44 CFR 78.3 - Responsibilities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION... each State through the annual Cooperative Agreements; (2) Approve Flood Mitigation Plans in accordance... Planning and Projects Grants; (2) Prepare and submit the Flood Mitigation Plan; (3) Implement all approved...

44 CFR 78.3 - Responsibilities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION... each State through the annual Cooperative Agreements; (2) Approve Flood Mitigation Plans in accordance... Planning and Projects Grants; (2) Prepare and submit the Flood Mitigation Plan; (3) Implement all approved...

44 CFR 78.3 - Responsibilities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION... each State through the annual Cooperative Agreements; (2) Approve Flood Mitigation Plans in accordance... Planning and Projects Grants; (2) Prepare and submit the Flood Mitigation Plan; (3) Implement all approved...

Medicaid and Children's Health Insurance Programs; Mental Health Parity and Addiction Equity Act of 2008; the Application of Mental Health Parity Requirements to Coverage Offered by Medicaid Managed Care Organizations, the Children's Health Insurance Program (CHIP), and Alternative Benefit Plans. Final rule.

PubMed

2016-03-30

This final rule will address the application of certain requirements set forth in the Public Health Service Act, as amended by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, to coverage offered by Medicaid managed care organizations, Medicaid Alternative Benefit Plans, and Children’s Health Insurance Programs.

44 CFR 78.9 - Planning grant approval process.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78.9 Planning grant approval process. The State POC will evaluate and approve applications for Planning Grants. Funds will be provided only for the flood portion of any mitigation plan, and...

44 CFR 78.9 - Planning grant approval process.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78.9 Planning grant approval process. The State POC will evaluate and approve applications for Planning Grants. Funds will be provided only for the flood portion of any mitigation plan, and...

44 CFR 78.9 - Planning grant approval process.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78.9 Planning grant approval process. The State POC will evaluate and approve applications for Planning Grants. Funds will be provided only for the flood portion of any mitigation plan, and...

44 CFR 78.9 - Planning grant approval process.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78.9 Planning grant approval process. The State POC will evaluate and approve applications for Planning Grants. Funds will be provided only for the flood portion of any mitigation plan, and...

44 CFR 78.9 - Planning grant approval process.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78.9 Planning grant approval process. The State POC will evaluate and approve applications for Planning Grants. Funds will be provided only for the flood portion of any mitigation plan, and...

Trends in Health Insurance Coverage of Title X Family Planning Program Clients, 2005-2015.

PubMed

Decker, Emily J; Ahrens, Katherine A; Fowler, Christina I; Carter, Marion; Gavin, Loretta; Moskosky, Susan

2018-05-01

The federal Title X Family Planning Program supports the delivery of family planning services and related preventive care to 4 million individuals annually in the United States. The implementation of the 2010 Affordable Care Act's (ACA's) Medicaid expansion and provisions expanding access to health insurance, which took effect in January 2014, resulted in higher rates of health insurance coverage in the U.S. population; the ACA's impact on individuals served by the Title X program has not yet been evaluated. Using administrative data we examined changes in health insurance coverage among Title X clinic patients during 2005-2015. We found that the percentage of clients without health insurance decreased from 60% in 2005 to 48% in 2015, with the greatest annual decrease occurring between 2013 and 2014 (63% to 54%). Meanwhile, between 2005 and 2015, the percentage of clients with Medicaid or other public health insurance increased from 20% to 35% and the percentage of clients with private health insurance increased from 8% to 15%. Although clients attending Title X clinics remained uninsured at substantially higher rates compared with the national average, the increase in clients with health insurance coverage aligns with the implementation of ACA-related provisions to expand access to affordable health insurance.

44 CFR 78.3 - Responsibilities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78... State through the annual Cooperative Agreements; (2) Approve Flood Mitigation Plans in accordance with... Planning and Projects Grants; (2) Prepare and submit the Flood Mitigation Plan; (3) Implement all approved...

26 CFR 54.9801-4 - Rules relating to creditable coverage.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Health Benefits Program). (ix) A public health plan. For purposes of this section, a public health plan... individuals who are enrolled in the plan. (x) A health benefit plan under section 5(e) of the Peace Corps Act... plan provides benefits through an insurance policy that, as required by applicable State insurance laws...

78 FR 78802 - Medicare Program; Right of Appeal for Medicare Secondary Payer Determination Relating to...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-27

...This proposed rule would implement provisions of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act) which require us to provide a right of appeal and an appeal process for liability insurance (including self-insurance), no-fault insurance, and workers' compensation laws or plans when Medicare pursues a Medicare Secondary Payer (MSP) recovery claim directly from the liability insurance (including self-insurance), no fault insurance, or workers' compensation law or plan.

How to Shop for Health Insurance

MedlinePlus

... by or be eligible for free or low-cost coverage through a public program. If you need to get insurance for ... plans cover 90% or more of health care costs. All catastrophic, bronze, ... and other services. Specific benefits differ from plan to plan, though, so you' ...

42 CFR 457.70 - Program options.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies § 457.70 Program options. (a) Health... 42 Public Health 4 2010-10-01 2010-10-01 false Program options. 457.70 Section 457.70 Public...

42 CFR 457.40 - State program administration.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies § 457.40 State program... 42 Public Health 4 2010-10-01 2010-10-01 false State program administration. 457.40 Section 457.40...

42 CFR 457.1 - Program description.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies § 457.1 Program description. Title XXI... 42 Public Health 4 2010-10-01 2010-10-01 false Program description. 457.1 Section 457.1 Public...

44 CFR 78.6 - Flood Mitigation Plan approval process.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Flood Mitigation Plan..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78.6 Flood Mitigation Plan approval process. The State POC will forward all Flood...

44 CFR 78.11 - Minimum project eligibility criteria.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD... activity in an approved Flood Mitigation Plan does not mean it meets FMA eligibility criteria. Projects... with the Flood Mitigation Plan; the type of project being proposed must be identified in the plan. (f...

44 CFR 78.11 - Minimum project eligibility criteria.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD... activity in an approved Flood Mitigation Plan does not mean it meets FMA eligibility criteria. Projects... with the Flood Mitigation Plan; the type of project being proposed must be identified in the plan. (f...

44 CFR 78.6 - Flood Mitigation Plan approval process.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Flood Mitigation Plan..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78.6 Flood Mitigation Plan approval process. The State POC will forward all Flood...

44 CFR 78.11 - Minimum project eligibility criteria.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD... activity in an approved Flood Mitigation Plan does not mean it meets FMA eligibility criteria. Projects... with the Flood Mitigation Plan; the type of project being proposed must be identified in the plan. (f...

44 CFR 78.6 - Flood Mitigation Plan approval process.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Flood Mitigation Plan..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78.6 Flood Mitigation Plan approval process. The State POC will forward all Flood...

44 CFR 78.11 - Minimum project eligibility criteria.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD... activity in an approved Flood Mitigation Plan does not mean it meets FMA eligibility criteria. Projects... with the Flood Mitigation Plan; the type of project being proposed must be identified in the plan. (f...

29 CFR 4047.5 - Repayment of PBGC payments of guaranteed benefits.

Code of Federal Regulations, 2010 CFR

2010-07-01

... from its single-employer insurance fund (the fund established pursuant to ERISA section 4005(a)) to pay... owed to the plan, the liquidity of plan assets, the interests of the single-employer insurance program...

42 CFR 409.43 - Plan of care requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Plan of care requirements. 409.43 Section 409.43 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Home Health Services Under Hospital Insurance § 409.43 Plan of care...

44 CFR 79.6 - Eligibility.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION GRANTS § 79.6... develop or update the flood portion of any mitigation plan. Planning grants are not eligible for funding... requirement. (1) States must have an approved State Mitigation Plan meeting the requirements of §§ 201.4 or...

44 CFR 79.6 - Eligibility.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION GRANTS § 79.6... develop or update the flood portion of any mitigation plan. Planning grants are not eligible for funding... requirement. (1) States must have an approved State Mitigation Plan meeting the requirements of §§ 201.4 or...

44 CFR 78.6 - Flood Mitigation Plan approval process.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Flood Mitigation Plan approval..., DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78.6 Flood Mitigation Plan approval process. The State POC will forward all Flood...

44 CFR 79.6 - Eligibility.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION GRANTS § 79.6... develop or update the flood portion of any mitigation plan. Planning grants are not eligible for funding... requirement. (1) States must have an approved State Mitigation Plan meeting the requirements of §§ 201.4 or...

44 CFR 79.6 - Eligibility.

Code of Federal Regulations, 2012 CFR

2012-10-01

... INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION GRANTS § 79.6 Eligibility... develop or update the flood portion of any mitigation plan. Planning grants are not eligible for funding... requirement. (1) States must have an approved State Mitigation Plan meeting the requirements of §§ 201.4 or...

42 CFR 457.120 - Public involvement in program development.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies § 457.120 Public... 42 Public Health 4 2010-10-01 2010-10-01 false Public involvement in program development. 457.120...

Taking the hassle out of wellness: Do peers and health matter?

PubMed

Danagoulian, Shooshan

2018-03-01

Despite substantial financial incentives provided by the Affordable Care Act and employers, employee enrollment in wellness programs is low. This paper studies enrollment in a wellness program offered along an employer-provided health insurance plan. Two factors are considered in the choice of health plan with wellness: the effect of peer choices and family health on plan choice. Using exclusively obtained data of health insurance plan choice and utilization, this paper compares similar plans and focuses on a subsample of new employees. Result show that peers affect own choice of health insurance: a 10 percentage point rise in the share of colleagues enrolled in Aetna Wellness increases the probability of own enrollment in the plan by up to 3.9 percentage points. This result suggests that lack of experience with a wellness program are key to employee reluctance to enroll. Health effect on probability of enrollment in Aetna Wellness ranges from a 3 percentage point decline to a 3 percentage point rise depending on the measure, suggesting that while wellness programs appeal to low- to medium-intensity users of medical services, they do not appeal to individuals with more severe medical conditions which might benefit most from better coordinated medical care.

78 FR 17900 - Shared Responsibility Payment for Not Maintaining Minimum Essential Coverage; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-25

... program under title XIX of the Social Security Act, (3) the Children's Health Insurance Program (CHIP... program under title XIX of the Social Security Act; (3) the Children's Health Insurance Program (CHIP... qualified health plans in which the taxpayers or a member of the taxpayers family (coverage family) is...

44 CFR Appendix B to Part 62 - National Flood Insurance Program

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false National Flood Insurance Program B Appendix B to Part 62 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... Plan to Maintain Financial Control for Business Written Under the Write Your Own Program. (a) In...

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.

42 CFR 457.110 - Enrollment assistance and information requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies... 42 Public Health 4 2010-10-01 2010-10-01 false Enrollment assistance and information requirements...

Marketing Services: Insurance. Marketing and Distributive Education Curriculum Guide.

ERIC Educational Resources Information Center

Luft, Roger L.; And Others

This guide is designed to provide the curriculum coordinator with a basis for planning a comprehensive program in the field of marketing as well as to provide marketing and distributive education teacher/coordinators with maximum flexibility in planning an insurance marketing curriculum. The guide was constructed by identifying the competencies…

42 CFR 457.170 - Withdrawal process.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies § 457.170 Withdrawal process. (a... 42 Public Health 4 2010-10-01 2010-10-01 false Withdrawal process. 457.170 Section 457.170 Public...

42 CFR 457.90 - Outreach.

Code of Federal Regulations, 2010 CFR

2010-10-01

... CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies § 457.90 Outreach. (a) Procedures required. A... 42 Public Health 4 2010-10-01 2010-10-01 false Outreach. 457.90 Section 457.90 Public Health...

22 CFR 146.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Health and insurance benefits and services. 146... the Basis of Sex in Education Programs or Activities Prohibited § 146.440 Health and insurance... insurance benefit, service, policy, or plan to any of its students, a recipient shall not discriminate on...

22 CFR 229.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Health and insurance benefits and services. 229... on the Basis of Sex in Education Programs or Activities Prohibited § 229.440 Health and insurance... insurance benefit, service, policy, or plan to any of its students, a recipient shall not discriminate on...

6 CFR 17.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Health and insurance benefits and services. 17... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 17.440 Health and insurance... insurance benefit, service, policy, or plan to any of its students, a recipient shall not discriminate on...

31 CFR 28.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Health and insurance benefits and... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 28.440 Health and insurance... insurance benefit, service, policy, or plan to any of its students, a recipient shall not discriminate on...

43 CFR 41.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Health and insurance benefits and services... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 41.440 Health and insurance... insurance benefit, service, policy, or plan to any of its students, a recipient shall not discriminate on...

14 CFR 1253.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Health and insurance benefits and services... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 1253.440 Health and insurance... insurance benefit, service, policy, or plan to any of its students, a recipient shall not discriminate on...

28 CFR 54.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Health and insurance benefits and... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 54.440 Health and insurance... insurance benefit, service, policy, or plan to any of its students, a recipient shall not discriminate on...

Five features of value-based insurance design plans were associated with higher rates of medication adherence.

PubMed

Choudhry, Niteesh K; Fischer, Michael A; Smith, Benjamin F; Brill, Gregory; Girdish, Charmaine; Matlin, Olga S; Brennan, Troyen A; Avorn, Jerry; Shrank, William H

2014-03-01

Value-based insurance design (VBID) plans selectively lower cost sharing to increase medication adherence. Existing plans have been structured in a variety of ways, and these variations could influence the effectiveness of VBID plans. We evaluated seventy-six plans introduced by a large pharmacy benefit manager during 2007-10. We found that after we adjusted for the other features and baseline trends, VBID plans that were more generous, targeted high-risk patients, offered wellness programs, did not offer disease management programs, and made the benefit available only for medication ordered by mail had a significantly greater impact on adherence than plans without these features. The effects were as large as 4-5 percentage points. These findings can provide guidance for the structure of future VBID plans.

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.

A distributional assessment of Rhode Island's Catastrophic Health Insurance Plan (CHIP)

PubMed Central

Lord, Blair M.

1984-01-01

Since 1975, Rhode Island has operated a government-sponsored catastrophic health insurance program that is consistent in spirit with several of the national health insurance proposals. An important but often overlooked effect of such a program is its effect on the distribution of income. Actual claims data for the years 1975-79 are available for the Rhode Island program permitting direct estimation of an average benefit per family and an average tax burden per family in each of 12 income classes. This permits an assessment of the program's redistributional effects. PMID:10310850

Health insurance exchanges of past and present offer examples of features that could attract small-business customers.

PubMed

Gardiner, Terry

2012-02-01

The Affordable Care Act calls on states to create health insurance exchanges serving small businesses by 2014. These exchanges will allow small-business owners to pool their buying power, have more choices of health plans, and buy affordable health insurance. However, creating an exchange that appeals to small-business owners poses several challenges. Past and current exchanges provide valuable insights into the role exchanges can play, services they can offer, and design features that can make them successful. For example, states should allow insurance brokers to provide employers with advice and analysis regarding plans offered in the exchanges. Exchanges should also provide services to ease enrollment, such as a single application for all of the plans they offer, and make additional benefits, such as wellness programs, available on a stand-alone basis or within insurance plans.

42 CFR 457.130 - Civil rights assurance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies § 457.130 Civil rights assurance... 42 Public Health 4 2010-10-01 2010-10-01 false Civil rights assurance. 457.130 Section 457.130...

A modeling framework for optimal long-term care insurance purchase decisions in retirement planning.

PubMed

Gupta, Aparna; Li, Lepeng

2004-05-01

The level of need and costs of obtaining long-term care (LTC) during retired life require that planning for it is an integral part of retirement planning. In this paper, we divide retirement planning into two phases, pre-retirement and post-retirement. On the basis of four interrelated models for health evolution, wealth evolution, LTC insurance premium and coverage, and LTC cost structure, a framework for optimal LTC insurance purchase decisions in the pre-retirement phase is developed. Optimal decisions are obtained by developing a trade-off between post-retirement LTC costs and LTC insurance premiums and coverage. Two-way branching models are used to model stochastic health events and asset returns. The resulting optimization problem is formulated as a dynamic programming problem. We compare the optimal decision under two insurance purchase scenarios: one assumes that insurance is purchased for good and other assumes it may be purchased, relinquished and re-purchased. Sensitivity analysis is performed for the retirement age.

Fixing flaws in Medicare drug coverage that prompt insurers to avoid low-income patients.

PubMed

Hsu, John; Fung, Vicki; Huang, Jie; Price, Mary; Brand, Richard; Hui, Rita; Fireman, Bruce; Dow, William H; Bertko, John; Newhouse, Joseph P

2010-12-01

Since 2006 numerous insurers have stopped serving the low-income segment of the Medicare Part D program, forcing millions of beneficiaries to change prescription drug plans. Using data from participating plans, we found that Medicare payments do not sufficiently reimburse insurers for the relatively high medication use among this population, creating perverse incentives for plans to avoid this part of the Part D market. Plans can accomplish this by increasing their premiums for all beneficiaries to an amount above regional benchmarks. We demonstrate that improving the accuracy of Medicare's risk and subsidy adjustments could mitigate these perverse incentives.

77 FR 70619 - Incentives for Nondiscriminatory Wellness Programs in Group Health Plans

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-26

...-2713T, 29 CFR 2590.715-2713, and 45 CFR 147.130 require non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage to provide... paragraph (f) of the 2006 regulations and would apply to both grandfathered and non- grandfathered group...

42 CFR 406.24 - Special enrollment period related to coverage under group health plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE ELIGIBILITY AND ENTITLEMENT Premium Hospital Insurance § 406.24 Special enrollment period related to coverage under group health plans... 42 Public Health 2 2010-10-01 2010-10-01 false Special enrollment period related to coverage under...

7 CFR Exhibit L to Subpart A of... - Insured 10-Year Home Warranty Plan Requirements

Code of Federal Regulations, 2010 CFR

2010-01-01

..., construction inspection procedures, coverage provided and claims procedures. (5) A sample copy of the warranty... AGENCY, DEPARTMENT OF AGRICULTURE PROGRAM REGULATIONS CONSTRUCTION AND REPAIR Planning and Performing Construction and Other Development Pt. 1924, Subpt. A, Exh. L Exhibit L to Subpart A of Part 1924—Insured 10...

The relationship between employer health insurance characteristics and the provision of employee assistance programs.

PubMed

Zarkin, G A; Garfinkel, S A

1994-01-01

Workplace drug and alcohol abuse imposes substantial costs on employers. In response, employers have implemented a variety of programs to decrease substance abuse in the workplace, including drug testing, health and wellness programs, and employee assistance programs (EAPs). This paper focuses on the relationship between enterprises' organizational and health insurance characteristics and the firms' decisions to provide EAPs. Using data from the 1989 Survey of Health Insurance Plans (SHIP), sponsored by the Health Care Financing Administration (HCFA), we estimated the prevalence of EAPs by selected organizational and health insurance characteristics for those firms that offer health insurance to their workers. In addition, we estimated logistic models of the enterprises' decisions to provide EAPs as functions of the extent of state substance abuse and mental health insurance mandates, state-level demographic variables, and organizational and health insurance characteristics. Our results suggest that state mandates and demographic variables, as well as organizational and health insurance characteristics, are important explanatory variables of enterprises' decisions to provide EAPs.

Patient Protection and Affordable Care Act; establishment of the multi-state plan program for the Affordable Insurance Exchanges.

PubMed

2013-03-11

The U.S. Office of Personnel Management (OPM) is issuing a final regulation establishing the Multi-State Plan Program (MSPP) pursuant to the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. Through contracts with OPM, health insurance issuers will offer at least two multi-State plans (MSPs) on each of the Affordable Insurance Exchanges (Exchanges). One of the issuers must be non-profit. Under the law, an MSPP issuer may phase in the States in which it offers coverage over 4 years, but it must offer MSPs on Exchanges in all States and the District of Columbia by the fourth year in which the MSPP issuer participates in the MSPP. This rule aims to balance adhering to the statutory goals of MSPP while aligning its standards to those applying to qualified health plans to promote a level playing field across health plans.

Hospital and Health Plan Partnerships: The Affordable Care Act's Impact on Promoting Health and Wellness.

PubMed

Vu, Michelle; White, Annesha; Kelley, Virginia P; Hopper, Jennifer Kuca; Liu, Cathy

2016-07-01

The Affordable Care Act (ACA) healthcare reforms, centered on achieving the Centers for Medicare & Medicaid Services (CMS) Triple Aim goals of improving patient care quality and satisfaction, improving population health, and reducing costs, have led to increasing partnerships between hospitals and insurance companies and the implementation of employee wellness programs. Hospitals and insurance companies have opted to partner to distribute the risk and resources and increase coordination of care. To examine the ACA's impact on the health and wellness programs that have resulted from the joint ventures of hospitals and health plans based on the published literature. We conducted a review of the literature to identify successful mergers and best practices of health and wellness programs. Articles published between January 2007 and January 2015 were compiled from various search engines, using the search terms "corporate," "health and wellness program," "health plan," "insurance plan," "hospital," "joint venture," and "vertical merger." Publications that described consolidations or wellness programs not tied to health insurance plans were excluded. Noteworthy characteristics of these programs were summarized and tabulated. A total of 44 eligible articles were included in the analysis. The findings showed that despite rising healthcare costs, joint ventures prevent hospitals from trading-off quality and services for cost reductions. Administrators believed that partnering would allow the companies to meet ACA standards for improving clinical outcomes at reduced costs. Before the implementation of the ACA, some employers had wellness programs, but these were not standardized and did not need to produce measurable results. The ACA encouraged improvement of employee wellness programs by providing funding for expanded health services and by mandating quality care. Successful workplace health and wellness programs have varying components, but all include monetary incentives and documented outcomes. The concurrent growth of hospital health plans (especially those emerging from vertical mergers and partnerships) and wellness programs in the United States provides a unique opportunity for employees and patient populations to promote wellness and achieve the Triple Aim goals as initiated by CMS.

