enrollment, and relatively low Dr. Dynasaur premiums (no more than $720 per year) will require significant new tax revenues to meet program obligations. PMID:29057152

78 FR 62441 - VA Dental Insurance Program-Federalism

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-22

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AO85 VA Dental Insurance Program... Veterans Affairs (VA) is taking direct final action to amend its regulations related to the VA Dental Insurance Program (VADIP), a pilot program to offer premium-based dental insurance to enrolled veterans and...

78 FR 63143 - VA Dental Insurance Program-Federalism

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-23

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AO86 VA Dental Insurance Program... Affairs (VA) proposes to amend its regulations related to the VA Dental Insurance Program (VADIP), a pilot program to offer premium-based dental insurance to enrolled veterans and certain survivors and dependents...

How the ACA's Health Insurance Expansions Have Affected Out-of-Pocket Cost-Sharing and Spending on Premiums.

PubMed

Glied, Sherry; Solís-Román, Claudia; Parikh, Shivani

2016-09-01

One important benefit gained by the millions of Americans with health insurance through the Affordable Care Act (ACA) is protection from high out-of-pocket health spending. While Medicaid unambiguously reduces out-of-pocket premium and medical costs for low-income people, it is less certain that marketplace coverage and other types of insurance purchased to comply with the law's individual mandate also protect from high health spending. Goal: To compare out-of-pocket spending in 2014 to spending in 2013; assess how this spending changed in states where many people enrolled in the marketplaces relative to states where few people enrolled; and project the decline in the percentage of people paying high amounts out-of-pocket. Methods: Linear regression models were used to estimate whether people under age 65 spent above certain thresholds. Key findings and conclusions: The probability of incurring high out-of-pocket costs and premium expenses declined as marketplace enrollment increased. The percentage reductions were greatest among those with incomes between 250 percent and 399 percent of poverty, those who were eligible for premium subsidies, and those who previously were uninsured or had very limited nongroup coverage. These effects appear largely attributable to marketplace enrollment rather than to other ACA provisions or to economic trends.

Subsidies and the demand for individual health insurance in California.

PubMed

Marquis, M Susan; Buntin, Melinda Beeuwkes; Escarce, José J; Kapur, Kanika; Yegian, Jill M

2004-10-01

To estimate the effect of changes in premiums for individual insurance on decisions to purchase individual insurance and how this price response varies among subgroups of the population. Survey responses from the Current Population Survey (http://www.bls.census.gov/cps/cpsmain.htm), the Survey of Income and Program Participation (http://www.sipp.census.gov/sipp), the National Health Interview Survey (http://www.cdc.gov/nchs/nhis.htm), and data about premiums and plans offered in the individual insurance market in California, 1996-2001. A logit model was used to estimate the decisions to purchase individual insurance by families without access to group insurance. This was modeled as a function of premiums, controlling for family characteristics and other characteristics of the market. A multinomial model was used to estimate the choice between group coverage, individual coverage, and remaining uninsured for workers offered group coverage as a function of premiums for individual insurance and out-of-pocket costs of group coverage. The elasticity of demand for individual insurance by those without access to group insurance is about -.2 to -.4, as has been found in earlier studies. However, there are substantial differences in price responses among subgroups with low-income, young, and self-employed families showing the greatest response. Among workers offered group insurance, a decrease in individual premiums has very small effects on the choice to purchase individual coverage versus group coverage. Subsidy programs may make insurance more affordable for some families, but even sizeable subsidies are unlikely to solve the problem of the uninsured. We do not find evidence that subsidies to individual insurance will produce an unraveling of the employer-based health insurance system.

48 CFR 5215.605 - Evaluation factors.

Code of Federal Regulations, 2010 CFR

2010-10-01

... appropriate premiums for measured increments of quality. When a cost/benefit approach is used, cost must carry... recent Forward Pricing Rate Agreements (FPRAs)). (iv) Cost realism evaluation generally will be performed... realism data are required, the contracting officer shall not request a formal field pricing report but...

78 FR 26727 - Pension Benefit Statements

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-08

... Consensus Estimate for the Equity Premium by Academic Financial Economists in December 2008, Social Sciences... Labor Statistics. Furthermore, the trustees of the Social Security Trust Fund assume that cost of living... either monthly or annual payments. The second method is the annuitization approach. This approach, for...

MARRIAGE AND MEN’S WEALTH ACCUMULATION IN THE UNITED STATES, 1860-1870

PubMed Central

HONG, SOK CHUL

2013-01-01

This paper explores how changes in marital status affected men’s wealth accumulation in mid-nineteenth-century America, using a longitudinal sample of Union Army veterans linked to the 1860 and 1870 census manuscript schedules. Controlling for the endogeneity of wealth and marital selection, this paper provides strong evidence that marriage had positive effects on men’s wealth accumulation, whereas ending a marriage had negative effects. The estimated wealth premium on married men is about 60 percent per marital year. This substantial wealth premium is closely related to wives’ specializing in household production, and farmers and craftsmen economically benefited from the unpaid labor of their wives. PMID:24058226

Modeling Dr. Dynasaur 2.0 Coverage and Finance Proposals: Effects of the Expansion of Vermont's Dr. Dynasaur Program to All Individuals Through Age 25.