Hospital and Health Plan Partnerships: The Affordable Care Act's Impact on Promoting Health and Wellness

PubMed Central

Vu, Michelle; White, Annesha; Kelley, Virginia P.; Hopper, Jennifer Kuca; Liu, Cathy

2016-01-01

Background The Affordable Care Act (ACA) healthcare reforms, centered on achieving the Centers for Medicare & Medicaid Services (CMS) Triple Aim goals of improving patient care quality and satisfaction, improving population health, and reducing costs, have led to increasing partnerships between hospitals and insurance companies and the implementation of employee wellness programs. Hospitals and insurance companies have opted to partner to distribute the risk and resources and increase coordination of care. Objective To examine the ACA's impact on the health and wellness programs that have resulted from the joint ventures of hospitals and health plans based on the published literature. Method We conducted a review of the literature to identify successful mergers and best practices of health and wellness programs. Articles published between January 2007 and January 2015 were compiled from various search engines, using the search terms “corporate,” “health and wellness program,” “health plan,” “insurance plan,” “hospital,” “joint venture,” and “vertical merger.” Publications that described consolidations or wellness programs not tied to health insurance plans were excluded. Noteworthy characteristics of these programs were summarized and tabulated. Results A total of 44 eligible articles were included in the analysis. The findings showed that despite rising healthcare costs, joint ventures prevent hospitals from trading-off quality and services for cost reductions. Administrators believed that partnering would allow the companies to meet ACA standards for improving clinical outcomes at reduced costs. Before the implementation of the ACA, some employers had wellness programs, but these were not standardized and did not need to produce measurable results. The ACA encouraged improvement of employee wellness programs by providing funding for expanded health services and by mandating quality care. Successful workplace health and wellness programs have varying components, but all include monetary incentives and documented outcomes. Conclusion The concurrent growth of hospital health plans (especially those emerging from vertical mergers and partnerships) and wellness programs in the United States provides a unique opportunity for employees and patient populations to promote wellness and achieve the Triple Aim goals as initiated by CMS. PMID:27625744

42 CFR 457.135 - Assurance of compliance with other provisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies § 457.135... 42 Public Health 4 2010-10-01 2010-10-01 false Assurance of compliance with other provisions. 457...

49 CFR 25.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 25.440 Health and insurance benefits and..., service, policy, or plan to any of its students, a recipient shall not discriminate on the basis of sex...

The Administrator's Role in Insuring Quality in Off-Campus Programs.

ERIC Educational Resources Information Center

Massey, T. Benjamin

The administrator's role in insuring off-campus program quality is considered. An essential difference between administrators and leaders is noted: administrators are status quo oriented, crisis oriented, reactive, and less flexible; leaders are change oriented, planning oriented, proactive, and less flexible. When such factors as new technology…

42 CFR 457.10 - Definitions and use of terms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies § 457.10 Definitions and use of... to be an Indian for any purpose. Applicant means a child who has filed an application (or who has an...

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

44 CFR Appendix B to Part 62 - National Flood Insurance Program

Code of Federal Regulations, 2014 CFR

2014-10-01

... quality control departments, or both, and independent Certified Public Accountant (CPA) firms. This Plan... individual State Insurance Departments, NAIC Zone examinations, and independent CPA firms. (c) Standards... company must— (A) Have a biennial audit of the flood insurance financial statements conducted by a CPA...

44 CFR Appendix B to Part 62 - National Flood Insurance Program

Code of Federal Regulations, 2013 CFR

2013-10-01

... quality control departments, or both, and independent Certified Public Accountant (CPA) firms. This Plan... individual State Insurance Departments, NAIC Zone examinations, and independent CPA firms. (c) Standards... company must— (A) Have a biennial audit of the flood insurance financial statements conducted by a CPA...

Patient Protection and Affordable Care Act; establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges. Final rule.

PubMed

2014-02-24

The U.S. Office of Personnel Management (OPM) is issuing a final rule implementing modifications to the Multi-State Plan (MSP) Program based on the experience of the Program to date. OPM established the MSP Program pursuant to the Affordable Care Act. This rule clarifies the approach used to enforce the applicable standards of the Affordable Care Act with respect to health insurance issuers that contract with OPM to offer MSP options; amends MSP standards related to coverage area, benefits, and certain contracting provisions under section 1334 of the Affordable Care Act; and makes non-substantive technical changes.

Mental health and substance abuse insurance parity for federal employees: how did health plans respond?

PubMed

Barry, Colleen L; Ridgely, M Susan

2008-01-01

A fundamental concern with competitive health insurance markets is that they will not supply efficient levels of coverage for treatment of costly, chronic, and predictable illnesses, such as mental illness. Since the inception of employer-based health insurance, coverage for mental health services has been offered on a more limited basis than coverage for general medical services. While mental health advocates view insurance limits as evidence of discrimination, adverse selection and moral hazard can also explain these differences in coverage. The intent of parity regulation is to equalize private insurance coverage for mental and physical illness (an equity concern) and to eliminate wasteful forms of competition due to adverse selection (an efficiency concern). In 2001, a presidential directive requiring comprehensive parity was implemented in the Federal Employees Health Benefits (FEHB) Program. In this study, we examine how health plans responded to the parity directive. Results show that in comparison with a set of unaffected health plans, federal employee plans were significantly more likely to augment managed care through contracts with managed behavioral health "carve-out" firms after parity. This finding helps to explain the absence of an effect of the FEHB Program directive on total spending, and is relevant to the policy debate in Congress over federal parity.

44 CFR 19.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Health and insurance benefits... Education Programs or Activities Prohibited § 19.440 Health and insurance benefits and services. Subject to..., including family planning services. However, any recipient that provides full coverage health service shall...

77 FR 25378 - Regulations Pertaining to the Disclosure of Return Information To Carry Out Eligibility...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-30

... Health Insurance Affordability Programs AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice... marketplaces for individuals and small employers to directly compare available private health insurance options...-based Exchange. In general, a QHP is a health plan offered by a health insurance issuer that meets...

44 CFR 19.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Health and insurance benefits... Education Programs or Activities Prohibited § 19.440 Health and insurance benefits and services. Subject to..., including family planning services. However, any recipient that provides full coverage health service shall...

29 CFR 36.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Health and insurance benefits and services. 36.440 Section... Education Programs or Activities Prohibited § 36.440 Health and insurance benefits and services. Subject to..., including family planning services. However, any recipient that provides full coverage health service shall...

10 CFR 5.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Health and insurance benefits and services. 5.440 Section... Education Programs or Activities Prohibited § 5.440 Health and insurance benefits and services. Subject to..., including family planning services. However, any recipient that provides full coverage health service shall...

24 CFR 221.300 - Changes in the plan of apartment ownership.

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 LOW COST AND MODERATE INCOME MORTGAGE INSURANCE-SAVINGS CLAUSE Contract Rights and Obligations-Low...

45 CFR 155.320 - Verification process related to eligibility for insurance affordability programs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... information regarding eligibility for and enrollment in a health plan, which may be considered protected health information, as that term is defined in § 160.103 of this subchapter, is expressly authorized, for... insurance affordability programs. 155.320 Section 155.320 Public Welfare Department of Health and Human...

42 CFR 457.125 - Provision of child health assistance to American Indian and Alaska Native children.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and... 42 Public Health 4 2010-10-01 2010-10-01 false Provision of child health assistance to American...

42 CFR 457.2 - Basis and scope of subchapter D.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies § 457.2 Basis and scope of... 42 Public Health 4 2010-10-01 2010-10-01 false Basis and scope of subchapter D. 457.2 Section 457...

45 CFR 86.39 - Health and insurance benefits and services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 86.39 Health and insurance..., policy, or plan to any of its students, a recipient shall not discriminate on the basis of sex, or...

40 CFR 5.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 5.440 Health and insurance... of sex, or provide such benefit, service, policy, or plan in a manner that would violate §§ 5.500...

45 CFR 86.39 - Health and insurance benefits and services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 86.39 Health and insurance..., policy, or plan to any of its students, a recipient shall not discriminate on the basis of sex, or...

28 CFR 54.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2013 CFR

2013-07-01

... ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 54.440 Health and insurance... the basis of sex, or provide such benefit, service, policy, or plan in a manner that would violate...

43 CFR 41.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 41.440 Health and insurance... the basis of sex, or provide such benefit, service, policy, or plan in a manner that would violate...

40 CFR 5.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2013 CFR

2013-07-01

... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 5.440 Health and insurance... of sex, or provide such benefit, service, policy, or plan in a manner that would violate §§ 5.500...

Where Is the Malpractice Crisis Taking Us?

PubMed Central

Cooper, James K.; Egeberg, Roger O.; Stephens, Sharman K.

1977-01-01

There have been several approaches taken to solve the malpractice insurance problem in this country. However, since the cost of malpractice insurance continues to climb, the changes so far have not solved the problem, and more changes seem inevitable. A major change could be the development of a patient insurance plan that would provide compensation for certain injuries related to medical care. The insurance coverage would be centered on hospital care. If certain requirements are met, the plan may not be more expensive than the current tort liability system, and would offer several advantages. In addition to the patient injury insurance, there could be federal assumption of liability for national immunization programs. PMID:906461

The Role of Publicly Funded Family Planning Sites In Health Insurance Enrollment.

PubMed

Yarger, Jennifer; Daniel, Sara; Biggs, M Antonia; Malvin, Jan; Brindis, Claire D

2017-06-01

Publicly funded family planning providers are well positioned to help uninsured individuals learn about health insurance coverage options and effectively navigate the enrollment process. Understanding how these providers are engaged in enrollment assistance and the challenges they face in providing assistance is important for maximizing their role in health insurance outreach and enrollment. In 2014, some 684 sites participating in California's family planning program were surveyed about their involvement in helping clients enroll in health insurance. Weighted univariate and bivariate analyses were conducted to examine enrollment activities and perceived barriers to facilitating enrollment by site characteristics. Most family planning program sites provided eligibility screening (68%), enrollment education (77%), on-site enrollment assistance (55%) and referrals for off-site enrollment support (91%). The proportion of sites offering each type of assistance was highest among community clinics (83-96%), primary care and multispecialty sites (65-95%), Title X-funded sites (72-98%), sites with contracts to provide primary care services (64-93%) and sites using only electronic health records (66-94%). Commonly identified barriers to providing assistance were lack of staff time (reported by 52% of sites), lack of funding (47%), lack of physical space (34%) and lack of staff knowledge (33%); only 20% of sites received funding to support enrollment activities. Although there were significant variations among them, publicly funded family planning providers in California are actively engaged in health insurance enrollment. Supporting their vital role in enrollment could help in the achievement of universal health insurance coverage. Copyright © 2017 by the Guttmacher Institute.

42 CFR 407.20 - Special enrollment period related to coverage under group health plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND... coverage under group health plans. (a) Terminology—(1) Group health plan (GHP) and large group health plan...

42 CFR 407.20 - Special enrollment period related to coverage under group health plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND... coverage under group health plans. (a) Terminology—(1) Group health plan (GHP) and large group health plan...

42 CFR 407.20 - Special enrollment period related to coverage under group health plans.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND... coverage under group health plans. (a) Terminology—(1) Group health plan (GHP) and large group health plan...

42 CFR 407.20 - Special enrollment period related to coverage under group health plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND... coverage under group health plans. (a) Terminology—(1) Group health plan (GHP) and large group health plan...

42 CFR 407.20 - Special enrollment period related to coverage under group health plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND... coverage under group health plans. (a) Terminology—(1) Group health plan (GHP) and large group health plan...

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.

Ontario University Benefits Survey. Part I. (All Benefits Excluding Pensions). December 1, 1978. Report No. 78-18.

ERIC Educational Resources Information Center

McMaster Univ., Hamilton (Ontario).

Presented are the results of a survey of university benefit programs. Information and data relating to the following areas are presented: administration and insurance plans, communication of benefits, proposed changes in benefits, provision of life and dismemberment insurance, maternity leave policy, Ontario health insurance, supplementary health…

78 FR 65045 - Patient Protection and Affordable Care Act; Program Integrity: Exchange, Premium Stabilization...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-30

.... Definitions (Sec. 144.103) B. Part 147--Health Insurance Reform Requirements for the Group and Individual... Risk Adjustment Methodology 5. Subpart E--Health Insurance Issuer and Group Health Plan Standards... (PHS Act) relating to health insurance issuers in the group and individual markets and to group health...

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.

76 FR 77392 - Patient Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-13

... to protect CO-OP members against insurance industry involvement and interference. To ensure consumer... Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan (CO-OP) Program... the Consumer Operated and Oriented Plan (CO-OP) program, which provides loans to foster the creation...

Private Voucher and Scholarship Plans. Trends and Issues.

ERIC Educational Resources Information Center

Hadderman, Margaret

This article examines an increasingly popular alternative to government-funded voucher plans: private voucher and scholarship plans. Through the 1998-99 school year, spending on privately funded voucher programs totalled $61 million. Private vouchers began with the Golden Rule Program in Indianapolis in 1991 and was inspired by insurance CEO J.…

77 FR 72581 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-05

... least two multi-State plans (MSPs) on each of the Affordable Insurance Exchanges (Exchanges). Under the... issuers to offer at least two multi-State plans (MSPs) on each of the Exchanges in the 50 States and the... Patient Protection and Affordable Care Act; Establishment of the Multi- State Plan Program for the...

24 CFR 214.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES HOUSING COUNSELING... part: Action plan. A plan that outlines what the housing counseling agency and the client will do in...). Affiliate. A nonprofit organization participating in the HUD-related Housing Counseling program of a...

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.

Plan selection in Medicare Part D: Evidence from administrative data

PubMed Central

Heiss, Florian; Leive, Adam; McFadden, Daniel; Winter, Joachim

2014-01-01

We study the Medicare Part D prescription drug insurance program as a bellwether for designs of private, non-mandatory health insurance markets, focusing on the ability of consumers to evaluate and optimize their choices of plans. Our analysis of administrative data on medical claims in Medicare Part D suggests that fewer than 25 percent of individuals enroll in plans that are ex ante as good as the least cost plan specified by the Plan Finder tool made available to seniors by the Medicare administration, and that consumers on average have expected excess spending of about $300 per year, or about 15 percent of expected total out-of-pocket cost for drugs and Part D insurance. These numbers are hard to reconcile with decision costs alone; it appears that unless a sizeable fraction of consumers place large values on plan features other than cost, they are not optimizing effectively. PMID:24308882

77 FR 52614 - Pre-Existing Condition Insurance Plan Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-30

...This document contains an amendment regarding program eligibility to the interim final regulation implementing the Pre- Existing Condition Plan program under provisions of the Patient Protection and Affordable Care Act. In light of a new process recently announced by the Department of Homeland Security, eligibility for the program is being amended so that the program does not inadvertently expand the scope of that process.

Is the malpractice crisis filtering down to family planning?

PubMed

1986-06-01

Evidence now exists that the insurance industry is including contraceptive researchers and family planning clinics in its crackdown on malpractice and liability policies. Family planning practioners have been lumped together with private physicians under the category "Profit-buster" for most major insurers, and the effects are just beginning to show. The liability problems of family planning clinics overlap those of physicians and drug companies. Essentially, they, too, can be held responsible for the products they prescribe and dispense to their clients. When the family planning clinic of NEWCAP, Inc., a community action program in Wisconsin, was abruptly dropped by its insurer in November, the staff was puzzled. NEWCAP had a spotless record and had experienced no previous insurance problems. The insurance company justified its actions by explaining it was getting out of the malpractice field altogether. Although NEWCAP's dilemma seems to be unique at this time, family planning organizations are concerned about the future. The malpractice crackdown also is causing problems for contraceptive researchers. Over the past few years, research and development programs have suffered because of difficulty in obtaining product liability insurance. Due to insurance costs, the Popuation Council's US clinical trials of the promising NORPLANT contraceptive implant were pared down to the minimum number required for Food and Drug Administration approval. Family Planning International's clinical trials of the biodegradable contraceptive implant Capronor have been postponed because an insurer could not be found. Acquiring insurance does not put the researcher over the hurdle, according to Richard Lincoln, senior vice president of the Alan Guttmacher Institute. There are more problems ahead after the research is completed. Dr. Harold Nash, New York's Population Council, has some suggestions for alleviating what seems to be a growing problem. If interest rates increase and insurers raise rates across the board, "they will start seeing a good return on their investments, and the problem will just go away," he said. "But if that doesn't happen, and maybe even if it does, some legislative remedies are needed to control all this litigation." Several different ideas now are being considered by state legislatures and by Congress. One suggestion is to limit the contingency fees that lawyers can charge. Another is to limit the amount of damages that can be levied based on pain and suffering. A third considers the problem of frivolous suits and would require a plantiff entering into a trivial suit to pay the expenses incurred by the defendant.

78 FR 13405 - Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-27

...This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state- specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

Patient Protection and Affordable Care Act; health insurance market rules. Final rule.

PubMed

2013-02-27

This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state-specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

7 CFR 23.4 - State Rural Development Advisory Council.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 23.4 Agriculture Office of the Secretary of Agriculture STATE AND REGIONAL ANNUAL PLANS OF WORK State... Development Advisory Council will insure that programs proposed under title V including regional programs... research and extension plan which would impact directly on rural development activities being developed or...

7 CFR 23.4 - State Rural Development Advisory Council.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 23.4 Agriculture Office of the Secretary of Agriculture STATE AND REGIONAL ANNUAL PLANS OF WORK State... Development Advisory Council will insure that programs proposed under title V including regional programs... research and extension plan which would impact directly on rural development activities being developed or...

7 CFR 23.4 - State Rural Development Advisory Council.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 23.4 Agriculture Office of the Secretary of Agriculture STATE AND REGIONAL ANNUAL PLANS OF WORK State... Development Advisory Council will insure that programs proposed under title V including regional programs... research and extension plan which would impact directly on rural development activities being developed or...

7 CFR 23.4 - State Rural Development Advisory Council.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 23.4 Agriculture Office of the Secretary of Agriculture STATE AND REGIONAL ANNUAL PLANS OF WORK State... Development Advisory Council will insure that programs proposed under title V including regional programs... research and extension plan which would impact directly on rural development activities being developed or...

Alvarado Flood Risk Management Modifications to Existing Project Section 408 Review. Review Plan

DTIC Science & Technology

2012-12-26

Digital Flood Insurance Rate Maps) through the Nationa l Flood Insurance Program ( NFIP ). In order to obtain FEMA accreditation, the levee owner...compliance documentation for meeting NFIP requirements. Barr conducted a thorough review of relevant documents to gain a better understanding of...compliance documentation for meeting NFIP requirements. Barr Engineering has prepared a Phase I Engineer’s Report and is developing plans and

Chlamydia screening for sexually active young women under the Affordable Care Act: new opportunities and lingering barriers.

PubMed

Loosier, Penny S; Malcarney, Mary-Beth; Slive, Lauren; Cramer, Ryan C; Burgess, Brittany; Hoover, Karen W; Romaguera, Raul

2014-09-01

The Affordable Care Act of 2010 (ACA) contains a provision requiring private insurers issuing or renewing plans on or after September 23, 2010, to provide, without cost sharing, preventive services recommended by US Preventive Services Task Force (grades A and B), among other recommending bodies. As a grade A recommendation, chlamydia screening for sexually active young women 24 years and younger and older women at risk for chlamydia falls under this requirement. This article examines the potential effect on chlamydia screening among this population across private and public health plans and identifies lingering barriers not addressed by this legislation. Examination of the impact on women with private insurance touches upon the distinction between coverage under grandfathered plans, where the requirement does not apply, and nongrandfathered plans, where the requirement does apply. Acquisition of private health insurance through health insurance Marketplaces is also discussed. For public health plans, coverage of preventive services without cost sharing differs for individuals enrolled in standard Medicaid, covered under the Medicaid expansion included in the ACA, or those enrolled under the Children's Health Insurance Program or who fall under Early, Periodic, Screening, Diagnosis and Treatment criteria. The discussion of lingering barriers not addressed by the ACA includes the uninsured, physician reimbursement, cost sharing, confidentiality, low rates of appropriate sexual history taking by providers, and disclosures of sensitive information. In addition, the role of safety net programs that provide health care to individuals regardless of ability to pay is examined in light of the expectation that they also remain a payer of last resort.

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.

44 CFR 78.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78.2... organization, that has zoning and building code jurisdiction over a particular area having special flood..., that is designated to develop and administer a mitigation plan by political subdivisions, all of which...

44 CFR 78.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78... organization, that has zoning and building code jurisdiction over a particular area having special flood..., that is designated to develop and administer a mitigation plan by political subdivisions, all of which...

44 CFR 78.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78... organization, that has zoning and building code jurisdiction over a particular area having special flood..., that is designated to develop and administer a mitigation plan by political subdivisions, all of which...

44 CFR 78.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78... organization, that has zoning and building code jurisdiction over a particular area having special flood..., that is designated to develop and administer a mitigation plan by political subdivisions, all of which...

44 CFR 78.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78... organization, that has zoning and building code jurisdiction over a particular area having special flood..., that is designated to develop and administer a mitigation plan by political subdivisions, all of which...

Infusing Adult Education Principles Into a Health Insurance Literacy Program.

PubMed

Brown, Virginia

2018-03-01

Health insurance literacy is an emerging concept in the health education and health promotion field. The passage of the Affordable Care Act highlighted the link between health insurance and health outcomes. However, the law does not specifically address how the public should be educated on choosing an appropriate health insurance plan. Research shows adults, regardless of previous health insurance status, are likely confused and uncertain about their selection. The University of Maryland Extension developed and created health insurance Smart Choice Health Insurance™ to reduce confusion and increase confidence and capability to make this decision. Andragogy, an adult learning theory, was used to guide the development of the program and help ensure best practices are used to achieve desired outcomes. Using the six principles of andragogy, the team incorporated reality-based case studies, allowed adults time to practice, and emphasized choice making and many other elements to create an atmosphere conducive to adult learning. Results from Smart Choice indicate the program is successful in reducing confusion and increasing confidence. Furthermore, feedback from participants and trained educators indicates that adults were engaged in the program and found the materials useful. Based on program success, creation of new health insurance literacy programs grounded in adult education principles is under way.

Improving Risk Management and Resiliency: A Plan for a Proactive National Policy on Insurance Practices in FEMA’s Public Assistance Program

DTIC Science & Technology

2013-12-01

DisasterRecoveryExpenditure/Pag es/default.aspx, Canadian Disaster Database, and www.fema.gov) 116 Table 15. Comparison of declaration criteria and disasters for $30 million...the role of insurance in FEMA’s Public Assistance program. The guidance provided in the 44 CFR has not kept up with the industry since being...the nation. xxix THIS PAGE INTENTIONALLY LEFT BLANK I. INTRODUCTION Insurance is a complex industry , which is a large component of the U.S

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.

A race against time: can CO-OPs and provider start-ups survive in the health insurance marketplaces?

PubMed

Eggbeer, Bill

2015-12-01

> The Affordable Care Act's state and federal health insurance marketplaces, designed to provide affordable insurance coverage to individuals and small groups, are proving hostile territory to new market entrants. Efforts to inject competition into the marketplaces are being challenged by the wide-scale withdrawal o consumer-operated and oriented plans (CO-OPs). Meanwhile, premiums appear likely to increase for consumers as plans seek to balance medical losses. Flaws in the "Three R's" (reinsurance, risk corridors, and risk-adjustment) program are viewed as a threat to the survival of CO-OPs and start-ups.