PubMed

Dick, Andrew W; Price, Carter C; Woods, Dulani; Freund, Deborah Anne; McNamara, Martin; Schramm, Steven P; Berkman, Elrycc; Dehner, Tom

2017-01-01

The authors assessed an expansion of Vermont's Dr. Dynasaur program that would cover all residents age 25 and younger. The current Dr. Dynasaur program combines Vermont's Medicaid program and Child Health Insurance Program for children ages 0 through 18 to provide a seamless insurance program for those with family incomes below 317 percent of the federal poverty level. The authors used RAND's COMPARE-VT microsimulation model with Vermont-specific demographic, economic, and actuarial data to estimate the effects on health insurance coverage, costs, and premiums. They also identified the new revenues required to fund the program expansion and explored three alternative financing strategies to raise those funds: (1) an increase in the Vermont income tax, (2) a Vermont payroll tax, and (3) a Vermont business enterprise tax. The authors found that enrollment would increase by more than 260 percent under the 100-percent enrollment scenario and by nearly 200 percent under the 70-percent enrollment scenario by 2019. Not surprisingly, the children and young adults who move off employer-sponsored insurance (ESI) and into Dr. Dynasaur 2.0 have considerably lower expected health care costs than those who remain on ESI, increasing the per-person premiums by nearly $1,000 for those remaining enrolled in ESI. Annual health care expenditures per person for children and young adults in 2019 are estimated at $4,325 with Medicare prices. The combination of increased reimbursement rates, large increases in enrollment, and relatively low Dr. Dynasaur premiums (no more than $720 per year) will require significant new tax revenues to meet program obligations.

Perceived affordability of health insurance and medical financial burdens five years in to Massachusetts health reform.

PubMed

Zallman, Leah; Nardin, Rachel; Sayah, Assaad; McCormick, Danny

2015-10-29

Under the Massachusetts health reform, low income residents (those with incomes below 150 % of the Federal Poverty Level [FPL]) were eligible for Medicaid and health insurance exchange-based plans with minimal cost-sharing and no premiums. Those with slightly higher incomes (150 %-300 % FPL) were eligible for exchange-based plans that required cost-sharing and premium payments. We conducted face to face surveys in four languages with a convenience sample of 976 patients seeking care at three hospital emergency departments five years after Massachusetts reform. We compared perceived affordability of insurance, financial burden, and satisfaction among low cost sharing plan recipients (recipients of Medicaid and insurance exchange-based plans with minimal cost-sharing and no premiums), high cost sharing plan recipients (recipients of exchange-based plans that required cost-sharing and premium payments) and the commercially insured. We found that despite having higher incomes, higher cost-sharing plan recipients were less satisfied with their insurance plans and perceived more difficulty affording their insurance than those with low cost-sharing plans. Higher cost-sharing plan recipients also reported more difficulty affording medical and non-medical health care as well as insurance premiums than those with commercial insurance. In contrast, patients with low cost-sharing public plans reported higher plan satisfaction and less financial concern than the commercially insured. Policy makers with responsibility for the benefit design of public insurance available under health care reforms in the U.S. should calibrate cost-sharing to income level so as to minimize difficulty affording care and financial burdens.

48 CFR 1602.170-14 - FEHB-specific medical loss ratio threshold calculation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... issuer's expenditures for activities that improve health care quality, to total premium revenue determined by OPM, as defined by the Department of Health and Human Services. (b) The FEHB-specific MLR will... OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL...

42 CFR 422.1 - Basis and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... enrollment. 1852—Benefits and beneficiary protections. 1853—Payments to Medicare Advantage (MA) organizations. 1854—Premiums. 1855—Organization, licensure, and solvency of MA organizations. 1856—Standards. 1857—Contract requirements. 1858—Special rules for MA Regional Plans. 1859—Definitions; enrollment restriction...

5 CFR 550.186 - Relationship to other payments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Section 550.186 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.186 Relationship to other payments... retirement benefits; and (8) For any other purposes explicitly provided for by law or as the Office of...

5 CFR 550.186 - Relationship to other payments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Section 550.186 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.186 Relationship to other payments... retirement benefits; and (8) For any other purposes explicitly provided for by law or as the Office of...

5 CFR 550.186 - Relationship to other payments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Section 550.186 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.186 Relationship to other payments... retirement benefits; and (8) For any other purposes explicitly provided for by law or as the Office of...