Private Health Insurance Exchanges

PubMed Central

Buttorff, Christine; Nowak, Sarah; Syme, James; Eibner, Christine

2017-01-01

Abstract Private health insurance exchanges offer employer health insurance, combining online shopping, increased plan choice, benefit administration, and cost-containment strategies. This article examines how private exchanges function, how they may affect employers and employees, and the possible implications for the Affordable Care Act's (ACA's) Small Business Health Options Program (SHOP) Marketplaces. The authors found that private exchanges could encourage employees to select less-generous plans. This could expose employees to higher out-of-pocket costs, but premium contributions would drop substantially, so net spending would decrease. On the other hand, employee spending may increase if, in moving to private exchanges, employers decrease their health insurance contributions. Most employers can avoid the ACA's “Cadillac tax” by reducing the generosity of the plans they offer, regardless of whether they move to a private exchange. There is not yet enough evidence to determine whether the private exchanges will become prominent in the insurance market and how they will affect employers and their employees. PMID:28845340

Insurance-related Practices at Title X-funded Family Planning Centers under the Affordable Care Act: Survey and Interview Findings.

PubMed

Zolna, Mia R; Kavanaugh, Megan L; Hasstedt, Kinsey

Given the recent reforms in the United States health care system, including the passage and implementation of the Affordable Care Act, as well as anticipated upcoming changes to health care coverage, it is critical that publicly funded health care providers understand how to effectively work with their states' Medicaid programs and the private health insurance plans in their service areas to provide high-quality contraceptive care to the millions of women relying on services at these sites annually. We collected survey data from a nationally representative sample of 535 clinics providing family planning services that received Title X funding and conducted semistructured interviews with 23 administrators at a subsample of surveyed clinics to explore provider-reported experiences working with health plans and to identify barriers to, and practices that lead to, adequate reimbursement for services provided. Providers report that knowledgeable staff are crucial to securing contracts with both public and private insurance plan issuers, and that the contracts they secure often include coverage restrictions on methods or services clinics offer their clients. Good staff relationships with issuers are key to obtaining adequate and consistent reimbursement for all covered services. Providers are trying to understand how insurance programs in their area knit together. Regardless of how U.S. health policies and delivery systems may change in the coming years, it is imperative that publicly funded family planning centers continue to work with health plans and maximize their third-party revenue to provide services to those in need. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Insurance-related Practices at Title X-funded Family Planning Centers under the Affordable Care Act: Survey and Interview Findings

PubMed Central

Zolna, Mia R.; Kavanaugh, Megan L.; Hasstedt, Kinsey

2018-01-01

Introduction Given the recent reforms in the United States health care system, including the passage and implementation of the Affordable Care Act, as well as anticipated upcoming changes to health care coverage, it is critical that publicly funded health care providers understand how to effectively work with their states’ Medicaid programs and the private health insurance plans in their service areas to provide high-quality contraceptive care to the millions of women relying on services at these sites annually. Methods We collected survey data from a nationally representative sample of 535 clinics providing family planning services that received Title X funding and conducted semistructured interviews with 23 administrators at a subsample of surveyed clinics to explore provider-reported experiences working with health plans and to identify barriers to, and practices that lead to, adequate reimbursement for services provided. Results Providers report that knowledgeable staff are crucial to securing contracts with both public and private insurance plan issuers, and that the contracts they secure often include coverage restrictions on methods or services clinics offer their clients. Good staff relationships with issuers are key to obtaining adequate and consistent reimbursement for all covered services. Conclusions Providers are trying to understand how insurance programs in their area knit together. Regardless of how U.S. health policies and delivery systems may change in the coming years, it is imperative that publicly funded family planning centers continue to work with health plans and maximize their third-party revenue to provide services to those in need. PMID:29108987

The association between medical costs and participation in the vitality health promotion program among 948,974 members of a South African health insurance company.

PubMed

Patel, Deepak N; Lambert, Estelle V; da Silva, Roseanne; Greyling, Mike; Nossel, Craig; Noach, Adam; Derman, Wayne; Gaziano, Thomas

2010-01-01

Examine the association between the levels of participation in an incentive-based health promotion program (Vitality) and inpatient medical claims among members of a major health insurer. A 1-year, cross-sectional, correlational analyses of engagement with a health promotion program and hospital claims experience (admissions costs, days in hospital, and admission rate) of members of a national private health insurer. Adult members of South Africa's largest national private health insurer, Discovery Health. Insured members were also eligible for voluntary membership in an insurance-linked incentivized health promotion program, Vitality. The study sample included 948,974 adult members of the Discovery Health plan for the year 2006. Of these, 591,134 (62.3%) were also members of the Vitality health promotion program. The study sample was grouped based on registration and the level of engagement with the Vitality health promotion program into the following: not registered (37.5%), registered but not engaged with any health promotion activity (21.9%), low engagement (30.9%), and high engagement (9.5%). High engagement was defined a priori by the accumulation of an arbitrary number of points on the Vitality program, allocated against specific activities (knowledge, fitness-related activities, assessment and screening, and healthy choices). Hospital admission costs, the number of days in hospital, and hospital admission rates were compared among highly engaged members and those members who were not enrolled in the program, nonengaged, and lowly engaged. Data were normalized for age, gender, plan type, and chronic disease status. Highly engaged members had lower costs per patient, shorter stays in hospital, and fewer admissions compared with other groups (p < .001). Low or no engagement was not associated with lower hospital costs. Admission rates were also 7.4% lower for cardiovascular disease, 13.2% lower for cancers, and 20.7% lower for endocrine and metabolic diseases in the highly engaged group compared with any of the other groups (p < .01). Engagement in an incentive-based wellness program, offered by a health insurer, was associated with lower health care costs.

University Benefits Survey: Part I (All Benefits Excluding Pensions).

ERIC Educational Resources Information Center

University of Western Ontario, London.

Information on all benefits, excluding pensions, provided by 16 Ontario universities is presented. The following general questions concerning benefits are covered: administration and insurance plans, communication of benefit programs to employees, proposed changes in benefits, provision of life and dismemberment insurance, and maternity leave…

Insuring That Families Plan and Save for College.

ERIC Educational Resources Information Center

Belvin, James

1995-01-01

Because so many Americans can afford to save for children's college costs but do not, it is proposed that employers take a more active role in promoting college financial planning. Possible solutions include company-sponsored contributory accounts, educational savings plans; payroll deduction plans, educational annuity programs, subsidized or…

Risk Adjustment, Reinsurance Improved Financial Outcomes For Individual Market Insurers With The Highest Claims.

PubMed

Jacobs, Paul D; Cohen, Michael L; Keenan, Patricia

2017-04-01

The Affordable Care Act (ACA) reformed the individual health insurance market. Because insurers can no longer vary their offers of coverage based on applicants' health status, the ACA established a risk adjustment program to equalize health-related cost differences across plans. The ACA also established a temporary reinsurance program to subsidize high-cost claims. To assess the impact of these programs, we compared revenues to claims costs for insurers in the individual market during the first two years of ACA implementation (2014 and 2015), before and after the inclusion of risk adjustment and reinsurance payments. Before these payments were included, for the 30 percent of insurers with the highest claims costs, claims (not including administrative expenses) exceeded premium revenues by $90-$397 per enrollee per month. The effect was reversed after these payments were included, with revenues exceeding claims costs by $0-$49 per month. The risk adjustment and reinsurance programs were relatively well targeted in the first two years. While there is ongoing discussion regarding the future of the ACA, our findings can shed light on how risk-sharing programs can address risk selection among insurers-a pervasive issue in all health insurance markets. Project HOPE—The People-to-People Health Foundation, Inc.

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...

44 CFR 60.24 - Planning considerations for flood-related erosion-prone areas.

Code of Federal Regulations, 2010 CFR

2010-10-01

... flood-related erosion-prone areas. 60.24 Section 60.24 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program CRITERIA FOR LAND MANAGEMENT AND USE Additional Considerations in Managing Flood-Prone...

Self-Insurance (Waukegan Style).

ERIC Educational Resources Information Center

Falkinham, Ken

The health and dental self-insurance program instituted in the Waukegan (Illinois) Public Schools can credit three major factors for much of its success. First, claims are processed in-house by the district, resulting in improved communications about claim decisions, faster payments, and higher employee satisfaction. Second, the plan is…

75 FR 70927 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-19

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [Document... Pre-Existing Condition Insurance Plan; Use: The Department of Health and Human Services (HHS) is... law establishes a ``temporary high risk health insurance pool program'' (which has been named the Pre...

The Financial Impact of Advanced Kidney Disease on Canada Pension Plan and Private Disability Insurance Costs

PubMed Central

Manns, Braden; McKenzie, Susan Q.; Au, Flora; Gignac, Pamela M.; Geller, Lawrence Ian

2017-01-01

Background: Many working-age individuals with advanced chronic kidney disease (CKD) are unable to work, or are only able to work at a reduced capacity and/or with a reduction in time at work, and receive disability payments, either from the Canadian government or from private insurers, but the magnitude of those payments is unknown. Objective: The objective of this study was to estimate Canada Pension Plan Disability Benefit and private disability insurance benefits paid to Canadians with advanced kidney failure, and how feasible improvements in prevention, identification, and early treatment of CKD and increased use of kidney transplantation might mitigate those costs. Design: This study used an analytical model combining Canadian data from various sources. Setting and Patients: This study included all patients with advanced CKD in Canada, including those with estimated glomerular filtration rate (eGFR) <30 mL/min/m2 and those on dialysis. Measurements: We combined disability estimates from a provincial kidney care program with the prevalence of advanced CKD and estimated disability payments from the Canada Pension Plan and private insurance plans to estimate overall disability benefit payments for Canadians with advanced CKD. Results: We estimate that Canadians with advanced kidney failure are receiving disability benefit payments of at least Can$217 million annually. These estimates are sensitive to the proportion of individuals with advanced kidney disease who are unable to work, and plausible variation in this estimate could mean patients with advanced kidney disease are receiving up to Can$260 million per year. Feasible strategies to reduce the proportion of individuals with advanced kidney disease, either through prevention, delay or reduction in severity, or increasing the rate of transplantation, could result in reductions in the cost of Canada Pension Plan and private disability insurance payments by Can$13.8 million per year within 5 years. Limitations: This study does not estimate how CKD prevention or increasing the rate of kidney transplantation might influence health care cost savings more broadly, and does not include the cost to provincial governments for programs that provide income for individuals without private insurance and who do not qualify for Canada Pension Plan disability payments. Conclusions: Private disability insurance providers and federal government programs incur high costs related to individuals with advanced kidney failure, highlighting the significance of kidney disease not only to patients, and their families, but also to these other important stakeholders. Improvements in care of individuals with kidney disease could reduce these costs. PMID:28491340

The Financial Impact of Advanced Kidney Disease on Canada Pension Plan and Private Disability Insurance Costs.

PubMed

Manns, Braden; McKenzie, Susan Q; Au, Flora; Gignac, Pamela M; Geller, Lawrence Ian

2017-01-01

Many working-age individuals with advanced chronic kidney disease (CKD) are unable to work, or are only able to work at a reduced capacity and/or with a reduction in time at work, and receive disability payments, either from the Canadian government or from private insurers, but the magnitude of those payments is unknown. The objective of this study was to estimate Canada Pension Plan Disability Benefit and private disability insurance benefits paid to Canadians with advanced kidney failure, and how feasible improvements in prevention, identification, and early treatment of CKD and increased use of kidney transplantation might mitigate those costs. This study used an analytical model combining Canadian data from various sources. This study included all patients with advanced CKD in Canada, including those with estimated glomerular filtration rate (eGFR) <30 mL/min/m 2 and those on dialysis. We combined disability estimates from a provincial kidney care program with the prevalence of advanced CKD and estimated disability payments from the Canada Pension Plan and private insurance plans to estimate overall disability benefit payments for Canadians with advanced CKD. We estimate that Canadians with advanced kidney failure are receiving disability benefit payments of at least Can$217 million annually. These estimates are sensitive to the proportion of individuals with advanced kidney disease who are unable to work, and plausible variation in this estimate could mean patients with advanced kidney disease are receiving up to Can$260 million per year. Feasible strategies to reduce the proportion of individuals with advanced kidney disease, either through prevention, delay or reduction in severity, or increasing the rate of transplantation, could result in reductions in the cost of Canada Pension Plan and private disability insurance payments by Can$13.8 million per year within 5 years. This study does not estimate how CKD prevention or increasing the rate of kidney transplantation might influence health care cost savings more broadly, and does not include the cost to provincial governments for programs that provide income for individuals without private insurance and who do not qualify for Canada Pension Plan disability payments. Private disability insurance providers and federal government programs incur high costs related to individuals with advanced kidney failure, highlighting the significance of kidney disease not only to patients, and their families, but also to these other important stakeholders. Improvements in care of individuals with kidney disease could reduce these costs.

Benefits planning--what you must know: interview with Daniel Fortuno, AIDS Benefits Counselors. Interview by John S. James.

PubMed

Fortuno, D

1996-09-20

Daniel Fortuno, a counselor with AIDS Benefits Counselors (ABC), summarizes key insurance and benefits information for persons living with AIDS (PWAs), particularly those who reside in California. Fortuno explains the managed care concept and basic health insurance terms, such as pre-existing conditions, health maintenance organizations (HMOs), preferred provider organizations (PPOs), contestability, and the Consolidated Omnibus Budget Reconciliation Act (COBRA). Fortuno explains a California law that became effective in July 1993 that greatly restricts the ability of health insurance companies to refuse insurance due to preexisting conditions to small groups of persons. This law, AB 1672, makes health insurance available to the sick with little overall rises in prices. Federal insurance laws and regulations that impact PWAs and HIV-positive individuals are outlined. In the interview, Fortuno also discusses Medicaid/Medi-Cal (California's Medicaid), Social Security programs, State disability, and the AIDS Drug Assistance Program. Fortuno offers suggestions for obtaining good private insurance and evaluates the pros and cons of HMOs, PPOs, and indemnity insurance.

Exploration of Selection Bias Issues for the DoD Federal Employees Health Benefits Program Demonstration

DTIC Science & Technology

2002-01-01

e.g., employer or Medicare). Thus we focus on the details of theory of consumer preferences and choices in the discussion below, while providing similar...health status. Two important factors in consumer health plan choices are inherent to any insurance market. First, the consumer preferences that guide...important factors in consumer health plan choices are inherent to any insurance market. First, the consumer preferences that guide their choices of

25 CFR Appendix A to Part 276 - Principles for Determining Costs Applicable to Grants

Code of Federal Regulations, 2010 CFR

2010-04-01

... responsible for the efficient and effective administration of grant programs through the application of sound... government and is not allowable. 2. Advertising. Advertising media includes newspapers, magazines, radio and... or expenses for social security, employees' life and health insurance plans, unemployment insurance...

HUD PowerSaver Pilot Loan Program

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

Zimring, Mark; Hoffman, Ian

2010-12-10

The U.S. Department of Housing and Urban Development (HUD) recently announced the creation of a pilot loan program for home energy improvements. The PowerSaver loan program is a new, energy-focused variant of the Title I Property Improvement Loan Insurance Program (Title I Program) and is planned for introduction in early 2011. The PowerSaver pilot will provide lender insurance for secured and unsecured loans up to $25,000 to single family homeowners. These loans will specifically target residential energy efficiency and renewable energy improvements. HUD estimates the two-year pilot will fund approximately 24,000 loans worth up to $300 million; the program ismore » not capped. The Federal Housing Administration (FHA), HUD's mortgage insurance unit, will provide up to $25 million in grants as incentives to participating lenders. FHA is seeking lenders in communities with existing programs for promoting residential energy upgrades.« less

Technology programs and related policies - Impacts on communications satellite business ventures

NASA Technical Reports Server (NTRS)

Greenberg, J. S.

1985-01-01

The DOMSAT II stochastic communication satellite business venture financial planning simulation model is described. The specification of business scenarios and the results of several analyses are presented. In particular, the impacts of NASA on-orbit propulsion and power technology programs are described. The effects of insurance rates and self-insurance and of the use of the Space Shuttle and Ariane transportation systems on a typical fixed satellite service business venture are discussed.

US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity.

PubMed

Gomez, G; Stanford, F C

2018-03-01

Obesity is now the most prevalent chronic disease in the United States, which amounts to an estimated $147 billion in health care spending annually. The Affordable Care Act (ACA) enacted in 2010 included provisions for private and public health insurance plans that expanded coverage for lifestyle/behavior modification and bariatric surgery for the treatment of obesity. Pharmacotherapy, however, has not been included despite their evidence-based efficacy. We set out to investigate the coverage of Food and Drug Administration-approved medications for obesity within Medicare, Medicaid and ACA-established marketplace health insurance plans. We examined coverage for phentermine, diethylpropion, phendimetrazine, Benzphentamine, Lorcaserin, Phentermine/Topiramate (Qysmia), Liraglutide (Saxenda) and Buproprion/Naltrexone (Contrave) among Medicare, Medicaid and marketplace insurance plans in 34 states. Among 136 marketplace health insurance plans, 11% had some coverage for the specified drugs in only nine states. Medicare policy strictly excludes drug therapy for obesity. Only seven state Medicaid programs have drug coverage. Obesity requires an integrated approach to combat its public health threat. Broader coverage of pharmacotherapy can make a significant contribution to fighting this complex and chronic disease.

Still-Born Autonomy Insurance Plan in Quebec: An Example of a Public Long-Term Care Insurance System in Canada.

PubMed

Hébert, Réjean

2016-01-01

Funding long-term care (LTC) is a challenge under the existing Beveridgean universal healthcare system. The Autonomy Insurance (AI) plan developed in Quebec was an attempt to introduce public LTC insurance into our healthcare system. The AI benefit was based on an assessment of the needs of older people and those with disabilities using a disability scale (SMAF) and case-mix classification system (Iso-SMAF Profiles). Under the plan, the benefit would be used to fund public institutions or purchase services from private organizations. Case managers were responsible for assessments and helping users and their families plan services and decide how to use the AI benefit. Funding AI was based on general tax revenues without capitalized funding, under a separate protected budget program. Projections were made for the additional budget needed to support AI, which would have mitigated the forecast increase in LTC spending due to population aging. All the legal, administrative, funding, training and contractual issues were dealt with, for implementation of the plan in April 2015. Unfortunately, the project was still-born for political reasons, but it demonstrates the feasibility of this essential innovation for Canada.

Using insurance to enhance nitrogen fertilizer application to reduce nitrogen losses to the environment.

PubMed

Huang, W Y; Heifner, R G; Taylor, H; Uri, N D

2001-05-01

The advantage of using insurance to help a farmer adopt a best nitrogen management plan (BNMP) that reduces the impact of agricultural production on the environment is analytically and empirically demonstrated. Using an expected value analysis, it is shown that an insurance program can be structured so as to reduce a farmer's cost of bearing the adoption risk associated with changing production practices and, thus, to improve the farmer's certainty equivalent net return thereby promoting the adoption of a BNMP. Using the adoption of growing-season only N fertilizer application in Iowa as a case study, it is illustrated how insurance may be used to promote the adoption of this practice to reduce N fertilizer use. It is shown that it is possible for a farmer and an insurance company both to have an incentive to develop an insurance adoption program that will benefit both the farmer and the insurance company, increasing net social welfare and improving environmental quality in Iowa.

Irondequoit Creek Watershed New York, Final Feasibility Report and Environmental Impact Statement.

DTIC Science & Technology

1982-03-01

National Flood Insurance Program 58 8 System of Accounts 95 9 Summary of Benefits and Costs 96 10 Summary of Average Annual Benefits - Selected Plan 112...material, velocity distribution, vegetation, soil type, topography, and especially rainfall regime, where a few intense storms can account for severe...Alternative B is described later in this report. Flood Insurance - Flood insurance provides some financial protection to vic- tims of flood related

5 CFR 875.414 - Will benefits be coordinated with other coverage?

Code of Federal Regulations, 2010 CFR

2010-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Coverage § 875.414 Will benefits... coordination of benefits (COB) guidelines set by the National Association of Insurance Commissioners. The total benefits from all plans that pay a long term care benefit to you should not exceed the actual costs you...

Defined contribution health care: future direction or fantasy?

PubMed

Ostuw, R

2000-01-01

Will payers embrace defined contribution plans as an alternative to traditional health insurance or is this new approach a pipe dream? Are consumers truly ready to make informed decisions on purchasing their own health care? This article explores barriers to defined contribution health plans, including consumer reluctance to take ownership of buying insurance and a preference for the cost predictability of liberal coverage in employer-sponsored programs versus MSAs or higher co-payment arrangements. For the ultimate form of defined contribution health care to work, several tax and insurance barriers must be overcome. As a practical matter, the author argues that the current employer-sponsored approach is the most efficient system for large employers.

Getting Started in the Child Care Business.

ERIC Educational Resources Information Center

Kimery, Sharon

This pamphlet discusses questions to consider when planning a child care facility. Topics discussed include licensing, financial management, written policies on facility operation, recordkeeping, insurance, the physical nature of the facility, program planning, scheduling of daily activities, personnel selection, staff development, parent…

Access to Care: The Physician's Perspective

PubMed Central

Ruckle, Janessa E; Sultan, Omar S; Kemble, Stephen

2011-01-01

Private practice physicians in Hawai‘i were surveyed to better understand their impressions of different insurance plans and their willingness to care for patients with those plans. Physician experiences and perspectives were investigated in regard to reimbursement, formulary limitations, pre-authorizations, specialty referrals, responsiveness to problems, and patient knowledge of their plans. The willingness of physicians to accept new patients from specific insurance company programs clearly correlated with the difficulties and limitations physicians perceive in working with the companies (p < 0.0012). Survey results indicate that providers in private practice were much more likely to accept University Health Alliance (UHA) and Hawai‘i Medical Services Association (HMSA) Commercial insurance than Aloha Care Advantage and Aloha Quest. This was likely related to the more favorable impressions of the services, payments, and lower administrative burden offered by those companies compared with others. PMID:21308645

Access to care: the physician's perspective.

PubMed

Tice, Alan; Ruckle, Janessa E; Sultan, Omar S; Kemble, Stephen

2011-02-01

Private practice physicians in Hawaii were surveyed to better understand their impressions of different insurance plans and their willingness to care for patients with those plans. Physician experiences and perspectives were investigated in regard to reimbursement, formulary limitations, pre-authorizations, specialty referrals, responsiveness to problems, and patient knowledge of their plans. The willingness of physicians to accept new patients from specific insurance company programs clearly correlated with the difficulties and limitations physicians perceive in working with the companies (p<0.0012). Survey results indicate that providers in private practice were much more likely to accept University Health Alliance (UHA) and Hawaii Medical Services Association (HMSA) Commercial insurance than Aloha Care Advantage and Aloha Quest. This was likely related to the more favorable impressions of the services, payments, and lower administrative burden offered by those companies compared with others. Hawaii Medical Journal Copyright 2011.

The Big Five Health Insurers' Membership And Revenue Trends: Implications For Public Policy.

PubMed

Schoen, Cathy; Collins, Sara R

2017-12-01

The five largest US commercial health insurance companies together enroll 125 million members, or 43 percent of the country's insured population. Over the past decade these insurers have become increasingly dependent for growth and profitability on public programs, according to an analysis of corporate reports. In 2016 Medicare and Medicaid accounted for nearly 60 percent of the companies' health care revenues and 20 percent of their comprehensive plan membership. Although headlines have focused on losses in the state Marketplaces created by the Affordable Care Act (ACA), the Marketplaces represent only a small fraction of insurers' members. Overall, the five largest insurers have remained profitable since passage of the ACA as a result of profits in other market segments. Notably, companies with significant Medicare or Medicaid enrollment have continued to insure beneficiaries in states where the insurers do not participate in Marketplaces. Given the insurers' dependence on public programs, there is potential to improve access if federal or state governments, or both, required insurers that participate in Medicare or Medicaid to also participate in the Marketplaces in the same geographic area. Such requirements could ensure more viable and less volatile insurance, benefiting people insured within each market as well as those who cycle on and off public and private insurance.

42 CFR 457.1180 - Program specific review process: Notice.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Applicant and Enrollee Protections § 457.1180 Program specific review process... explanation of applicable rights to review of that determination, the standard and expedited time frames for...

42 CFR 457.1180 - Program specific review process: Notice.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Applicant and Enrollee Protections § 457.1180 Program specific review process... explanation of applicable rights to review of that determination, the standard and expedited time frames for...

42 CFR 457.1180 - Program specific review process: Notice.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Applicant and Enrollee Protections § 457.1180 Program specific review process... explanation of applicable rights to review of that determination, the standard and expedited time frames for...

42 CFR 457.1180 - Program specific review process: Notice.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Applicant and Enrollee Protections § 457.1180 Program specific review process... explanation of applicable rights to review of that determination, the standard and expedited time frames for...

42 CFR 457.1180 - Program specific review process: Notice.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Applicant and Enrollee Protections § 457.1180 Program specific review process... explanation of applicable rights to review of that determination, the standard and expedited time frames for...

The Affordable Care Act's plan for consumer assistance with insurance moves states forward but remains a work in progress.

PubMed

Grob, Rachel; Schlesinger, Mark; Davis, Sarah; Cohen, Deborah; Lapps, Joshua

2013-02-01

The Affordable Care Act provides support for state-run consumer assistance programs to help privately insured consumers who experience problems with their coverage. Its provisions signify the first national commitment to such assistance and to using cases aggregated by these state programs to inform policy. We interviewed state-level administrators and analyzed program documents to assess whether federal support for state-run consumer assistance programs achieved certain goals. We found that some federally supported programs made substantial progress in supporting and empowering patients by reorienting state agencies to become active advocates for their citizens. Yet progress across the country was inconsistent, and there was little evidence that programs addressed systemic problems experienced by consumers. On balance, the consumer assistance provisions of health care reform do not yet ensure protection for all privately insured Americans because of uneven implementation-a problem likely to be of further concern as coverage is expanded and health insurance exchanges come on line in 2014. At the same time, the demonstrated impact of consumer assistance programs in the most innovative states is arguably a useful "proof of concept" for this young federal program.

Evaluation of a population-level strategy to promote tobacco treatment use among insured smokers: a pragmatic, randomized trial.

PubMed

McClure, Jennifer B; Anderson, Melissa L

2018-02-08

Most smokers do not use evidence-based smoking cessation treatment. Increasing utilization of these services is an important public health goal. Health care systems and insurers are well positioned to support this goal within their patient populations. We tested whether a brief, mail-based intervention increased utilization of tobacco cessation services among insured smokers. Adult smokers were identified via automated health plan data and randomized to one of five treatment arms (n = 4767). Randomization was stratified by gender, age, and type of health plan coverage. Three arms received a letter containing motivational content and treatment referral information. Motivational content emphasized either the financial, health, or values-based benefits of quitting. One arm received a referral letter with no motivational content, and one arm received no letter. Enrollment in the referred tobacco cessation program was monitored for 5 months. Treatment was available to all participants through their insurance. Across all four letter conditions, 0.8% of participants enrolled in tobacco treatment compared to 0.9% in the no letter reference group (p = .69). No single letter condition was superior to the others (p = .71), but treatment uptake was greater among participants who received their care and coverage from the health plan versus those with insurance coverage only (1.2% vs. 0.3%, p < .01). A one-time, mailed letter is not a cost-effective strategy for promoting use of covered smoking cessation treatment within large health plan populations, particularly when the message source is an insurance provider only and does not also provide clinical care. Health plans and insurers should consider alternative outreach efforts to promote treatment uptake among smokers. TRN registered retrospectively with ISRCTN registry ( www.isrctn.com ). Registered on 11/01/2018. Registration number: ISRCTN32311137 .

48 CFR 2828.307-1 - Group insurance plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Group insurance plans... CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 2828.307-1 Group insurance plans. Under cost-reimbursement contracts, before buying insurance under a group insurance plan, the contractor shall submit the...

48 CFR 2828.307-1 - Group insurance plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Group insurance plans... CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 2828.307-1 Group insurance plans. Under cost-reimbursement contracts, before buying insurance under a group insurance plan, the contractor shall submit the...

48 CFR 2828.307-1 - Group insurance plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Group insurance plans... CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 2828.307-1 Group insurance plans. Under cost-reimbursement contracts, before buying insurance under a group insurance plan, the contractor shall submit the...

75 FR 35816 - Establishment of the Consumer Operated and Oriented Plan (CO-OP) Advisory Board

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-23

... (CO-OP) Advisory Board AGENCY: Department of Health and Human Services, Office of Consumer Information & Insurance Oversight. ACTION: Federal Register Notice. Authority: The Consumer Operated and Oriented Plan (CO... (PPACA) that calls for the establishment of the Consumer Operated and Oriented Plans (CO-OP) Program...

What Americans think of the new insurance marketplaces and Medicaid expansion: findings from the Commonwealth Fund Health Insurance Marketplace Survey, 2013.

PubMed

Collins, Sara R; Rasmussen, Petra W; Doty, Michelle M; Garber, Tracy

2013-09-01

The Affordable Care Act's health insurance marketplaces are opening for enrollment on October 1, 2013. The Commonwealth Fund Health Insurance Marketplace Survey, 2013, finds that only two of five adults are aware of the marketplaces or of potential financial help that may be available to them to pay for plans purchased though the marketplaces. However, three of five adults who might be eligible for these new options said they were likely to take advantage of them. The survey also finds broad support for state expansion of the Medicaid program, even in states that have not yet decided to expand their programs. While outreach and education are critical to ensuring that those eligible for the new coverage options will enroll, the survey results suggest that eligible Americans will likely take advantage of the law's insurance reforms in the months and years to come.

48 CFR 28.307-1 - Group insurance plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 1 2014-10-01 2014-10-01 false Group insurance plans. 28... CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 28.307-1 Group insurance plans. (a) Prior approval requirement. Under cost-reimbursement contracts, before buying insurance under a group insurance plan, the...

48 CFR 28.307-1 - Group insurance plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 1 2012-10-01 2012-10-01 false Group insurance plans. 28... CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 28.307-1 Group insurance plans. (a) Prior approval requirement. Under cost-reimbursement contracts, before buying insurance under a group insurance plan, the...

48 CFR 28.307-1 - Group insurance plans.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Group insurance plans. 28... CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 28.307-1 Group insurance plans. (a) Prior approval requirement. Under cost-reimbursement contracts, before buying insurance under a group insurance plan, the...

48 CFR 428.307-1 - Group insurance plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Group insurance plans. 428... CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 428.307-1 Group insurance plans. Under cost-reimbursement contracts, before buying insurance under a group insurance plan, the contractor shall submit the...

48 CFR 428.307-1 - Group insurance plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Group insurance plans. 428... CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 428.307-1 Group insurance plans. Under cost-reimbursement contracts, before buying insurance under a group insurance plan, the contractor shall submit the...

48 CFR 428.307-1 - Group insurance plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Group insurance plans. 428... CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 428.307-1 Group insurance plans. Under cost-reimbursement contracts, before buying insurance under a group insurance plan, the contractor shall submit the...

48 CFR 28.307-1 - Group insurance plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false Group insurance plans. 28... CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 28.307-1 Group insurance plans. (a) Prior approval requirement. Under cost-reimbursement contracts, before buying insurance under a group insurance plan, the...

48 CFR 428.307-1 - Group insurance plans.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Group insurance plans. 428... CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 428.307-1 Group insurance plans. Under cost-reimbursement contracts, before buying insurance under a group insurance plan, the contractor shall submit the...

48 CFR 428.307-1 - Group insurance plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Group insurance plans. 428... CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 428.307-1 Group insurance plans. Under cost-reimbursement contracts, before buying insurance under a group insurance plan, the contractor shall submit the...

48 CFR 2828.307-1 - Group insurance plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Group insurance plans. 2828... Contracting Requirements BONDS AND INSURANCE Insurance 2828.307-1 Group insurance plans. Under cost-reimbursement contracts, before buying insurance under a group insurance plan, the contractor shall submit the...

Strategies for financing national health insurance: who wins and who loses.

PubMed

Mitchell, B M; Schwartz, W B

1976-10-14

Two sources of funds are available to underwrite the costs of any national health-insurance plan: prepayments (premiums, payroll taxes and income taxes) and out-of-pocket payments (coinsurance and deductibles). The extent to which taxes rather than premiums are used to finance an insurance program will be the major determinant of how large a share of the costs of health care will be borne by higher-income groups. The extent to which coinsurance and deductible provisions are reduced or waived for low-income persons will have a less important, but still substantial, role in determining how the costs of a program are distributed. These financing principles, once understood, provide a basis for the design of health-insurance legislation that will achieve any pattern of income redistribution that may be desired.

44 CFR 62.24 - WYO participation criteria.

Code of Federal Regulations, 2010 CFR

2010-10-01

... accounting firm performed in compliance with generally accepted accounting principles that show no material..., including marketing of flood insurance policies, the applicant will submit information concerning its plans for the WYO Program including plans for the training and support of producers and staff, marketing...

Expertise on Call.

ERIC Educational Resources Information Center

Jordan, Ronald R.

1996-01-01

College and university planned giving program administrators are advised to establish an advisory committee of financial professionals (attorneys, certified public accountants, brokers, investment advisors, financial planners, trust officers, insurance professionals) to act as a source of referrals, advice, and program support. Member selection,…

45 CFR 95.1 - Scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... of Health and Human Services GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH INSURANCE PROGRAMS) Time Limits for States To File... State to claim Federal financial participation in expenditures under State plans approved under the...

45 CFR 95.1 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH INSURANCE PROGRAMS) Time Limits for States To File... State to claim Federal financial participation in expenditures under State plans approved under the...

45 CFR 95.1 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH INSURANCE PROGRAMS) Time Limits for States To File... State to claim Federal financial participation in expenditures under State plans approved under the...

45 CFR 95.1 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH INSURANCE PROGRAMS) Time Limits for States To File... State to claim Federal financial participation in expenditures under State plans approved under the...

45 CFR 95.1 - Scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH INSURANCE PROGRAMS) Time Limits for States To File... State to claim Federal financial participation in expenditures under State plans approved under the...

45 CFR 95.505 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH INSURANCE PROGRAMS) Cost Allocation Plans § 95.505... State agency except expenditures for financial assistance, medical vendor payments, and payments for...

45 CFR 95.505 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Department of Health and Human Services (HHS) organizational components responsible for administering public... DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH INSURANCE PROGRAMS) Cost Allocation Plans § 95.505...

5 CFR 894.507 - After I'm enrolled, may I change from one dental or vision plan or plan option to another?

Code of Federal Regulations, 2011 CFR

2011-01-01

... dental or vision plan or plan option to another? 894.507 Section 894.507 Administrative Personnel OFFICE... AND VISION INSURANCE PROGRAM Enrollment and Changing Enrollment § 894.507 After I'm enrolled, may I change from one dental or vision plan or plan option to another? (a) You may change from one dental and...

5 CFR 894.507 - After I'm enrolled, may I change from one dental or vision plan or plan option to another?

Code of Federal Regulations, 2010 CFR

2010-01-01

... dental or vision plan or plan option to another? 894.507 Section 894.507 Administrative Personnel OFFICE... AND VISION INSURANCE PROGRAM Enrollment and Changing Enrollment § 894.507 After I'm enrolled, may I change from one dental or vision plan or plan option to another? (a) You may change from one dental and...

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 first private sector health insurance company in Ghana.

PubMed

Huff-Rousselle, M; Akuamoah-Boateng, J

1998-01-01

This article analyses the development of Ghana's first private sector health insurance company, the Nationwide Medical Insurance Company. Taking both policy and practical considerations into account (stakeholders' perspectives, economic viability, equity and efficiency), it is structured around key questions which help to define the position and roles of stakeholders--the insurance agency itself, contributors, beneficiaries, and providers--and how they relate to one another and the insurance scheme. These relationships will to a large extent determine Nationwide's long-term success or failure. By creating a unique alliance between physician providers and private sector companies, Nationwide has used employers' interest in cost containment and physicians' interest in expanding their client base as an entrée into the virgin territory of health insurance, and created a hybrid variety of private sector insurance with some of the attributes of a health maintenance organization or managed care. The case study is unusual in that, while public sector programs are often open to academic scrutiny, researchers have rarely had access to detailed data on the establishment of a single private sector insurance company in a developing country. Given that Ghana is planning to launch a national health insurance plan, the article concludes by considering what the experience of this private sector initiative might have to offer public sector planners.

Determinants of health insurance ownership among women in Kenya: evidence from the 2008–09 Kenya demographic and health survey

PubMed Central

2014-01-01

Background The Government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. The objective of this study was to examine the determinants associated with health insurance ownership among women in Kenya. Methods Data came from the 2008–09 Kenya Demographic and Health Survey, a nationally representative survey. The sample comprised 8,435 women aged 15–49 years. Descriptive statistics and multivariable logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with health insurance ownership. Results Being employed in the formal sector, being married, exposure to the mass media, having secondary education or higher, residing in households in the middle or rich wealth index categories and residing in a female-headed household were associated with having health insurance. However, region of residence was associated with a lower likelihood of having insurance coverage. Women residing in Central (OR = 0.4; p < 0.01) and North Eastern (OR = 0.1; p < 0.5) provinces were less likely to be insured compared to their counterparts in Nairobi province. Conclusions As the Kenyan government transforms the NHIF into a universal health program, it is important to implement a program that will increase equity and access to health care services among the poor and vulnerable groups. PMID:24678655

48 CFR 228.307-1 - Group insurance plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Group insurance plans. 228..., DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 228.307-1 Group insurance plans. The Defense Department Group Term Insurance Plan is available for contractor use under cost...

48 CFR 1228.307-1 - Group insurance plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Group insurance plans... GENERAL CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 1228.307-1 Group insurance plans. (a) Prior... basis on proposed purchases of group insurance plans. Legal advice should be sought where necessary on...

48 CFR 228.307-1 - Group insurance plans.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Group insurance plans. 228..., DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 228.307-1 Group insurance plans. The Defense Department Group Term Insurance Plan is available for contractor use under cost...

48 CFR 228.307-1 - Group insurance plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 3 2013-10-01 2013-10-01 false Group insurance plans. 228..., DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 228.307-1 Group insurance plans. The Defense Department Group Term Insurance Plan is available for contractor use under cost...

48 CFR 1228.307-1 - Group insurance plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Group insurance plans... GENERAL CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 1228.307-1 Group insurance plans. (a) Prior... basis on proposed purchases of group insurance plans. Legal advice should be sought where necessary on...

48 CFR 228.307-1 - Group insurance plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false Group insurance plans. 228..., DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 228.307-1 Group insurance plans. The Defense Department Group Term Insurance Plan is available for contractor use under cost...

48 CFR 1228.307-1 - Group insurance plans.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Group insurance plans... GENERAL CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 1228.307-1 Group insurance plans. (a) Prior... basis on proposed purchases of group insurance plans. Legal advice should be sought where necessary on...

48 CFR 1228.307-1 - Group insurance plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Group insurance plans... GENERAL CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 1228.307-1 Group insurance plans. (a) Prior... basis on proposed purchases of group insurance plans. Legal advice should be sought where necessary on...

48 CFR 228.307-1 - Group insurance plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Group insurance plans. 228..., DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 228.307-1 Group insurance plans. The Defense Department Group Term Insurance Plan is available for contractor use under cost...

Why a national high-risk insurance pool is not a workable alternative to the marketplace.

PubMed

Hall, Jean P

2014-12-01

The Pre-Existing Condition Insurance Plan (PCIP) was a national high-risk pool established under the Affordable Care Act (ACA) to provide coverage for individuals with preexisting conditions who had been uninsured for at least six months. It was intended to be a temporary program: PCIPs opened in 2010 and closed in April 2014. At that point, those with preexisting conditions could shop for health insurance in the marketplaces, where plans are prevented from using applicants' health status to deny coverage or charge more. This issue brief draws on the PCIP experience to outline why national high-risk pools, which continue to be proposed as policy alternatives to ACA coverage expansions, are expensive to enrollees as well as their administrators and ultimately unsustainable. The key lesson--and the principle on which the ACA is built--is that insurance works best when risk is evenly spread across a broad population.

Self-insured health plans

PubMed Central

McDonnell, Patricia; Guttenberg, Abbie; Greenberg, Leonard; Arnett, Ross H.

1986-01-01

Nationwide, 8 percent of all employment-related health plans were self-insured in 1984, which translates into more than 175,000 self-insured plans according to our latest study of independent health plans. The propensity of an organization to self-insure differs primarily by its size, with large establishments more likely to self-insure. In the overwhelming majority of cases, the self-insured benefit was hospital and/or medical. Among employers who self-insure, 23 percent self-administer, and the remaining 77 percent hire a commercial insurance company, Blue Cross/Blue Shield plan, or an independent third-party administrator to administer the health plan. PMID:10312008

42 CFR 457.805 - State plan requirement: Procedures to address substitution under group health plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS... child otherwise eligible for CHIP is disenrolled from coverage under a group health plan. (2) A waiting period may not be applied to a child following the loss of eligibility for and enrollment in Medicaid or...

Agriculture Insurance: Adaptation to Vulnerability of Climate Change in Bali, Indonesia

NASA Astrophysics Data System (ADS)

Ambarawati, I. G. A. A.; Hongo, C.; Mirah Adi, A. A. A.; Tamura, E.

2014-12-01

Bali province of Indonesia is worldwide known for its tourist destination and it contributes more than 60 per cent to the regional domestic product. Meanwhile, agricultural sector including rice production still plays an important role in the Bali economy because of its 30 per cent contribution. Rice production in Bali is not just susceptible to loss caused by flood, drought and pest and disease attack but also from the climate change. The impact of climate change on food production in Indonesia is expected to decline in 2050, ranging from 38 per cent to more than ten-folds of the current production (Syaukat, 2011). Accordingly, adaptation to climate changes is required to minimize the risk along with the plans and strategies for food security and sustainable development. The government of Indonesia (GoI) has launched several pilot projects including agriculture insurance program to minimize the risk in production failure particularly rice farming, unfortunately Bali was excluded from the projects. Implementation of agriculture insurance in Indonesia has the legal basis now after the announcement of the Farmer Protection and Empowerment Act (Law No. 19/2013). Agriculture insurance is seen better in mitigating farmer's risk than that of the other program in rice production. The GoI plans to implement the insurance scheme in the beginning of 2015. This scheme is something "new" to farmers in Bali and Indonesia. Considering the importance of crop insurance to agriculture, this study attempts to explore the potential of such insurance to reveal a clear picture of opportunities and challenges in agriculture insurance implementation in Bali. The study empirically presents awareness and perception of farmers towards the insurance and adaptation to vulnerability of climate change. The study concludes with various suggestions for increasing the awareness of farmers for ensuring better penetration of agriculture insurance in Bali. Key words: agriculture insurance, farmer's awareness and perception, climate change, Bali

Low-wage workers and health insurance coverage: can policymakers target them through their employers?

PubMed

Long, S H; Marquis, M S

2001-01-01

Many policy initiatives to increase health insurance coverage would subsidize employers to offer coverage or subsidize employees to participate in their employers' health plans. Using data from the 1997 Robert Wood Johnson Foundation Employer Health Insurance Survey, we contrast "low-wage employers" with all other employers. Employees in low-wage businesses have significantly worse access to employment-based insurance than other employees do; they are less likely to work for an employer that offers insurance, less likely to be eligible if working in a business that offers insurance, and less likely to be enrolled if eligible. Low-wage employers contribute lower shares of premiums and offer less generous benefits than other employers do. Policies that would target subsidies to selected employers to increase insurance offers to low-wage workers are difficult to design, however, because several commonly mentioned employer characteristics (including firm size) are found to be poor indicators of low-wage worker concentration. Programs that would set minimum standards for employer plans to be eligible for "buy-ins" need to base these standards on the less generous terms offered by low-wage employers in order to effectively reach low-wage workers and their dependents.

[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.

Comparing employer-sponsored and federal exchange plans: wide variations in cost sharing for prescription drugs.

PubMed

Buttorff, Christine; Andersen, Martin S; Riggs, Kevin R; Alexander, G Caleb

2015-03-01

Just under seven million Americans acquired private insurance through the new health insurance exchanges, or Marketplaces, in 2014. The exchange plans are required to cover essential health benefits, including prescription drugs. However, the generosity of prescription drug coverage in the plans has not been well described. Our primary objective was to examine the variability in drug coverage in the exchanges across plan types (health maintenance organization or preferred provider organization) and metal tiers (bronze, silver, gold, and platinum). Our secondary objective was to compare the exchange coverage to employer-sponsored coverage. Analyzing prescription drug benefit design data for the federally facilitated exchanges, we found wide variation in enrollees' out-of-pocket costs for generic, preferred brand-name, nonpreferred brand-name, and specialty drugs, not only across metal tiers but also within those tiers across plan types. Compared to employer-sponsored plans, exchange plans generally had lower premiums but provided less generous drug coverage. However, for low-income enrollees who are eligible for cost-sharing subsidies, the exchange plans may be more comparable to employer-based coverage. Policies and programs to assist consumers in matching their prescription drug needs with a plan's benefit design may improve the financial protection for the newly insured. Project HOPE—The People-to-People Health Foundation, Inc.