5 CFR 550.186 - Relationship to other payments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Section 550.186 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.186 Relationship to other payments... retirement benefits; and (8) For any other purposes explicitly provided for by law or as the Office of...

5 CFR 550.186 - Relationship to other payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Section 550.186 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.186 Relationship to other payments... retirement benefits; and (8) For any other purposes explicitly provided for by law or as the Office of...

Working with an Insurance Market in Turmoil.

ERIC Educational Resources Information Center

Boggs, Ronald R.

1985-01-01

Outlines specific ways for schools to react to insurance premium increases and new coverage restrictions. Suggests such options as buying less insurance, considering larger retentions,and starting pooling programs, and discusses other non-traditional approaches to conventional insurance programs. (MD)

Costs, commitment and locality: a comparison of for-profit and not-for-profit health plans.

PubMed

2004-01-01

Following on the heels of the first national study demonstrating differences in the community benefits provided by not-for-profit and for-profit health maintenance organizations (HMOs) (Schlesinger, Mitchell, and Gray 2003), this study of the New York state market shows significant differences in premiums, administrative overhead and commitment to safety net coverage between nonprofit and for-profit health plans. This study shows that for-profit health plans do act differently than not-for-profit plans in terms of performance, efficiency, and contribution to safety net programs. Moreover, it suggests that not-for-profit health insurers operating in a predominantly for-profit market act in many ways like for-profits. The New York state insurance market provides an ideal study environment because one can compare a large number of policyholders and plans in both business models (for-profit and not-for-profit) that share an identical legislative and regulatory environment. New York has large populations being provided coverage under both models and no allowances had to be made for state-to-state political and/or legal differences. Specifically, this study shows that: The downstate insurance market is predominantly for-profit, while the upstate market is almost entirely not-for-profit. The recent conversion of Empire Blue Cross Blue Shield to a for-profit model moves the downstate market further into the for-profit column, while the upstate region remains not-for-profit. Insurers in the upstate not-for-profit market are more administratively efficient than insurers in the downstate region. Compared to the downstate region, insurers in upstate New York spent 1.5% less of their operating revenues on administrative expenses. The additional 1.5% of spending on administrative expenses downstate totals dollars 137,000,000. Upstate insurers spend significantly more of the revenues received on payments for medical care. Downstate insurers spent 80.4% of operating revenues on medical care. Upstate insurers spent 87.7% of operating revenue on medical care. If health care spending patterns downstate were similar to upstate, the additional 7.3% allocated to medical care would total dollars 678,000,000. A lower level of investment in medical care in the downstate region translated into higher underwriting gains, which totaled 8.1% of operating revenue. Plans in the upstate region reported underwriting gains of only 2.3%. Not-for-profit insurers offer more cost effective (i.e., lower) premium options for consumers. In 2002, the upstate market had the lowest operating revenues (premiums) statewide, averaging dollars 184 per member per month (pmpm); the not-for-profit plans downstate averaged dollars 203 pmpm. Premiums in the for-profit segment of the downstate market averaged dollars 221 pmpm in 2002. The not-for-profit upstate market has proved its viability, while maintaining commitments to New York safety net and Medicare programs. The not-for-profit upstate market experienced a dollars 12 million loss in New York safety net programs in 2002, but generated dollars 131 million in underwriting gains for all product lines combined. Furthermore, upstate revenue gains in 2002 exceeded 2001 results by dollars 45 million. Not-for-profit HMOs, both upstate and downstate, participate in state-sponsored safety net programs to a far greater degree than the downstate for-profit managed care organizations. Within the plan group selected for this study, the not-for-profit plans supported 88% of the enrollment in New York state-sponsored programs, compared with for-profit plans' support of only 12% of safety net membership. Not-for-profit plans have also demonstrated a higher level of dedication to the Medicare Plus Choice product line than for-profit insurers downstate. In 2002, not-for-profit plans enrolled 73% of this population of 385,000 elderly statewide. Despite the favorable financial returns in the product line, for-profit insurers downstate enrolled only 105,000 Medicare risk members in 2002, or 27% of the statewide total. The emergence in New York of health care insurance markets that are predominantly for-profit raises significant public policy issues, especially with reference to community benefits and services. Should the upstate health insurance environment change with the entrance of for-profit plans or conversion of existing plans to for-profit status, the upstate market is likely to look very similar to the downstate in that there will be diminished access to care for the at-risk population; premium costs will be higher and administrative costs will be higher. The health care insurance market upstate would become less attentive to the provision of public goods as insurers strive to maximize their economic advantages.

32 CFR 199.22 - TRICARE Retiree Dental Program (TRDP).

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 2 2013-07-01 2013-07-01 false TRICARE Retiree Dental Program (TRDP). 199.22... TRICARE Retiree Dental Program (TRDP). (a) Purpose. The TRDP is a premium based indemnity dental insurance... and capabilities of the Uniformed Services overseas dental treatment facilities and a particular...