42 CFR 457.750 - Annual report.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Strategic Planning... reducing the number of uncovered, low-income children and; in meeting other strategic objectives and...

24 CFR 35.1135 - Eligible costs.

Code of Federal Regulations, 2010 CFR

2010-04-01

....1135 Eligible costs. A PHA may use financial assistance received under the modernization program (CIAP... reduction activities, and costs for insurance coverage associated with these activities. (b) Planning costs. Planning costs are costs that are incurred before HUD approval of the CGP or CIAP application and that are...

Public subsidies for employees' contributions to employer-sponsored insurance.

PubMed

Merlis, M

2001-01-01

Proposals to provide or subsidize health insurance for low-income families must take account of the fact that many workers have access to employer-sponsored insurance (ESI), but decline it because of required employee premium contributions. This article considers a tax credit for the employee share of ESI in the context of a broader program of income-based health insurance tax credits. Helping uninsured workers pay for available ESI could be more cost-effective than subsidizing their coverage in the nongroup market. The credit would also be available to workers who were already covered, both for equity reasons and to reduce the incentives for employers to drop coverage or for workers to shift to subsidized individual plans. One key issue is how to prevent employers from reducing their current health plan contributions to take advantage of the new funding. Other design questions considered by the article include whether workers should be able to choose between ESI and nongroup coverage, whether minimum benefit standards should apply for employer plans, and how to achieve a fair balance in subsidies for group and nongroup coverage.

Determinants for participation in a public health insurance program among residents of urban slums in Nairobi, Kenya: results from a cross-sectional survey.

PubMed

Kimani, James K; Ettarh, Remare; Kyobutungi, Catherine; Mberu, Blessing; Muindi, Kanyiva

2012-03-19

The government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. This paper examines the determinants associated with participation in the NHIF among residents of urban slums in Nairobi city. The study used data from the Nairobi Urban Health and Demographic Surveillance System in two slums in Nairobi city, where a total of about 60,000 individuals living in approximately 23,000 households are under surveillance. Descriptive statistics and multivariate logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with participation in the NHIF program. Only 10% of the respondents were participating in the NHIF program, while less than 1% (0.8%) had private insurance coverage. The majority of the respondents (89%) did not have any type of insurance coverage. Females were more likely to participate in the NHIF program (OR = 2.4; p < 0.001), while respondents who were formerly in a union (OR = 0.5; p < 0.05) and who were never in a union (OR = 0.6; p < 0.05) were less likely to have public insurance coverage. Respondents working in the formal employment sector (OR = 4.1; p < 0.001) were more likely to be enrolled in the NHIF program compared to those in the informal sector. Membership in microfinance institutions such as savings and credit cooperative organizations (SACCOs) and community-based savings and credit groups were important determinants of access to health insurance. The proportion of slum residents without any type of insurance is high, which underscores the need for a social health insurance program to ensure equitable access to health care among the poor and vulnerable segments of the population. As the Kenyan government moves toward transforming the NHIF into a universal health program, it is important to harness the unique opportunities offered by both the formal and informal microfinance institutions in improving health care capacity by considering them as viable financing options within a comprehensive national health financing policy framework.

Patient Protection and Affordable Care Act; standards related to reinsurance, risk corridors, and risk adjustment. Final rule.

PubMed

2012-03-23

This final rule implements standards for States related to reinsurance and risk adjustment, and for health insurance issuers related to reinsurance, risk corridors, and risk adjustment consistent with title I of the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. These programs will mitigate the impact of potential adverse selection and stabilize premiums in the individual and small group markets as insurance reforms and the Affordable Insurance Exchanges ("Exchanges") are implemented, starting in 2014. The transitional State-based reinsurance program serves to reduce uncertainty by sharing risk in the individual market through making payments for high claims costs for enrollees. The temporary Federally administered risk corridors program serves to protect against uncertainty in rate setting by qualified health plans sharing risk in losses and gains with the Federal government. The permanent State-based risk adjustment program provides payments to health insurance issuers that disproportionately attract high-risk populations (such as individuals with chronic conditions).

42 CFR 457.130 - Civil rights assurance.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Civil rights assurance. 457.130 Section 457.130...; State Plans for Child Health Insurance Programs and Outreach Strategies § 457.130 Civil rights assurance. The State plan must include an assurance that the State will comply with all applicable civil rights...

42 CFR 457.130 - Civil rights assurance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Civil rights assurance. 457.130 Section 457.130...; State Plans for Child Health Insurance Programs and Outreach Strategies § 457.130 Civil rights assurance. The State plan must include an assurance that the State will comply with all applicable civil rights...

42 CFR 457.130 - Civil rights assurance.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Civil rights assurance. 457.130 Section 457.130...; State Plans for Child Health Insurance Programs and Outreach Strategies § 457.130 Civil rights assurance. The State plan must include an assurance that the State will comply with all applicable civil rights...

42 CFR 457.130 - Civil rights assurance.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Civil rights assurance. 457.130 Section 457.130...; State Plans for Child Health Insurance Programs and Outreach Strategies § 457.130 Civil rights assurance. The State plan must include an assurance that the State will comply with all applicable civil rights...

42 CFR 457.140 - Budget.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Budget. 457.140 Section 457.140 Public Health... Child Health Insurance Programs and Outreach Strategies § 457.140 Budget. The State plan, or plan amendment that has a significant impact on the approved budget, must include a budget that describes the...

76 FR 41865 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-15

... Organization IHS Indian Health Service IRS Internal Revenue Service NAIC National Association of Insurance... Organization QHP Qualified Health Plan SHOP Small Business Health Options Program SSA Social Security... (IHS), Indian tribes, tribal organizations, and urban Indian organizations. We propose some provisions...

How does beneficiary knowledge of the Medicare program vary by type of insurance?

PubMed

McCormack, Lauren A; Uhrig, Jennifer D

2003-08-01

Prior research found that Medicare beneficiaries' knowledge of the Medicare program varied by the type of supplemental insurance they had. However, none of these studies used both multivariate methods and nationally representative data to examine the issue. OBJECTIVES To measure beneficiary knowledge of the Medicare program and to evaluate how knowledge varies by type of supplemental insurance. A mail survey with telephone follow-up to a nationally representative random sample of Medicare beneficiaries, which had a 76% response rate. The purpose of the study was to evaluate the effects of providing the Medicare & You handbook on beneficiary knowledge, information needs, and health plan decision making. A total of 3738 Medicare beneficiaries who completed the survey. A psychometrically validated 22-item index that reflects Medicare-related knowledge in seven different content areas. RESULTS Overall, beneficiaries with a Medicare HMO or non-employer-sponsored supplemental insurance were more knowledgeable about Medicare than those who had Medicare only. In general, beneficiaries tended to be more knowledgeable about issues related to the type of insurance they had (fee-for-service or managed care) than other types of insurance. Higher levels of knowledge about one's own type of insurance may suggest that beneficiaries learn by experience or they learn more about that type of insurance before enrollment. Further research is needed to better understand how and when beneficiaries learn about insurance and what educational strategies are more effective at increasing knowledge.

Health Promotion and the Costs of Illness.

ERIC Educational Resources Information Center

Rosenstein, Alan H.

1989-01-01

As industry, individuals, and insurance providers realize the benefits of disease prevention, the demand for information and services will grow. Health promotion activities should be tapered to individual needs and resource requirements of the institution planning the program. Programs should include screening procedures to identify underlying…

48 CFR 1028.307-1 - Group insurance plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Group insurance plans. 1028.307-1 Section 1028.307-1 Federal Acquisition Regulations System DEPARTMENT OF THE TREASURY GENERAL CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 1028.307-1 Group insurance plans. (a) Plans shall be...

48 CFR 1028.307-1 - Group insurance plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Group insurance plans. 1028.307-1 Section 1028.307-1 Federal Acquisition Regulations System DEPARTMENT OF THE TREASURY GENERAL CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 1028.307-1 Group insurance plans. (a) Plans shall be...

48 CFR 1028.307-1 - Group insurance plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Group insurance plans. 1028.307-1 Section 1028.307-1 Federal Acquisition Regulations System DEPARTMENT OF THE TREASURY GENERAL CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 1028.307-1 Group insurance plans. (a) Plans shall be...

48 CFR 1028.307-1 - Group insurance plans.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Group insurance plans. 1028.307-1 Section 1028.307-1 Federal Acquisition Regulations System DEPARTMENT OF THE TREASURY GENERAL CONTRACTING REQUIREMENTS BONDS AND INSURANCE Insurance 1028.307-1 Group insurance plans. (a) Plans shall be...

41 CFR 60-741.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Health insurance, life insurance and other benefit plans. 60-741.25 Section 60-741.25 Public Contracts and Property Management... Health insurance, life insurance and other benefit plans. (a) An insurer, hospital, or medical service...

Findings from the 2011 EBRI/MGA Consumer Engagement in Health Care Survey.

PubMed

Fronstin, Paul

2011-12-01

SEVENTH ANNUAL SURVEY: This Issue Brief presents findings from the 2011 EBRI/MGA Consumer Engagement in Health Care Survey. This study is based on an online survey of 4,703 privately insured adults ages 21-64 to provide nationally representative data regarding the growth of consumer-driven health plans (CDHPs) and high-deductible health plans (HDHPs), and the impact of these plans and consumer engagement more generally on the behavior and attitudes of adults with private health insurance coverage. Findings from this survey are compared with EBRI's findings from earlier surveys. ENROLLMENT CONTINUES TO GROW: The survey finds continued growth in consumer-driven health plans: In 2011, 7 percent of the population was enrolled in a CDHP, up from 5 percent in 2010. Enrollment in HDHPs increased from 14 percent in 2010 to 16 percent in 2011. The 7 percent of the population with a CDHP represents 8.4 million adults ages 21-64 with private insurance, while the 16 percent with a HDHP represents 19.3 million people. Among the 19.3 million individuals with an HDHP, 38 percent (or 7.3 million) reported that they were eligible for a health savings ccount (HSA) but did not have such an account. Overall, 15.8 million adults ages 21-64 with private insurance, representing 13.1 percent of that market, were either in a CDHP or were in an HDHP that was eligible for an HSA but had not opened the account. When their children are counted, about 21 million individuals with private insurance, representing about 12 percent of the market, were either in a CDHP or an HSA-eligible plan. MORE COST-CONSCIOUS BEHAVIOR: Individuals in CDHPs were more likely than those with traditional coverage to exhibit a number of cost-conscious behaviors. They were more likely to say that they had checked whether their plan would cover care; asked for a generic drug instead of a brand name; talked to their doctor about treatment options and costs; talked to their doctor about prescription drug options and costs; developed a budget to manage health care expenses; checked a price of service before getting care; and used an online cost-tracking tool. CDHP ENROLLEES MORE ENGAGED IN WELLNESS PROGRAMS: CDHP enrollees were more likely than traditional plan enrollees to report that they had the opportunity to fill out a health risk assessment, and they were also more likely to report that they had access to a health promotion program. CDHP enrollees were also more likely to report that they had been offered a cash incentive or reward to participate in a wellness program when a program was offered. HDHP enrollees were less likely to report having the opportunity to fill out a health risk assessment and to have access to a health promotion program. FINANCIAL INCENTIVES MATTER: When it comes to participating in a wellness program, CDHP enrollees were more likely than traditional plan enrollees to take advantage of the health risk assessment but not the health promotion program. Among those participating, the reasons they gave were that they were offered incentive prizes and reduced premiums. Among those not participating, the reasons they gave were that they could make changes on their own; they lacked time; and they were already healthy. Financial incentives were more a factor for CDHP enrollees than for traditional plan enrollees when it came to participating in wellness programs. CONSUMER USE OF TECHNOLOGY: A significant portion of the population reported using a smartphone, and 1 in 5 reported using a tablet. Among them, about one-quarter reported using an app for health-related purposes. Among those not using an app, nearly one-half were interested in using one.

Are Integrated Plan Providers Associated With Lower Premiums on the Health Insurance Marketplaces?

PubMed

La Forgia, Ambar; Maeda, Jared Lane K; Banthin, Jessica S

2018-04-01

As the health insurance industry becomes more consolidated, hospitals and health systems have started to enter the insurance business. Insurers are also rapidly acquiring providers. Although these "vertically" integrated plan providers are small players in the insurance market, they are becoming more numerous. The health insurance marketplaces (HIMs) offer a unique setting to study integrated plan providers relative to other insurer types because the HIMs were designed to promote competition. In this descriptive study, the authors compared the premiums of the lowest priced silver plans of integrated plan providers with other insurer types on the 2015 and 2016 HIMs. Integrated plan providers were associated with modestly lower premiums relative to most other insurer types. This study provides early insights into premium competition on the HIMs. Examining integrated plan providers as a separate insurer type has important policy implications because they are a growing segment of the marketplaces and their pricing behavior may influence future premium trends.

45 CFR 95.505 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... assistance programs. These components are the Administration for Children and Families (ACF) and the Centers... 45 Public Welfare 1 2013-10-01 2013-10-01 false Definitions. 95.505 Section 95.505 Public Welfare... ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH INSURANCE PROGRAMS) Cost Allocation Plans § 95.505...

45 CFR 95.505 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... assistance programs. These components are the Administration for Children and Families (ACF) and the Centers... 45 Public Welfare 1 2014-10-01 2014-10-01 false Definitions. 95.505 Section 95.505 Public Welfare... ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH INSURANCE PROGRAMS) Cost Allocation Plans § 95.505...

State of emergency preparedness for US health insurance plans.

PubMed

Merchant, Raina M; Finne, Kristen; Lardy, Barbara; Veselovskiy, German; Korba, Caey; Margolis, Gregg S; Lurie, Nicole

2015-01-01

Health insurance plans serve a critical role in public health emergencies, yet little has been published about their collective emergency preparedness practices and policies. We evaluated, on a national scale, the state of health insurance plans' emergency preparedness and policies. A survey of health insurance plans. We queried members of America's Health Insurance Plans, the national trade association representing the health insurance industry, about issues related to emergency preparedness issues: infrastructure, adaptability, connectedness, and best practices. Of 137 health insurance plans queried, 63% responded, representing 190.6 million members and 81% of US plan enrollment. All respondents had emergency plans for business continuity, and most (85%) had infrastructure for emergency teams. Some health plans also have established benchmarks for preparedness (eg, response time). Regarding adaptability, 85% had protocols to extend claim filing time and 71% could temporarily suspend prior medical authorization rules. Regarding connectedness, many plans shared their contingency plans with health officials, but often cited challenges in identifying regulatory agency contacts. Some health insurance plans had specific policies for assisting individuals dependent on durable medical equipment or home healthcare. Many plans (60%) expressed interest in sharing best practices. Health insurance plans are prioritizing emergency preparedness. We identified 6 policy modifications that health insurance plans could undertake to potentially improve healthcare system preparedness: establishing metrics and benchmarks for emergency preparedness; identifying disaster-specific policy modifications, enhancing stakeholder connectedness, considering digital strategies to enhance communication, improving support and access for special-needs individuals, and developing regular forums for knowledge exchange about emergency preparedness.

75 FR 70159 - Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

... Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered Health Plan... contracts of insurance. The temporary regulations provide guidance to employers, group health plans, and health insurance issuers providing group health insurance coverage. The IRS is issuing the temporary...

Fraud and fiduciary liability.

PubMed

Hodge, Brian Ray

2003-12-01

All employee benefit plans are potential targets of fraudulent schemes. Smaller plans are targeted by unscrupulous brokers and promoters selling fraudulent policies; plans large enough to be self-insured face greater risks of fraud by providers and participants misrepresenting claims. Plan trustees, administrators and consultants should be alert to the many ways fraudulent schemes manifest themselves and to the legal remedies available; establish investigative programs to detect and discourage fraud; and promote education and plan incentives for participants to report fraud.

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.

42 CFR 457.320 - Other eligibility standards.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., if the State is the State of residence of the child's custodial parent or caretaker at the time of... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan... children related to— (1) Geographic area(s) served by the plan; (2) Age (up to, but not including, age 19...

42 CFR 457.320 - Other eligibility standards.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., if the State is the State of residence of the child's custodial parent or caretaker at the time of... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan... children related to— (1) Geographic area(s) served by the plan; (2) Age (up to, but not including, age 19...

School-Sponsored Health Insurance: Planning for a New Reality

ERIC Educational Resources Information Center

Liang, Bryan A.

2010-01-01

Health care reform efforts in both the Clinton and Obama administrations have attempted to address college and university health. Yet, although the world of health care delivery has almost universally evolved to managed care, school health programs have not. In general, school-sponsored health plans do little to improve access and have adopted…

5 CFR 894.512 - What happens if I leave Federal Government and then return?

Code of Federal Regulations, 2010 CFR

2010-01-01

... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM... before you separated. Exceptions: (i) If you were enrolled in a dental or vision plan with a restricted... different dental or vision plan that serves that area. (ii) If you have since gained or lost an eligible...

5 CFR 894.801 - Will benefits be available in underserved areas?

Code of Federal Regulations, 2011 CFR

2011-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Benefits in Underserved Areas § 894.801 Will benefits be available in underserved areas? (a) Dental and vision plans under... underserved areas. (b) In any area where a FEDVIP dental or vision plan does not meet OPM access standards...

5 CFR 894.801 - Will benefits be available in underserved areas?

Code of Federal Regulations, 2010 CFR

2010-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Benefits in Underserved Areas § 894.801 Will benefits be available in underserved areas? (a) Dental and vision plans under... underserved areas. (b) In any area where a FEDVIP dental or vision plan does not meet OPM access standards...

5 CFR 894.512 - What happens if I leave Federal Government and then return?

Code of Federal Regulations, 2011 CFR

2011-01-01

... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM... before you separated. Exceptions: (i) If you were enrolled in a dental or vision plan with a restricted... different dental or vision plan that serves that area. (ii) If you have since gained or lost an eligible...

76 FR 37037 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-24

... Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and... interim final regulations published July 23, 2010 with respect to group health plans and health insurance..., group health plans, and health insurance issuers providing group health insurance coverage. The text of...

Medicare overpayments to private plans, 1985-2012: shifting seniors to private plans has already cost Medicare US$282.6 billion.

PubMed

Hellander, Ida; Himmelstein, David U; Woolhandler, Steffie

2013-01-01

Previous research has documented Medicare overpayments to the private Medicare Advantage (MA) plans that compete with traditional fee-for-service Medicare. This research has assessed individual categories of overpayment for, at most, a few years. However, no study has calculated the total overpayments to private plans since the program's inception. Prior to 2004, selective enrollment of healthier seniors was the major source of excess payments. We estimate this has added US$41 billion to Medicare's costs since 1985. Medicare adopted a risk-adjustment scheme in 2004, but this has not curbed private plans' ability to game the payment system. This has added US$122.5 billion to Medicare's costs since 2004. Congress mandated increased payment to private plans in the 2003 Medicare Modernization Act, which was mitigated, to a degree, by the subsequent Affordable Care Act. In total, we find that Medicare has overpaid private insurers by US$282.6 billion since 1985. Risk adjustment does not work in for-profit MA plans, which have a financial incentive, the data, and the ingenuity to game whatever system Medicare devises. It is time to end Medicare's costly experiment with privatization. The U.S. needs to adopt a single-payer national health insurance program with effective methods for controlling costs.

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.

7 CFR 23.4 - State Rural Development Advisory Council.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Development Advisory Council will insure that programs proposed under title V including regional programs... 7 Agriculture 1 2010-01-01 2010-01-01 false State Rural Development Advisory Council. 23.4 Section 23.4 Agriculture Office of the Secretary of Agriculture STATE AND REGIONAL ANNUAL PLANS OF WORK State...

45 CFR 618.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... FOUNDATION NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 618... shall not discriminate on the basis of sex, or provide such benefit, service, policy, or plan in a...

42 CFR 457.301 - Definitions and use of terms.

Code of Federal Regulations, 2012 CFR

2012-10-01

... under the Child Care and Development Block Grant Act of 1990; (4) Is authorized to determine eligibility of an infant or child to receive assistance under the special nutrition program for women, infants... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan...

42 CFR 457.301 - Definitions and use of terms.

Code of Federal Regulations, 2011 CFR

2011-10-01

... under the Child Care and Development Block Grant Act of 1990; (4) Is authorized to determine eligibility of an infant or child to receive assistance under the special nutrition program for women, infants... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan...

42 CFR 457.301 - Definitions and use of terms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... under the Child Care and Development Block Grant Act of 1990; (4) Is authorized to determine eligibility of an infant or child to receive assistance under the special nutrition program for women, infants... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan...

42 CFR 457.301 - Definitions and use of terms.

Code of Federal Regulations, 2013 CFR

2013-10-01

... under the Child Care and Development Block Grant Act of 1990; (4) Is authorized to determine eligibility of an infant or child to receive assistance under the special nutrition program for women, infants... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan...

42 CFR 457.301 - Definitions and use of terms.

Code of Federal Regulations, 2014 CFR

2014-10-01

... under the Child Care and Development Block Grant Act of 1990; (4) Is authorized to determine eligibility of an infant or child to receive assistance under the special nutrition program for women, infants... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan...

Overcoming Barriers to Implementing Outdoor and Environmental Education (Continued): Safety/Legal Liability.

ERIC Educational Resources Information Center

Hanna, Glenda

1994-01-01

A risk management plan for outdoor education programs should include procedures for regular program implementation, as well as rescue, first aid, and accident follow-up procedures. Stresses understanding legal and ethical responsibilities and the importance of sufficient insurance protection. Includes suggestions for dealing with conflicts in…

45 CFR 152.40 - Relation to State laws.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Relation to State laws. 152.40 Section 152.40...-EXISTING CONDITION INSURANCE PLAN PROGRAM Relationship to Existing Laws and Programs § 152.40 Relation to State laws. The standards established under this section shall supersede any State law or regulation...

5 CFR 892.101 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... employee or eligible family member loses coverage under FEHB or another group insurance coverage including... health plan as described in § 890.301 (i)(6). (11) An employee or eligible family member gains coverage.... FEHB Program means the Federal Employees Health Benefits Program described in 5 U.S.C. 8901. Open...

45 CFR 152.39 - Maintenance of effort.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-EXISTING CONDITION INSURANCE PLAN PROGRAM Relationship to Existing Laws and Programs § 152.39 Maintenance... the contract is entered. (b) Failure to maintain efforts. In situations where a State enters into a..., against any State that fails to maintain funding levels for existing State high risk pools as required...

Guide to Pertinent Articles for School Business Officials Published in 1969

ERIC Educational Resources Information Center

Yankow, Henry; And Others

1970-01-01

Annual review of periodical literature covering areas of interest in accounting and finance, school law, purchasing/supply control, safety and insurance, school lunch programs, school planning, and maintenance. (LN)

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.

24 CFR 203.200 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... FAMILY MORTGAGE INSURANCE Eligibility Requirements and Underwriting Procedures Insured Ten-Year... covered by an insured ten-year protection plan that are attributable to poor workmanship or to the use of... obligations by one or more insurance companies. Insured ten-year protection plan or Plan means an agreement...

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

77 FR 47573 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-09

... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Parts 40 and 46 [REG-136008-11] RIN 1545-BK59 Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes... on issuers of certain health insurance policies and plan sponsors of certain self-insured health...

20 CFR 323.2 - Definition of nongovernmental plan for unemployment or sickness insurance.

Code of Federal Regulations, 2010 CFR

2010-04-01

... unemployment or sickness insurance. 323.2 Section 323.2 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.2 Definition of nongovernmental plan for unemployment or sickness insurance. A...

20 CFR 323.2 - Definition of nongovernmental plan for unemployment or sickness insurance.

Code of Federal Regulations, 2014 CFR

2014-04-01

... unemployment or sickness insurance. 323.2 Section 323.2 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.2 Definition of nongovernmental plan for unemployment or sickness insurance. A...

20 CFR 323.2 - Definition of nongovernmental plan for unemployment or sickness insurance.

Code of Federal Regulations, 2011 CFR

2011-04-01

... unemployment or sickness insurance. 323.2 Section 323.2 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.2 Definition of nongovernmental plan for unemployment or sickness insurance. A...

20 CFR 323.2 - Definition of nongovernmental plan for unemployment or sickness insurance.

Code of Federal Regulations, 2013 CFR

2013-04-01

... unemployment or sickness insurance. 323.2 Section 323.2 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.2 Definition of nongovernmental plan for unemployment or sickness insurance. A...

20 CFR 323.2 - Definition of nongovernmental plan for unemployment or sickness insurance.

Code of Federal Regulations, 2012 CFR

2012-04-01

... unemployment or sickness insurance. 323.2 Section 323.2 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.2 Definition of nongovernmental plan for unemployment or sickness insurance. A...

75 FR 34537 - Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-17

... 45 CFR Part 147 Group Health Plans and Health Insurance Coverage Relating to Status as a... for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan... group health plans and health insurance coverage in the group and individual markets under provisions of...

Self-insurance and the potential effects of health reform on the small-group market.

PubMed

Linehan, Kathryn

2010-12-21

The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care Education Reconciliation Act of 2010 makes landmark changes to health insurance markets. Individual and small-group insurance plans and markets will see the biggest changes, but PPACA also affects large employer and self-insured plans by imposing rules for benefit design and health plan practices. Over half of workers--most often those in very large firms--are covered by self-insured health plans in which employers (or employee groups) bear all or some of the risk of providing insurance coverage to a defined population of workers and their dependents. As PPACA provisions become effective, some have argued that smaller firms that offer insurance may opt to self-insure their health benefits because of new small-group market rules. Such a shift could affect risk pooling in the small-group market. This paper examines the definition and prevalence of self-insured health plans, the application of PPACA provisions to these plans, and the possible effects on the broader health insurance market, should many more employers decide to self-insure.

29 CFR 2590.715-2711 - No lifetime or annual limits.

Code of Federal Regulations, 2010 CFR

2010-07-01

... paragraph (b) of this section, a group health plan, or a health insurance issuer offering group health... section, a group health plan, or a health insurance issuer offering group health insurance coverage, may... do not prevent a group health plan, or a health insurance issuer offering group health insurance...

26 CFR 1.105-11 - Self-insured medical reimbursement plan.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 2 2014-04-01 2014-04-01 false Self-insured medical reimbursement plan. 1.105... Self-insured medical reimbursement plan. (a) In general. Under section 105(a), amounts received by an employee through a self-insured medical reimbursement plan which are attributable to contributions of the...

26 CFR 1.105-11 - Self-insured medical reimbursement plan.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 2 2011-04-01 2011-04-01 false Self-insured medical reimbursement plan. 1.105... Self-insured medical reimbursement plan. (a) In general. Under section 105(a), amounts received by an employee through a self-insured medical reimbursement plan which are attributable to contributions of the...

26 CFR 1.105-11 - Self-insured medical reimbursement plan.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 2 2012-04-01 2012-04-01 false Self-insured medical reimbursement plan. 1.105... Self-insured medical reimbursement plan. (a) In general. Under section 105(a), amounts received by an employee through a self-insured medical reimbursement plan which are attributable to contributions of the...

26 CFR 1.105-11 - Self-insured medical reimbursement plan.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Self-insured medical reimbursement plan. 1.105... Self-insured medical reimbursement plan. (a) In general. Under section 105(a), amounts received by an employee through a self-insured medical reimbursement plan which are attributable to contributions of the...

26 CFR 1.105-11 - Self-insured medical reimbursement plan.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 2 2013-04-01 2013-04-01 false Self-insured medical reimbursement plan. 1.105... Self-insured medical reimbursement plan. (a) In general. Under section 105(a), amounts received by an employee through a self-insured medical reimbursement plan which are attributable to contributions of the...

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

42 CFR 457.805 - State plan requirement: Procedures to address substitution under group health plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) The child lost coverage due to the death or divorce of a parent. [78 FR 42313, July 15, 2013] ... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS... from the date a child otherwise eligible for CHIP is disenrolled from coverage under a group health...

5 CFR 894.204 - May I be enrolled in more than one dental or vision plan at a time?

Code of Federal Regulations, 2011 CFR

2011-01-01

... or vision plan at a time? 894.204 Section 894.204 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Coverage and Types of Enrollment § 894.204 May I be enrolled in more than one dental or vision...

5 CFR 894.204 - May I be enrolled in more than one dental or vision plan at a time?

Code of Federal Regulations, 2010 CFR

2010-01-01

... or vision plan at a time? 894.204 Section 894.204 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Coverage and Types of Enrollment § 894.204 May I be enrolled in more than one dental or vision...

34 CFR 682.418 - Prohibited uses of the assets of the Operating Fund during periods in which the Operating Fund...

Code of Federal Regulations, 2011 CFR

2011-07-01

..., pension plan costs, post-retirement health benefits, employee life insurance, unemployment benefit plans... used to promote or maintain a favorable image of the guaranty agency. The term “public relations” does... relations activities include training of program participants and secondary school personnel and customer...

Technology Assessment for Future MILSATCOM Systems; An Update of the EHF Bands

DTIC Science & Technology

1980-10-01

converging these efforts, the MSO has prepared a "Technology Development Program Plan" ( TDPP ). The TOPP defines a coordinated approach to the R&D...required to insure the availability of the technology necessary to support future systems. Some of the objectives of the TDPP are: to minimize...and TDPP have illuminated the need for technology development efforts directed toward minimizing the cost- risk and schedule-risk, and insuring the

75 FR 37242 - Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-28

... Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and Affordable... Labor and the Office of Consumer Information and Insurance Oversight of the U.S. Department of Health... guidance to employers, group health plans, and health insurance issuers providing group health insurance...

Guidelines for designing short-term bird monitoring projects

Treesearch

Jonathan Bart

2005-01-01

The Coordinated Bird Monitoring Program (Bart and Ralph, this volume) program is helping biologists around the country design short-term monitoring projects for birds. We have found that addressing a series of questions (table 1), in a systematic way, helps insure that projects are well planned. The process is being used by several States and...

Community-Based Facilitated Enrollment: Meeting Uninsured New Yorkers Where They Are.

ERIC Educational Resources Information Center

Lawler, Kate; Costello, Anne Marie

2005-01-01

In 1998, Governor Pataki and New York legislators created one of the country's most innovative programs for enrolling uninsured children and teens in public health insurance. Launched in 2000, the facilitated enrollment program uses community-based organizations and health plans to find and enroll "hard-to-reach" New Yorkers who have historically…

76 FR 44491 - Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

... 37208) entitled, ``Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims..., ``Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and... external review processes for group health plans and health insurance issuers offering coverage in the...

26 CFR 54.9815-2719T - Internal claims and appeals and external review processes (temporary).

Code of Federal Regulations, 2012 CFR

2012-04-01

... external review processes for group health plans and health insurance issuers that are not grandfathered...) In general. A group health plan and a health insurance issuer offering group health insurance...). (2) Requirements for group health plans and group health insurance issuers. A group health plan and a...

26 CFR 54.9815-2719T - Internal claims and appeals and external review processes (temporary).

Code of Federal Regulations, 2011 CFR

2011-04-01

... external review processes for group health plans and health insurance issuers that are not grandfathered...) In general. A group health plan and a health insurance issuer offering group health insurance...). (2) Requirements for group health plans and group health insurance issuers. A group health plan and a...

26 CFR 54.9815-2719T - Internal claims and appeals and external review processes (temporary).

Code of Federal Regulations, 2014 CFR

2014-04-01

... external review processes for group health plans and health insurance issuers that are not grandfathered...) In general. A group health plan and a health insurance issuer offering group health insurance...). (2) Requirements for group health plans and group health insurance issuers. A group health plan and a...

26 CFR 54.9815-2719T - Internal claims and appeals and external review processes (temporary).

Code of Federal Regulations, 2013 CFR

2013-04-01

... external review processes for group health plans and health insurance issuers that are not grandfathered...) In general. A group health plan and a health insurance issuer offering group health insurance...). (2) Requirements for group health plans and group health insurance issuers. A group health plan and a...

The medical care programs of the Farm Security Administration, 1932 through 1947: a rehearsal for national health insurance?

PubMed Central

Grey, M R

1994-01-01

At a time of renewed interest in universal health insurance, an examination of earlier periods when society grappled with the link between socioeconomic status and health is fruitful. Between 1935 and 1947, the federal government sponsored a comprehensive medical care program for low-income farmers, sharecroppers, and migrant workers under the auspices of the Farm Security Administration (FSA). Despite the strong opposition of the American Medical Association, humanitarian and economic concerns at the local level often promoted physicians' participation in the program's group prepayment plans. Many FSA leaders clearly saw the program as a model upon which national health insurance might advance. However, in the wake of World War II, the FSA program declined as physicians' income improved, the rural population declined, and traditional ideological objections to federal intervention in medical care resurfaced. The FSA experience illuminates the complex ideological, economic, and humanitarian motivations of American physicians in the face of health care reform. Images p1680-a p1682-a p1684-a PMID:7943497

Projecting the Unmet Need and Costs for Contraception Services After the Affordable Care Act

PubMed Central

Steinmetz, Erika; Gavin, Lorrie; Rivera, Maria I.; Pazol, Karen; Moskosky, Susan; Weik, Tasmeen; Ku, Leighton

2016-01-01

Objectives. We estimated the number of women of reproductive age in need who would gain coverage for contraceptive services after implementation of the Affordable Care Act, the extent to which there would remain a need for publicly funded programs that provide contraceptive services, and how that need would vary on the basis of state Medicaid expansion decisions. Methods. We used nationally representative American Community Survey data (2009), to estimate the insurance status for women in Massachusetts and derived the numbers of adult women at or below 250% of the federal poverty level and adolescents in need of confidential services. We extrapolated findings to simulate the impact of the Affordable Care Act nationally and by state, adjusting for current Medicaid expansion and state Medicaid Family Planning Expansion Programs. Results. The number of low-income women at risk for unintended pregnancy is expected to decrease from 5.2 million in 2009 to 2.5 million in 2016, based on states’ current Medicaid expansion plans. Conclusions. The Affordable Care Act increases women’s insurance coverage and improves access to contraceptive services. However, for women who remain uninsured, publicly funded family planning programs may still be needed. PMID:26691128

Small Group Health Insurance Reform in Rhode Island: Promises and Pitfalls of the HEALTHpact Plan

PubMed Central

Alan Miller, Edward; Trivedi, Amal; Kuo, Sylvia; Mor, Vincent

2011-01-01

Objective This study analyzes what design elements inhibited enrollment in HEALTHpact. Study Setting HEALTHpact is a high deductible plan with a premium capped at 10 percent of the average Rhode Island wage. Deductibles are reduced if enrollees meet wellness criteria. Study Design Qualitative case study. Data Collection Archival documents and 23 interviews. Principal Findings Inclusion of a subsidy would have led to lower premiums and more generous coverage. Although priced lower than other plans, HEALTHpact still did not offer good value for most firms. Wellness incentives also were too complex. Conclusions Subsidies for purchase of insurance coverage are critical to national reform of the small group market. Designers also will need to carefully balance program complexity with innovation in encouraging wellness and product appeal. PMID:21054375

Understanding health insurance plans

MedlinePlus

... page: //medlineplus.gov/ency/patientinstructions/000879.htm Understanding health insurance plans To use the sharing features on this ... plan for you and your family. Types of Health Insurance Plans Depending on how you get your health ...

Health Insurance and Risk of Divorce: Does Having Your Own Insurance Matter?

PubMed Central

Sohn, Heeju

2016-01-01

Most American adults under 65 obtain health insurance through their employers or their spouses’ employers. The absence of a universal healthcare system in the United States puts Americans at considerable risk for losing their coverage when transitioning out of jobs or marriages. Scholars have found evidence of reduced job mobility among individuals who are dependent on their employers for healthcare coverage. This paper finds similar relationships between insurance and divorce. I apply the hazard model to married individuals in the longitudinal Survey of Income Program Participation (N=17,388) and find lower divorce rates among people who are insured through their partners’ plans without alternative sources of their own. Furthermore, I find gender differences in the relationship between healthcare coverage and divorce rates: insurance dependent women have lower rates of divorce than men in similar situations. These findings draw attention to the importance of considering family processes when debating and evaluating health policies. PMID:26949269

5 CFR 894.508 - When may I increase my type of enrollment?

Code of Federal Regulations, 2011 CFR

2011-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Enrollment and... pay period in which you make the change. (e) You may not change from one dental or vision plan to...

5 CFR 894.510 - When may I decrease my type of enrollment?

Code of Federal Regulations, 2011 CFR

2011-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Enrollment and... change is based. (e) You may not change from one dental or vision plan or option to another, except as...

5 CFR 894.508 - When may I increase my type of enrollment?

Code of Federal Regulations, 2010 CFR

2010-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Enrollment and... pay period in which you make the change. (e) You may not change from one dental or vision plan to...

5 CFR 894.510 - When may I decrease my type of enrollment?

Code of Federal Regulations, 2010 CFR

2010-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Enrollment and... following the one in which you make the change. (e) You may not change from one dental or vision plan or...

75 FR 80817 - Office of Consumer Information and Insurance Oversight; Agency Information Collection Activities...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-23

... implementing regulations at 45 CFR part 149, employment-based plans that offer health benefits to early retirees and their spouses, surviving spouses and dependents are eligible under a temporary program to...

45 CFR 152.22 - Access to services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... CONDITION INSURANCE PLAN PROGRAM Benefits § 152.22 Access to services. (a) General rule. A PCIP may specify... failure to obtain immediate treatment could present a serious risk to his or her life or health; and (2...

Steps to reduce favorable risk selection in medicare advantage largely succeeded, boding well for health insurance exchanges

PubMed Central

Newhouse, Joseph P.; Price, Mary; Huang, Jie; McWilliams, J. Michael; Hsu, John

2012-01-01

Managing competition among health plans that attract different risks has been a challenging policy problem. Within Medicare, the Medicare Advantage (MA) program historically attracted better risks than did Traditional Medicare (TM). This favorable selection resulted in Medicare’s paying more for persons enrolled in MA than if they had been enrolled in TM. We studied whether policies Medicare implemented in the past decade to reduce favorable selection in the MA program succeeded, in particular improved matching of reimbursement with a beneficiary’s expected cost and restricting when beneficiaries could switch from MA to TM. We found they did. Differences in predicted spending between those switching from TM to MA relative to those who remained in TM markedly narrowed, as did adjusted mortality rates. Because insurance exchanges will employ similar policies to combat selection, our results give reason for optimism about managing competition among health plans. PMID:23213145

Financial barriers to implementing combination vaccines: perspectives from pediatricians and policy makers.

PubMed

Gidengil, Courtney A; Rusinak, Donna; Allred, Norma J; Luff, Donna; Lee, Grace M; Lieu, Tracy A

2009-06-01

To describe the factors that affect the use of new combination vaccines, the authors conducted qualitative interviews with pediatricians (n = 7), state immunization program managers (n = 7), and health insurance plan representatives (n = 6 plans). Respondents from each group identified reduction in pain and potentially increased immunization coverage as key benefits of new combination vaccines. For several pediatricians, low reimbursement for cost of vaccine doses and potential loss of fees for vaccine administration were barriers to using combination vaccines. For most state immunization programs, the higher cost of combination vaccines relative to separate vaccines was an important consideration but not a barrier to adoption. Most insurers were not aware of the financial issues for providers, but some had changed or were willing to change reimbursement to support the use of new combination vaccines. Financial issues for pediatric practices that purchase and provide vaccines for children may be an important barrier to offering combination vaccines.

75 FR 34571 - Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-17

... Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered Health Plan... of Consumer Information and Insurance Oversight of the U.S. Department of Health and Human Services... health insurance coverage offered in connection with a group health plan under the Employee Retirement...

24 CFR 203.203 - Issuance and nature of insured 10-year protection plans.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Issuance and nature of insured 10-year protection plans. 203.203 Section 203.203 Housing and Urban Development Regulations Relating to... Underwriting Procedures Insured Ten-Year Protection Plans (plan) § 203.203 Issuance and nature of insured 10...

24 CFR 203.203 - Issuance and nature of insured 10-year protection plans.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Issuance and nature of insured 10-year protection plans. 203.203 Section 203.203 Housing and Urban Development Regulations Relating to... Underwriting Procedures Insured Ten-Year Protection Plans (plan) § 203.203 Issuance and nature of insured 10...

24 CFR 203.203 - Issuance and nature of insured 10-year protection plans.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Issuance and nature of insured 10-year protection plans. 203.203 Section 203.203 Housing and Urban Development Regulations Relating to... Underwriting Procedures Insured Ten-Year Protection Plans (plan) § 203.203 Issuance and nature of insured 10...

24 CFR 203.203 - Issuance and nature of insured 10-year protection plans.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Issuance and nature of insured 10-year protection plans. 203.203 Section 203.203 Housing and Urban Development Regulations Relating to... Underwriting Procedures Insured Ten-Year Protection Plans (plan) § 203.203 Issuance and nature of insured 10...

24 CFR 203.203 - Issuance and nature of insured 10-year protection plans.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Issuance and nature of insured 10-year protection plans. 203.203 Section 203.203 Housing and Urban Development Regulations Relating to... Underwriting Procedures Insured Ten-Year Protection Plans (plan) § 203.203 Issuance and nature of insured 10...

Access to healthcare insurance and healthcare services among syringe exchange program clients in Massachusetts: qualitative findings from health navigators with the iDU ("I do") Care Collaborative.

PubMed

Stopka, Thomas J; Hutcheson, Marguerite; Donahue, Ashley

2017-05-18

Little is known about access to health insurance among people who inject drugs (PWID) who attend syringe exchange programs (SEPs). The goal of the current study was to assess perceptions of SEP staff, including health navigators and program managers, on access to health insurance and healthcare access among SEP clients following implementation of state and federal policies to enhance universal healthcare access in Massachusetts. Between December 2014 and January 2015, we conducted in-depth interviews (n = 14) with SEP staff, including both program managers and health navigators, to assess knowledge, attitudes, and beliefs related to health insurance enrollment and access to enhanced referrals among SEP clients. We developed a preliminary coding scheme from the interview guide and used a grounded theory approach to guide inclusion of subsequent thematic codes that emanated from the data. We analyzed the coded data thematically in an iterative fashion using a consensus-based approach. We identified five primary themes that emerged from the qualitative interviews, including high levels of health insurance enrollment among SEP clients; barriers to enrolling in health insurance; highly needed referrals to services, including improved access to substance use disorder treatment and hepatitis C virus treatment; barriers to referring clients to these highly needed services; and recommendations for policy change. While barriers to enrollment and highly needed referrals remain, access to and enrollment in healthcare insurance plans among PWID at SEPs in Massachusetts are high. With the uncertain stability of the Affordable Care Act following the US presidential election of 2016, our findings summarize the opportunities and challenges that are connected to health insurance and healthcare access in Massachusetts. SEPs can play an important role in facilitating access to health insurance and enhancing access to preventive health and primary care.

Public/private partnerships for prescription drug coverage: policy formulation and outcomes in Quebec's universal drug insurance program, with comparisons to the Medicare prescription drug program in the United States.

PubMed

Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Palley, Howard A; Martin, Elisabeth

2007-09-01

In January 1997, the government of Quebec, Canada, implemented a public/private prescription drug program that covered the entire population of the province. Under this program, the public sector collaborates with private insurers to protect all Quebecers from the high cost of drugs. This article outlines the principal features and history of the Quebec plan and draws parallels between the factors that led to its emergence and those that led to the passage of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) in the United States. It also discusses the challenges and similarities of both programs and analyzes Quebec's ten years of experience to identify adjustments that may help U.S. policymakers optimize the MMA.

Public/Private Partnerships for Prescription Drug Coverage: Policy Formulation and Outcomes in Quebec's Universal Drug Insurance Program, with Comparisons to the Medicare Prescription Drug Program in the United States

PubMed Central

Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Palley, Howard A; Martin, Elisabeth

2007-01-01

In January 1997, the government of Quebec, Canada, implemented a public/private prescription drug program that covered the entire population of the province. Under this program, the public sector collaborates with private insurers to protect all Quebecers from the high cost of drugs. This article outlines the principal features and history of the Quebec plan and draws parallels between the factors that led to its emergence and those that led to the passage of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) in the United States. It also discusses the challenges and similarities of both programs and analyzes Quebec's ten years of experience to identify adjustments that may help U.S. policymakers optimize the MMA. PMID:17718665

Type of Plan and Provider Network (Affordable Care Act)

MedlinePlus

... insurance plan & network types: HMOs, PPOs, and more Health insurance plan & network types: HMOs, PPOs, and more 3 things to know before you pick a health insurance plan The 'metal' categories: Bronze, Silver, Gold & Platinum ...