32 CFR 199.22 - TRICARE Retiree Dental Program (TRDP).

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 2 2012-07-01 2012-07-01 false TRICARE Retiree Dental Program (TRDP). 199.22... TRICARE Retiree Dental Program (TRDP). (a) Purpose. The TRDP is a premium based indemnity dental insurance... and capabilities of the Uniformed Services overseas dental treatment facilities and a particular...

32 CFR 199.22 - TRICARE Retiree Dental Program (TRDP).

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 2 2014-07-01 2014-07-01 false TRICARE Retiree Dental Program (TRDP). 199.22... TRICARE Retiree Dental Program (TRDP). (a) Purpose. The TRDP is a premium based indemnity dental insurance... and capabilities of the Uniformed Services overseas dental treatment facilities and a particular...

32 CFR 199.22 - TRICARE Retiree Dental Program (TRDP).

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 2 2011-07-01 2011-07-01 false TRICARE Retiree Dental Program (TRDP). 199.22... TRICARE Retiree Dental Program (TRDP). (a) Purpose. The TRDP is a premium based indemnity dental insurance... and capabilities of the Uniformed Services overseas dental treatment facilities and a particular...

32 CFR 199.22 - TRICARE Retiree Dental Program (TRDP).

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 2 2010-07-01 2010-07-01 false TRICARE Retiree Dental Program (TRDP). 199.22... TRICARE Retiree Dental Program (TRDP). (a) Purpose. The TRDP is a premium based indemnity dental insurance... and capabilities of the Uniformed Services overseas dental treatment facilities and a particular...

Determinants of consumer intention to purchase animal-friendly milk.

PubMed

de Graaf, Sophie; Van Loo, Ellen J; Bijttebier, Jo; Vanhonacker, Filiep; Lauwers, Ludwig; Tuyttens, Frank A M; Verbeke, Wim

2016-10-01

Concern about the welfare of production animals is growing among various stakeholders, including the general public. Citizens can influence the market for premium welfare products by expressing public concerns, and consumers-the actors who actually purchase products-can do so through their purchasing behavior. However, current market shares for premium welfare products are small in Europe. To better align purchase behavior with public and individuals' concerns, insight is needed into determinants that influence the intention to purchase premium welfare products. A cross-sectional online survey of 787 Flemish milk consumers was conducted to investigate attitudes toward and intention to purchase animal-friendly milk. More than half of the sample (52.5%) expressed the intention to purchase animal-friendly milk. Linear regression modeling indicated that intention was positively influenced by (1) higher perceived product benefits from animal-friendly milk (milk with more health benefits and higher quality); (2) higher personal importance of extrinsic product attributes such as local production and country of origin; (3) higher personal importance of animal welfare; (4) a more natural living oriented attitude toward cows; and (5) a more positive general attitude toward milk. Intention was negatively influenced by (1) a stronger business-oriented attitude toward cows; and (2) by a higher personal importance attached to price. These insights in key components of purchase intention can assist producers, the dairy industry, and retailers to position and market animal-friendly milk. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Evaluation of the new rural cooperative medical system in China: is it working or not?

PubMed Central

Dib, Hassan H; Pan, Xilong; Zhang, Hong

2008-01-01

Background To prove the possibility of implementing the New Rural Cooperative Medical System (NRCMS) at different levels with a premium funding according to their economic level in developed and less developed areas in Guangdong province, and study the insurable inpatients in different types of regions, taking into account limitations of indemnities and loss ratios. Method All data samples were randomly collected from the NRCMS Department, Guangdong Province. Gross domestic product (GDP) at 10000 Yuan per capita was employed to divide Guangdong into two economic levels: (1) economically developed & (2) less economically developed regions. A descriptive analysis about tendency of raising premium and reimbursement ratios of common fund was performed with independent samples and t-test as well as implementing a model to evaluate the differences in premium contribution differences in co-payments, thresholds, and rebates. Also, a qualitative study measured several economic factors to evaluate farmers' financial and social potency in contributing to the NRCMS. Result A higher GDP per capita were found within economically developed regions (p < 0.05) than in less developed areas, with higher tendency for funding capacity and average funding capability in villages and towns within economically developed regions (p < 0.05) than in economically less developed. Maximum benefits between two regions in medical insurance coverage showed significant difference (p < 0.05); differences between basic medical insurance coverage between two regions was insignificant (p > 0.05); nevertheless, economically developed regions showed higher threshold and rebates with less co-payments in the economically developed than less developed. Conclusion Despite some loop holes in the NRCMS, the system is workable, but needs more strengthening by encouraging farmers' participation into NRCMS with a necessity to implement a new reimbursement payment system by health care providers. In addition it is proposed that for maximum benefits another premium funding should be secured. PMID:18590574