Diabetes in employer-sponsored health insurance.

PubMed

Peele, Pamela B; Lave, Judith R; Songer, Thomas J

2002-11-01

To examine medical and mental health care expenditures for large numbers of individuals with diabetes enrolled in employment-sponsored insurance plans. Health insurance billing data for approximately 1.3 million individuals enrolled in health insurance plans sponsored by 862 large self-insured employers nationwide were used to examine employer expenditures and consumer out-of-pocket payments for 20,937 people identified with diabetes. These expenditures were compared with expenditures for individuals with other chronic illnesses. Main outcome measures were covered charges, insurance plan reimbursements, and estimated consumer out-of-pocket payments for both medical and mental health services. A total of 1.7% of enrollees were identified as having diabetes and approximately 11% of those used at least one mental health service during 1996. Health care expenditures were three times higher for those with diabetes compared with all health care consumers in these insurance plans, but when compared with individuals with other chronic illnesses such as heart disease, HIV/AIDS, cancer, and asthma, those with diabetes were not more expensive for employers' insurance plans. Diabetes accounts for 6.5% of total health plan expenditures. Diabetes is not more expensive for either consumers or their employer-sponsored insurance plans than other chronic illnesses.

Seeing Health Insurance and HealthCare.gov Through the Eyes of Young Adults.

PubMed

Wong, Charlene A; Asch, David A; Vinoya, Cjloe M; Ford, Carol A; Baker, Tom; Town, Robert; Merchant, Raina M

2015-08-01

We describe young adults' perspectives on health insurance and HealthCare.gov, including their attitudes toward health insurance, health insurance literacy, and benefit and plan preferences. We observed young adults aged 19-30 years in Philadelphia from January to March 2014 as they shopped for health insurance on HealthCare.gov. Participants were then interviewed to elicit their perceived advantages and disadvantages of insurance and factors considered important for plan selection. A 1-month follow-up interview assessed participants' plan enrollment decisions and intended use of health insurance. Data were analyzed using qualitative methodology, and salience scores were calculated for free-listing responses. We enrolled 33 highly educated young adults; 27 completed the follow-up interview. The most salient advantages of health insurance for young adults were access to preventive or primary care (salience score .28) and peace of mind (.27). The most salient disadvantage was the financial strain of paying for health insurance (.72). Participants revealed poor health insurance literacy with 48% incorrectly defining deductible and 78% incorrectly defining coinsurance. The most salient factors reported to influence plan selection were deductible (.48) and premium (.45) amounts as well as preventive care (.21) coverage. The most common intended health insurance use was primary care. Eight participants enrolled in HealthCare.gov plans: six selected silver plans, and three qualified for tax credits. Young adults' perspective on health insurance and enrollment via HealthCare.gov can inform strategies to design health insurance plans and communication about these plans in a way that engages and meets the needs of young adult populations. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

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.

Family Planning in the Context of Latin America's Universal Health Coverage Agenda.

PubMed

Fagan, Thomas; Dutta, Arin; Rosen, James; Olivetti, Agathe; Klein, Kate

2017-09-27

Countries in Latin America and the Caribbean (LAC) have substantially improved access to family planning over the past 50 years. Many have also recently adopted explicit declarations of universal rights to health and universal health coverage (UHC) and have begun implementing UHC-oriented health financing schemes. These schemes will have important implications for the sustainability and further growth of family planning programs throughout the region. We examined the status of contraceptive methods in major health delivery and financing schemes in 9 LAC countries. Using a set of 37 indicators on family planning coverage, family planning financing, health financing, and family planning inclusion in UHC-oriented schemes, we conducted a desk review of secondary sources, including population surveys, health financing assessments, insurance enrollment reports, and unit cost estimates, and interviewed in-country experts. Findings: Although the modern contraceptive prevalence rate (mCPR) has continued to increase in the majority of LAC countries, substantial disparities in access for marginalized groups remain. On average, mCPR is 20% lower among indigenous women than the general population, 5% lower among uninsured women than insured, and 7% lower among the poorest women than the wealthiest. Among the poorest quintile of women, insured women had an mCPR 16.5 percentage points higher than that of uninsured women, suggesting that expansion of insurance coverage is associated with increased family planning access and use. In the high- and upper-middle-income countries we reviewed, all modern contraceptive methods are typically available through the social health insurance schemes that cover a majority of the population. However, in low- and lower-middle-income countries, despite free provision of most family planning services in public health facilities, stock-outs and implicit rationing present substantial barriers that prevent clients from accessing their preferred method or force them to pay out of pocket. Leveraging UHC-oriented schemes to sustain and further increase family planning progress will require that governments take deliberate steps to (1) target poor and informal sector populations, (2) include family planning in benefits packages, (3) ensure sufficient financing for family planning, and (4) reduce nonfinancial barriers to access. Through these steps, countries can increase financial protection for family planning and better ensure the right to health of poor and marginalized populations. © Fagan et al.

Family Planning in the Context of Latin America's Universal Health Coverage Agenda

PubMed Central

Fagan, Thomas; Dutta, Arin; Rosen, James; Olivetti, Agathe; Klein, Kate

2017-01-01

ABSTRACT Background: Countries in Latin America and the Caribbean (LAC) have substantially improved access to family planning over the past 50 years. Many have also recently adopted explicit declarations of universal rights to health and universal health coverage (UHC) and have begun implementing UHC-oriented health financing schemes. These schemes will have important implications for the sustainability and further growth of family planning programs throughout the region. Methods: We examined the status of contraceptive methods in major health delivery and financing schemes in 9 LAC countries. Using a set of 37 indicators on family planning coverage, family planning financing, health financing, and family planning inclusion in UHC-oriented schemes, we conducted a desk review of secondary sources, including population surveys, health financing assessments, insurance enrollment reports, and unit cost estimates, and interviewed in-country experts. Findings: Although the modern contraceptive prevalence rate (mCPR) has continued to increase in the majority of LAC countries, substantial disparities in access for marginalized groups remain. On average, mCPR is 20% lower among indigenous women than the general population, 5% lower among uninsured women than insured, and 7% lower among the poorest women than the wealthiest. Among the poorest quintile of women, insured women had an mCPR 16.5 percentage points higher than that of uninsured women, suggesting that expansion of insurance coverage is associated with increased family planning access and use. In the high- and upper-middle-income countries we reviewed, all modern contraceptive methods are typically available through the social health insurance schemes that cover a majority of the population. However, in low- and lower-middle-income countries, despite free provision of most family planning services in public health facilities, stock-outs and implicit rationing present substantial barriers that prevent clients from accessing their preferred method or force them to pay out of pocket. Conclusion: Leveraging UHC-oriented schemes to sustain and further increase family planning progress will require that governments take deliberate steps to (1) target poor and informal sector populations, (2) include family planning in benefits packages, (3) ensure sufficient financing for family planning, and (4) reduce nonfinancial barriers to access. Through these steps, countries can increase financial protection for family planning and better ensure the right to health of poor and marginalized populations. PMID:28765156

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.

Gait or Walking Problems

MedlinePlus

... be frank and upfront with your PT about cost, payment plans, and the benefits you can expect from therapy. Weakness Muscle weakness ... medical equipment) may be available through private or public insurance, community ... benefits if you have done military service. Reimbursement programs ...

Sustaining staff nurse support for a patient care ergonomics program in critical care.

PubMed

Haney, Linda L; Wright, Laurette

2007-06-01

Applying management concepts from marketing and business sources can assist critical care units with establishing a planned change in the way nurses perform manual handling tasks, and thus, help insure that it is sustained.

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.

Expanding access through public coverage: permitting families to use tax credits to buy into Medicaid or SCHIP.

PubMed

Weil, A R

2001-01-01

A new tax credit to help low-income families and individuals purchase health insurance can address the problem of affordability, but will not overcome other barriers these populations face in obtaining coverage. This paper proposes that families have the option of using a new tax credit to buy into a state-administered system such as Medicaid or the State Children's Health Insurance Program. This option has three advantages. First, it allows families to remain with a single health program and health plan as their income fluctuates. Second, it provides an alternative to the complex and confusing individual insurance market. This alternative is community rated, does not use underwriting, and allows health plan behavior to be monitored closely by the state. Third, it allows the state to act as a financial buffer-helping overcome the barrier to participation that cash-flow problems and year-end reconciliation concerns are likely to create among a low-income population. Many people would want to use their tax credit in the private market, but the buy-in option increases the likelihood that the tax credit approach would succeed.

Incentives for nondiscriminatory wellness programs in group health plans. Final rule.

PubMed

2013-06-03

This document contains final regulations, consistent with the Affordable Care Act, regarding nondiscriminatory wellness programs in group health coverage. Specifically, these final regulations increase the maximum permissible reward under a health-contingent wellness program offered in connection with a group health plan (and any related health insurance coverage) from 20 percent to 30 percent of the cost of coverage. The final regulations further increase the maximum permissible reward to 50 percent for wellness programs designed to prevent or reduce tobacco use. These regulations also include other clarifications regarding the reasonable design of health-contingent wellness programs and the reasonable alternatives they must offer in order to avoid prohibited discrimination.

Germany's long-term-care insurance: putting a social insurance model into practice.

PubMed

Geraedts, M; Heller, G V; Harrington, C A

2000-01-01

A growing population of elderly has intensified the demand for long-term care (LTC) services. In response to the mounting need, Germany put into effect a LTC Insurance Act in 1995 that introduced mandatory public or private LTC insurance for the entire population of 82 million. The program was based on the organizational principles that define the German social insurance system. Those individuals in the public system and their employers each pay contributions equal to 0.85 percent of each employee's gross wages or salary. Ten percent of the population with the highest incomes have chosen the option of purchasing private long term care insurance. Provisions were made for uniform eligibility criteria, benefits based on level of care needs, cost containment, and quality assurance. Over the first four years of its operation, the system has proved financially sound and has expanded access to organized LTC services. The German system thus may serve as an example for other countries that are planning to initiate social LTC insurance systems in other nations.

Determinants of Coverage Decisions in Health Insurance Marketplaces: Consumers' Decision-Making Abilities and the Amount of Information in Their Choice Environment

PubMed Central

Barnes, Andrew J; Hanoch, Yaniv; Rice, Thomas

2015-01-01

Objective To investigate the determinants and quality of coverage decisions among uninsured choosing plans in a hypothetical health insurance marketplace. Study Setting Two samples of uninsured individuals: one from an Internet-based sample comprised largely of young, healthy, tech-savvy individuals (n = 276), and the other from low-income, rural Virginians (n = 161). Study Design We assessed whether health insurance comprehension, numeracy, choice consistency, and the number of plan choices were associated with participants' ability to choose a cost-minimizing plan, given their expected health care needs (defined as choosing a plan costing no more than $500 in excess of the total estimated annual costs of the cheapest plan available). Data Collection Primary data were collected using an online questionnaire. Principal Findings Uninsured who were more numerate showed higher health insurance comprehension; those with more health insurance comprehension made choices of health insurance plans more consistent with their stated preferences; and those who made choices more concordant with their stated preferences were less likely to choose a plan that cost more than $500 in excess of the cheapest plan available. Conclusions Increasing health insurance comprehension and designing exchanges to facilitate plan comparison will be critical to ensuring the success of health insurance marketplaces. PMID:24779769

20 CFR 323.4 - Guidelines for content of a nongovernmental plan.

Code of Federal Regulations, 2010 CFR

2010-04-01

... UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.4 Guidelines for content of a nongovernmental plan. At a minimum, a nongovernmental plan for unemployment or sickness insurance should contain the following features: (a) The title of the plan (e.g., Supplemental Unemployment...

20 CFR 323.4 - Guidelines for content of a nongovernmental plan.

Code of Federal Regulations, 2011 CFR

2011-04-01

... UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.4 Guidelines for content of a nongovernmental plan. At a minimum, a nongovernmental plan for unemployment or sickness insurance should contain the following features: (a) The title of the plan (e.g., Supplemental Unemployment...

20 CFR 323.4 - Guidelines for content of a nongovernmental plan.

Code of Federal Regulations, 2013 CFR

2013-04-01

... UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.4 Guidelines for content of a nongovernmental plan. At a minimum, a nongovernmental plan for unemployment or sickness insurance should contain the following features: (a) The title of the plan (e.g., Supplemental Unemployment...

20 CFR 323.4 - Guidelines for content of a nongovernmental plan.

Code of Federal Regulations, 2012 CFR

2012-04-01

... UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.4 Guidelines for content of a nongovernmental plan. At a minimum, a nongovernmental plan for unemployment or sickness insurance should contain the following features: (a) The title of the plan (e.g., Supplemental Unemployment...

20 CFR 323.3 - Standards for Board approval of a nongovernmental plan.

Code of Federal Regulations, 2012 CFR

2012-04-01

... RAILROAD UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.3 Standards for Board approval of a nongovernmental plan. An unemployment or sickness benefit plan qualifies... conditions governing payment of benefits under the Railroad Unemployment Insurance Act. However, a plan will...

20 CFR 323.3 - Standards for Board approval of a nongovernmental plan.

Code of Federal Regulations, 2011 CFR

2011-04-01

... RAILROAD UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.3 Standards for Board approval of a nongovernmental plan. An unemployment or sickness benefit plan qualifies... conditions governing payment of benefits under the Railroad Unemployment Insurance Act. However, a plan will...

20 CFR 323.3 - Standards for Board approval of a nongovernmental plan.

Code of Federal Regulations, 2013 CFR

2013-04-01

... RAILROAD UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.3 Standards for Board approval of a nongovernmental plan. An unemployment or sickness benefit plan qualifies... conditions governing payment of benefits under the Railroad Unemployment Insurance Act. However, a plan will...

20 CFR 323.3 - Standards for Board approval of a nongovernmental plan.

Code of Federal Regulations, 2014 CFR

2014-04-01

... RAILROAD UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.3 Standards for Board approval of a nongovernmental plan. An unemployment or sickness benefit plan qualifies... conditions governing payment of benefits under the Railroad Unemployment Insurance Act. However, a plan will...

20 CFR 323.4 - Guidelines for content of a nongovernmental plan.

Code of Federal Regulations, 2014 CFR

2014-04-01

... UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.4 Guidelines for content of a nongovernmental plan. At a minimum, a nongovernmental plan for unemployment or sickness insurance should contain the following features: (a) The title of the plan (e.g., Supplemental Unemployment...

78 FR 63567 - Proposed Collection; Comment Request for Regulation Project

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-24

... health insurance portability for group health plans and group health insurance issuers under HIPAA Titles... Health Coverage Portability for Group Health Plans and Group Health Insurance Issuers Under HIPAA Titles... insurance coverage offered in connection with a group health plan. The rules contained in this document...

The commercial health insurance industry in an era of eroding employer coverage.

PubMed

Robinson, James C

2006-01-01

This paper analyzes the commercial health insurance industry in an era of weakening employer commitment to providing coverage and strengthening interest by public programs to offer coverage through private plans. It documents the willingness of the industry to accept erosion of employment-based enrollment rather than to sacrifice earnings, the movement of Medicaid beneficiaries into managed care, and the distribution of market shares in the employment-based, Medicaid, and Medicare markets. The profitability of the commercial health insurance industry, exceptionally strong over the past five years, will henceforth be linked to the budgetary cycles and political fluctuations of state and federal governments.

45 CFR 147.126 - No lifetime or annual limits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS § 147.126 No... section, a group health plan, or a health insurance issuer offering group or individual health insurance..., a group health plan, or a health insurance issuer offering group or individual health insurance...

41 CFR 60-250.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Health insurance, life... SEPARATED VETERANS, AND OTHER PROTECTED VETERANS Discrimination Prohibited § 60-250.25 Health insurance, life insurance and other benefit plans. (a) An insurer, hospital, or medical service company, health...

Influences on Adaptive Planning to Reduce Flood Risks among Parishes in South Louisiana.

PubMed

Paille, Mary; Reams, Margaret; Argote, Jennifer; Lam, Nina S-N; Kirby, Ryan

2016-02-01

Residents of south Louisiana face a range of increasing, climate-related flood exposure risks that could be reduced through local floodplain management and hazard mitigation planning. A major incentive for community planning to reduce exposure to flood risks is offered by the Community Rating System (CRS) of the National Flood Insurance Program (NFIP). The NFIP encourages local collective action by offering reduced flood insurance premiums for individual policy holders of communities where suggested risk-reducing measures have been implemented. This preliminary analysis examines the extent to which parishes (counties) in southern Louisiana have implemented the suggested policy actions and identifies key factors that account for variation in the implementation of the measures. More measures implemented results in higher CRS scores. Potential influences on scores include socioeconomic attributes of residents, government capacity, average elevation and past flood events. The results of multiple regression analysis indicate that higher CRS scores are associated most closely with higher median housing values. Furthermore, higher scores are found in parishes with more local municipalities that participate in the CRS program. The number of floods in the last five years and the revenue base of the parish does not appear to influence CRS scores. The results shed light on the conditions under which local adaptive planning to mitigate increasing flood risks is more likely to be implemented and offer insights for program administrators, researchers and community stakeholders.

Influences on Adaptive Planning to Reduce Flood Risks among Parishes in South Louisiana

PubMed Central

Paille, Mary; Reams, Margaret; Argote, Jennifer; Lam, Nina S.-N.; Kirby, Ryan

2016-01-01

Residents of south Louisiana face a range of increasing, climate-related flood exposure risks that could be reduced through local floodplain management and hazard mitigation planning. A major incentive for community planning to reduce exposure to flood risks is offered by the Community Rating System (CRS) of the National Flood Insurance Program (NFIP). The NFIP encourages local collective action by offering reduced flood insurance premiums for individual policy holders of communities where suggested risk-reducing measures have been implemented. This preliminary analysis examines the extent to which parishes (counties) in southern Louisiana have implemented the suggested policy actions and identifies key factors that account for variation in the implementation of the measures. More measures implemented results in higher CRS scores. Potential influences on scores include socioeconomic attributes of residents, government capacity, average elevation and past flood events. The results of multiple regression analysis indicate that higher CRS scores are associated most closely with higher median housing values. Furthermore, higher scores are found in parishes with more local municipalities that participate in the CRS program. The number of floods in the last five years and the revenue base of the parish does not appear to influence CRS scores. The results shed light on the conditions under which local adaptive planning to mitigate increasing flood risks is more likely to be implemented and offer insights for program administrators, researchers and community stakeholders. PMID:27330828

20 CFR 323.5 - Submitting proposed plan for Board approval.

Code of Federal Regulations, 2010 CFR

2010-04-01

... UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.5 Submitting... existing plan, to the Director of Unemployment and Sickness Insurance, Railroad Retirement Board, 844 Rush...

20 CFR 323.5 - Submitting proposed plan for Board approval.

Code of Federal Regulations, 2012 CFR

2012-04-01

... UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.5 Submitting... existing plan, to the Director of Unemployment and Sickness Insurance, Railroad Retirement Board, 844 Rush...

20 CFR 323.5 - Submitting proposed plan for Board approval.

Code of Federal Regulations, 2014 CFR

2014-04-01

... UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.5 Submitting... existing plan, to the Director of Unemployment and Sickness Insurance, Railroad Retirement Board, 844 Rush...

20 CFR 323.5 - Submitting proposed plan for Board approval.

Code of Federal Regulations, 2011 CFR

2011-04-01

... UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.5 Submitting... existing plan, to the Director of Unemployment and Sickness Insurance, Railroad Retirement Board, 844 Rush...

20 CFR 323.5 - Submitting proposed plan for Board approval.

Code of Federal Regulations, 2013 CFR

2013-04-01

... UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.5 Submitting... existing plan, to the Director of Unemployment and Sickness Insurance, Railroad Retirement Board, 844 Rush...

7 CFR 457.139 - Fresh market tomato (dollar plan) crop insurance provisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 6 2011-01-01 2011-01-01 false Fresh market tomato (dollar plan) crop insurance... Fresh market tomato (dollar plan) crop insurance provisions. The fresh market tomato (dollar plan) crop...) Both FCIC and Reinsured Policies Fresh market tomato (dollar plan) crop provisions If a conflict exists...

The cost of unintended pregnancies for employer-sponsored health insurance plans.

PubMed

Dieguez, Gabriela; Pyenson, Bruce S; Law, Amy W; Lynen, Richard; Trussell, James

2015-04-01

Pregnancy is associated with a significant cost for employers providing health insurance benefits to their employees. The latest study on the topic was published in 2002, estimating the unintended pregnancy rate for women covered by employer-sponsored insurance benefits to be approximately 29%. The primary objective of this study was to update the cost of unintended pregnancy to employer-sponsored health insurance plans with current data. The secondary objective was to develop a regression model to identify the factors and associated magnitude that contribute to unintended pregnancies in the employee benefits population. We developed stepwise multinomial logistic regression models using data from a national survey on maternal attitudes about pregnancy before and shortly after giving birth. The survey was conducted by the Centers for Disease Control and Prevention through mail and via telephone interviews between 2009 and 2011 of women who had had a live birth. The regression models were then applied to a large commercial health claims database from the Truven Health MarketScan to retrospectively assign the probability of pregnancy intention to each delivery. Based on the MarketScan database, we estimate that among employer-sponsored health insurance plans, 28.8% of pregnancies are unintended, which is consistent with national findings of 29% in a survey by the Centers for Disease Control and Prevention. These unintended pregnancies account for 27.4% of the annual delivery costs to employers in the United States, or approximately 1% of the typical employer's health benefits spending for 1 year. Using these findings, we present a regression model that employers could apply to their claims data to identify the risk for unintended pregnancies in their health insurance population. The availability of coverage for contraception without employee cost-sharing, as was required by the Affordable Care Act in 2012, combined with the ability to identify women who are at high risk for an unintended pregnancy, can help employers address the costs of unintended pregnancies in their employee benefits population. This can also help to bring contraception efforts into the mainstream of other preventive and wellness programs, such as smoking cessation, obesity management, and diabetes control programs.

The Cost of Unintended Pregnancies for Employer-Sponsored Health Insurance Plans

PubMed Central

Dieguez, Gabriela; Pyenson, Bruce S.; Law, Amy W.; Lynen, Richard; Trussell, James

2015-01-01

Background Pregnancy is associated with a significant cost for employers providing health insurance benefits to their employees. The latest study on the topic was published in 2002, estimating the unintended pregnancy rate for women covered by employer-sponsored insurance benefits to be approximately 29%. Objectives The primary objective of this study was to update the cost of unintended pregnancy to employer-sponsored health insurance plans with current data. The secondary objective was to develop a regression model to identify the factors and associated magnitude that contribute to unintended pregnancies in the employee benefits population. Methods We developed stepwise multinomial logistic regression models using data from a national survey on maternal attitudes about pregnancy before and shortly after giving birth. The survey was conducted by the Centers for Disease Control and Prevention through mail and via telephone interviews between 2009 and 2011 of women who had had a live birth. The regression models were then applied to a large commercial health claims database from the Truven Health MarketScan to retrospectively assign the probability of pregnancy intention to each delivery. Results Based on the MarketScan database, we estimate that among employer-sponsored health insurance plans, 28.8% of pregnancies are unintended, which is consistent with national findings of 29% in a survey by the Centers for Disease Control and Prevention. These unintended pregnancies account for 27.4% of the annual delivery costs to employers in the United States, or approximately 1% of the typical employer's health benefits spending for 1 year. Using these findings, we present a regression model that employers could apply to their claims data to identify the risk for unintended pregnancies in their health insurance population. Conclusion The availability of coverage for contraception without employee cost-sharing, as was required by the Affordable Care Act in 2012, combined with the ability to identify women who are at high risk for an unintended pregnancy, can help employers address the costs of unintended pregnancies in their employee benefits population. This can also help to bring contraception efforts into the mainstream of other preventive and wellness programs, such as smoking cessation, obesity management, and diabetes control programs. PMID:26005515

44 CFR 201.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SECURITY DISASTER ASSISTANCE MITIGATION PLANNING § 201.2 Definitions. Administrator means the head of the Federal Emergency Management Agency, or his/her designated representative. Flood Mitigation Assistance (FMA) means the program authorized by section 1366 of the National Flood Insurance Act of 1968, as...

44 CFR 201.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SECURITY DISASTER ASSISTANCE MITIGATION PLANNING § 201.2 Definitions. Administrator means the head of the Federal Emergency Management Agency, or his/her designated representative. Flood Mitigation Assistance (FMA) means the program authorized by section 1366 of the National Flood Insurance Act of 1968, as...

44 CFR 201.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SECURITY DISASTER ASSISTANCE MITIGATION PLANNING § 201.2 Definitions. Administrator means the head of the Federal Emergency Management Agency, or his/her designated representative. Flood Mitigation Assistance (FMA) means the program authorized by section 1366 of the National Flood Insurance Act of 1968, as...

44 CFR 201.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SECURITY DISASTER ASSISTANCE MITIGATION PLANNING § 201.2 Definitions. Administrator means the head of the Federal Emergency Management Agency, or his/her designated representative. Flood Mitigation Assistance (FMA) means the program authorized by section 1366 of the National Flood Insurance Act of 1968, as...

44 CFR 201.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SECURITY DISASTER ASSISTANCE MITIGATION PLANNING § 201.2 Definitions. Administrator means the head of the Federal Emergency Management Agency, or his/her designated representative. Flood Mitigation Assistance (FMA) means the program authorized by section 1366 of the National Flood Insurance Act of 1968, as...

26 CFR 46.4376-1 - Fee on sponsors of self-insured health plans.

Code of Federal Regulations, 2013 CFR

2013-04-01

... capita amount of the National Health Expenditures most recently released by the Department of Health and... 26 Internal Revenue 16 2013-04-01 2013-04-01 false Fee on sponsors of self-insured health plans... (CONTINUED) MISCELLANEOUS EXCISE TAXES EXCISE TAX ON CERTAIN INSURANCE POLICIES, SELF-INSURED HEALTH PLANS...

78 FR 25909 - Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

... Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance Premium.... SUMMARY: This document contains proposed regulations relating to the health insurance premium tax credit... who enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges) and claim the...

75 FR 41787 - Requirement for Group Health Plans and Health Insurance Issuers To Provide Coverage of Preventive...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-19

... Requirement for Group Health Plans and Health Insurance Issuers To Provide Coverage of Preventive Services... Insurance Oversight of the U.S. Department of Health and Human Services are issuing substantially similar interim final regulations with respect to group health plans and health insurance coverage offered in...

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...

Patient Protection and Affordable Care Act; annual eligibility redeterminations for exchange participation and insurance affordability programs; health insurance issuer standards under the Affordable Care Act, including standards related to exchanges. Final rule.

PubMed

2014-09-05

This final rule specifies additional options for annual eligibility redeterminations and renewal and re-enrollment notice requirements for qualified health plans offered through the Exchange, beginning with annual redeterminations for coverage for benefit year 2015. This final rule provides additional flexibility for Exchanges, including the ability to propose unique approaches that meet the specific needs of their state, while streamlining the consumer experience.

Check the right box. Credits or deductions? The three main presidential candidates take varying stances on adjusting tax code regarding insurance.

PubMed

Blesch, Gregg

2008-04-14

The battle over health reform has a taxing angle, and the debate involves whether tax credits or deductions would work better in relation to health insurance. Some type of credit seems to be favored by the three major candidates. One major facet is how it affects employer-based plans. "It's the third-largest health program in the country, and no one knows about it," says Jonathan Gruber, left, of MIT.

Use and reimbursement costs of smoking cessation medication under the Quebec public drug insurance plan.

PubMed

Tremblay, Michèle; Payette, Yves; Montreuil, Annie

2009-01-01

Since October 2000, the nicotine patch, nicotine gum and bupropion have been reimbursed under Quebec's public drug insurance plan. The objective of this study is to describe use of these medications between October 2000 and December 2004 by smokers covered by the public plan, as well as the costs of reimbursing these medications. Data from the Régie de l'assurance maladie du Québec were used to analyze prescriptions for smoking cessation medication issued to persons insured under the public drug insurance plan. Between October 1, 2000, and December 31, 2004, more than 300,000 Quebeckers covered by the public drug insurance plan were reimbursed for smoking cessation medications. This corresponds to a yearly average of 14% of all smokers insured under the public plan. The proportion of employment assistance recipients who used these medications was higher than the proportion of seniors or "other" insurance plan participants. Nicotine patches were the treatment of choice for most users. A total of $55 million was reimbursed by the public drug insurance plan for the nicotine patch, nicotine gum and bupropion over this four-year period. The reimbursement provisions put in place in Quebec in 2000 were successful in reaching financially disadvantaged smokers, at a cost that was comparable with other effective smoking cessation services.

Effects of enrollment in medicaid versus the state children's health insurance program on kindergarten children's untreated dental caries.

PubMed

Brickhouse, Tegwyn H; Rozier, R Gary; Slade, Gary D

2008-05-01

We compared levels of untreated dental caries in children enrolled in public insurance programs with those in nonenrolled children to determine the impact of public dental insurance and the type of plan (Medicaid vs State Children's Health Insurance Program [SCHIP]) on untreated dental caries in children. Dental health outcomes were obtained through a calibrated oral screening of kindergarten children (enrolled in the 2000-2001 school year). We obtained eligibility and claims data for children enrolled in Medicaid and SCHIP who were eligible for dental services during 1999 to 2000. We developed logistic regression models to compare children's likelihood and extent of untreated dental caries according to enrollment. Children enrolled in Medicaid or SCHIP were 1.7 times (95% confidence interval [CI] = 1.65, 1.77) more likely to have untreated dental caries than were nonenrolled children. SCHIP-enrolled children were significantly less likely to have untreated dental caries than were Medicaid-enrolled children (odds ratio [OR]=0.74; 95% CI=0.67, 0.82). According to a 2-part regression model, children enrolled in Medicaid or SCHIP have 17% more untreated dental caries than do nonenrolled children, whereas those in SCHIP had 16% fewer untreated dental caries than did those in Medicaid. Untreated tooth decay continues to be a significant problem for children with public insurance coverage. Children who participated in a separate SCHIP program had fewer untreated dental caries than did children enrolled in Medicaid.

41 CFR 60-300.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Health insurance, life... VETERANS, AND ARMED FORCES SERVICE MEDAL VETERANS Discrimination Prohibited § 60-300.25 Health insurance, life insurance and other benefit plans. (a) An insurer, hospital, or medical service company, health...

Benefits plans focus on flexibility. Hospitals increase choices for employees as emphasis moves from recruitment to retention.

PubMed

Berg, E

1991-09-23

As hospitals turn their attention from employee recruitment to employee retention, flexible benefits plans are becoming increasingly popular as a means of meeting workers' preference for choice when it comes to issues such as healthcare coverage, insurance and vacation days. At the same time, such programs can help hospitals hold down their long-term costs.

The effect of the Americans With Disabilities Act upon medical insurance and employee benefits.

PubMed

Brislin, J A

1992-03-01

The Americans With Disabilities Act will have a significant impact upon plan sponsors and the administration of an employee benefit plan. Prior to the July 26, 1992 effective date, a plan sponsor or trustee should meet with the plan's attorney, provider and other insurance advisers and review the effect ADA will have upon the plan. The EEOC will be issuing additional interpretive rules before the effective date of ADA, and there will be numerous court challenges after the effective date. Plan sponsors and trustees should keep abreast of the developments as they occur. Before a benefit change or premium adjustment is made, it should be reviewed with legal counsel to assure that it conforms to ADA's insurance exemption. Plan sponsors and trustees should have legal counsel, the provider and the plan's insurance advisers develop the documentation that will enable the plan to establish ADA's insurance exemption to defend any legal challenge.

Insurance Coverage and Clinical Trials

Cancer.gov

Most health insurance plans are required to cover routine patient care costs in clinical trials under certain conditions. Learn about the conditions that insurance plans take into account and how to work with your insurance company.

State insurance exchanges face challenges in offering standardized choices alongside innovative value-based insurance.

PubMed

Corlette, Sabrina; Downs, David; Monahan, Christine H; Yondorf, Barbara

2013-02-01

Value-based insurance is a relatively new approach to health insurance in which financial barriers, such as copayments, are lowered for clinical services that are considered high value, while consumer cost sharing may be increased for services considered to be of uncertain value. Such plans are complex and do not easily fit into the simplified, consumer-friendly comparison tools that many state health insurance exchanges are formulating for use in 2014. Nevertheless some states and plans are attempting to strike the right balance between a streamlined health exchange shopping experience and innovative, albeit complex, benefit design that promotes value. For example, agencies administering exchanges in Vermont and Oregon are contemplating offering value-based insurance plans as an option in addition to a set of standardized plans. In the postreform environment, policy makers must find ways to present complex value-based insurance plans in a way that consumers and employers can more readily understand.

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.

Examining the potential of information technology to improve public insurance application processes: enrollee assessments from a concurrent mixed method analysis.

PubMed

Mishra, Abhay Nath; Ketsche, Patricia; Marton, James; Snyder, Angela; McLaren, Susan

2014-01-01

To assess the perceived readiness of Medicaid and Children's Health Insurance Program (CHIP) enrollees to use information technologies (IT) in order to facilitate improvements in the application processes for these public insurance programs. We conducted a concurrent mixed method study of Medicaid and CHIP enrollees in a southern state. We conducted focus groups to identify enrollee concerns regarding the current application process and their IT proficiency. Additionally, we surveyed beneficiaries via telephone about their access to and use of the Internet, and willingness to adopt IT-enabled processes. 2013 households completed the survey. We used χ(2) analysis for comparisons across different groups of respondents. A majority of enrollees will embrace IT-enabled enrollment, but a small yet significant group continues to lack access to facilitating technologies. Moreover, a segment of beneficiaries in the two programs continues to place a high value on personal interactions with program caseworkers. IT holds the promise of improving efficiency and reducing barriers for enrollees, but state and federal agencies managing public insurance programs need to ensure access to traditional processes and make caseworkers available to those who require and value such assistance, even after implementing IT-enabled processes. The use of IT-enabled processes is essential for effectively managing eligibility and enrollment determinations for public programs and private plans offered through state or federally operated exchanges. However, state and federal officials should be cognizant of the technological readiness of recipients and provide offline help to ensure broad participation in the insurance market. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

An emergency room decision-support program that increased physician office visits, decreased emergency room visits, and saved money.

PubMed

Navratil-Strawn, Jessica L; Hawkins, Kevin; Wells, Timothy S; Ozminkowski, Ronald J; Hartley, Stephen K; Migliori, Richard J; Yeh, Charlotte S

2014-10-01

The objective of this study was to evaluate an Emergency Room having a Decision-Support (ERDS) program designed to appropriately reduce ER use among frequent users, defined as 3 or more visits within a 12-month period. To achieve this, adults with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York) were eligible to participate in the program. These included 7070 individuals who elected to enroll in the ERDS program and an equal number of matched nonparticipants who were eligible but either declined or were unreachable. Program-related benefits were estimated by comparing the difference in downstream health care utilization and expenditures between engaged and not engaged individuals after using propensity score matching to adjust for case mix differences between these groups. As a result, compared with the not engaged, engaged individuals experienced better care coordination, evidenced by a greater reduction in ER visits (P=0.033) and hospital admissions (P=0.002) and an increase in office visits (P<0.001). The program was cost-effective, with a return on investment (ROI) of 1.24, which was calculated by dividing the total program savings ($3.41 million) by the total program costs ($2.75 million). The ROI implies that for every dollar invested in this program, $1.24 was saved, most of which was for the federal Medicare program. In conclusion, the decrease in ER visits and hospital admissions and the increase in office visits may indicate the program helped individuals to seek the appropriate levels of care.

75 FR 27141 - Group Health Plans and Health Insurance Issuers Providing Dependent Coverage of Children to Age...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-13

... Group Health Plans and Health Insurance Issuers Providing Dependent Coverage of Children to Age 26 Under... Information and Insurance Oversight of the U.S. Department of Health and Human Services are issuing substantially similar interim final regulations with respect to group health plans and health insurance coverage...

75 FR 43109 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-23

... Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and... the Office of Consumer Information and Insurance Oversight of the U.S. Department of Health and Human... health insurance coverage offered in connection with a group health plan under the Employee Retirement...

48 CFR 3028.307-1 - Group insurance plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 7 2014-10-01 2014-10-01 false Group insurance plans. 3028.307-1 Section 3028.307-1 Federal Acquisition Regulations System DEPARTMENT OF HOMELAND SECURITY....307-1 Group insurance plans. Plans shall be submitted to the contracting officer, who must obtain the...

48 CFR 3028.307-1 - Group insurance plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 7 2013-10-01 2012-10-01 true Group insurance plans. 3028.307-1 Section 3028.307-1 Federal Acquisition Regulations System DEPARTMENT OF HOMELAND SECURITY....307-1 Group insurance plans. Plans shall be submitted to the contracting officer, who must obtain the...

48 CFR 3028.307-1 - Group insurance plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 7 2012-10-01 2012-10-01 false Group insurance plans. 3028.307-1 Section 3028.307-1 Federal Acquisition Regulations System DEPARTMENT OF HOMELAND SECURITY....307-1 Group insurance plans. Plans shall be submitted to the contracting officer, who must obtain the...

29 CFR 2590.701-6 - Special enrollment periods.

Code of Federal Regulations, 2010 CFR

2010-07-01

... individuals who lose coverage—(1) In general. A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, is required to permit current employees... plan was previously offered, the employee had coverage under any group health plan or health insurance...

78 FR 57622 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-19

... supplemental insurance plans as part of an employee benefit package. Employers may, however, offer TRICARE supplemental insurance plans as part of an employee benefit package provided the plan is not paid for in whole... offer TRICARE supplemental insurance plans as part of an employee benefit package. They may offer...

Incorporating Reporting Efforts to Manage and Improve Health and Wellness Programs.

PubMed

Wells, Timothy S; Ozminkowski, Ronald J; McGinn, Michael P; Hawkins, Kevin; Bhattarai, Gandhi R; Serxner, Seth A; Greame, Chris

2017-06-01

Wellness programs are designed to help individuals maintain or improve their health. This article describes how a reporting process can be used to help manage and improve a wellness program. Beginning in 2014, a wellness pilot program became available in New Jersey for individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company. The program has since expanded to include Missouri, Texas, Alabama, and Washington. This wellness program includes an online health portal, one-on-one telephonic coaching, gym membership discounts, and local health events. To assure smooth program operations and alignment with program objectives, weekly and monthly reports are produced. The weekly report includes metrics on member engagement and utilization for the aforementioned 4 program offerings and reports on the last 4 weeks, as well as for the current month and the current year to date. The monthly report includes separate worksheets for each state and a summary worksheet that includes all states combined, and provides metrics on overall engagement as well as utilization of the 4 program components. Although the monthly reports were used to better manage the 4 program offerings, the weekly reports help management to gauge response to program marketing. Reporting can be a data-driven management tool to help manage wellness programs. Reports provide rapid feedback regarding program performance. In contrast, in-depth program evaluations serve a different purpose, such as to report program-related savings, return on investment, or to report other longer term program-related outcomes.

Incorporating Reporting Efforts to Manage and Improve Health and Wellness Programs

PubMed Central

Ozminkowski, Ronald J.; McGinn, Michael P.; Hawkins, Kevin; Bhattarai, Gandhi R.; Serxner, Seth A.; Greame, Chris

2017-01-01

Abstract Wellness programs are designed to help individuals maintain or improve their health. This article describes how a reporting process can be used to help manage and improve a wellness program. Beginning in 2014, a wellness pilot program became available in New Jersey for individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company. The program has since expanded to include Missouri, Texas, Alabama, and Washington. This wellness program includes an online health portal, one-on-one telephonic coaching, gym membership discounts, and local health events. To assure smooth program operations and alignment with program objectives, weekly and monthly reports are produced. The weekly report includes metrics on member engagement and utilization for the aforementioned 4 program offerings and reports on the last 4 weeks, as well as for the current month and the current year to date. The monthly report includes separate worksheets for each state and a summary worksheet that includes all states combined, and provides metrics on overall engagement as well as utilization of the 4 program components. Although the monthly reports were used to better manage the 4 program offerings, the weekly reports help management to gauge response to program marketing. Reporting can be a data-driven management tool to help manage wellness programs. Reports provide rapid feedback regarding program performance. In contrast, in-depth program evaluations serve a different purpose, such as to report program-related savings, return on investment, or to report other longer term program-related outcomes. PMID:27575977

Behavioral health insurance parity for federal employees.

PubMed

Goldman, Howard H; Frank, Richard G; Burnam, M Audrey; Huskamp, Haiden A; Ridgely, M Susan; Normand, Sharon-Lise T; Young, Alexander S; Barry, Colleen L; Azzone, Vanessa; Busch, Alisa B; Azrin, Susan T; Moran, Garrett; Lichtenstein, Carolyn; Blasinsky, Margaret

2006-03-30

To improve insurance coverage of mental health and substance-abuse services, the Federal Employees Health Benefits (FEHB) Program offered mental health and substance-abuse benefits on a par with general medical benefits beginning in January 2001. The plans were encouraged to manage care. We compared seven FEHB plans from 1999 through 2002 with a matched set of health plans that did not have benefits on a par with mental health and substance-abuse benefits (parity of mental health and substance-abuse benefits). Using a difference-in-differences analysis, we compared the claims patterns of matched pairs of FEHB and control plans by examining the rate of use, total spending, and out-of-pocket spending among users of mental health and substance-abuse services. The difference-in-differences analysis indicated that the observed increase in the rate of use of mental health and substance-abuse services after the implementation of the parity policy was due almost entirely to a general trend in increased use that was observed in comparison health plans as well as FEHB plans. The implementation of parity was associated with a statistically significant increase in use in one plan (+0.78 percent, P<0.05) a significant decrease in use in one plan (-0.96 percent, P<0.05), and no significant difference in use in the other five plans (range, -0.38 percent to +0.23 percent; P>0.05 for each comparison). For beneficiaries who used mental health and substance-abuse services, spending attributable to the implementation of parity decreased significantly for three plans (range, -201.99 dollars to -68.97 dollars; P<0.05 for each comparison) and did not change significantly for four plans (range, -42.13 dollars to +27.11 dollars; P>0.05 for each comparison). The implementation of parity was associated with significant reductions in out-of-pocket spending in five of seven plans. When coupled with management of care, implementation of parity in insurance benefits for behavioral health care can improve insurance protection without increasing total costs.

45 CFR 147.128 - Rules regarding rescissions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS § 147.128... insurance issuer offering group or individual health insurance coverage, must not rescind coverage under the... of the plan or coverage. A group health plan, or a health insurance issuer offering group or...

42 CFR 457.750 - Annual report.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Strategic Planning... reducing the number of uncovered, low-income children and; in meeting other strategic objectives and... performance goals and measures as developed by the Secretary; (2) Report on the effectiveness of the State's...

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.

Church-based breast cancer screening education: impact of two approaches on Latinas enrolled in public and private health insurance plans.

PubMed

Sauaia, Angela; Min, Sung-joon; Lack, David; Apodaca, Cecilia; Osuna, Diego; Stowe, Angela; MGinnis, Gretchen F; Latts, Lisa M; Byers, Tim

2007-10-01

The Tepeyac Project is a church-based health promotion project that was conducted from 1999 through 2005 to increase breast cancer screening rates among Latinas in Colorado. Previous reports evaluated the project among Medicare and Medicaid enrollees in the state. In this report, we evaluate the program among enrollees in the state's five major insurance plans. We compared the Tepeyac Project's two interventions: the Printed Intervention and the Promotora Intervention. In the first, we mailed culturally tailored education packages to 209 Colorado Catholic churches for their use. In the second, promotoras (peer counselors) in four Catholic churches delivered breast-health education messages personally. We compared biennial mammogram claims from the five insurance plans in the analysis at baseline (1998-1999) and during follow-up (2000-2001) for Latinas who had received the interventions. We used generalized estimating equations (GEE) analysis to adjust rates for confounders. The mammogram rate for Latinas in the Printed Intervention remained the same from baseline to follow-up (58% [2979/5130] vs 58% [3338/5708]). In the Promotora Intervention, the rate was 59% (316/536) at baseline and 61% (359/590) at follow-up. Rates increased modestly over time and varied widely by insurance type. After adjusting for age, income, urban versus rural location, disability, and insurance type, we found that women exposed to the Promotora Intervention had a significantly higher increase in biennial mammograms than did women exposed to the Printed Intervention (GEE parameter estimate = .24 [+/-.11], P = .03). For insured Latinas, personally delivering church-based education through peer counselors appears to be a better breast-health promotion method than mailing printed educational materials to churches.

Patient Protection and Affordable Care Act of 2010 and children and youth with special health care needs.

PubMed

Feldman, Heidi M; Buysse, Christina A; Hubner, Lauren M; Huffman, Lynne C; Loe, Irene M

2015-04-01

The Patient Protection and Affordable Care Act (ACA) was designed to (1) decrease the number of uninsured Americans, (2) make health insurance and health care affordable, and (3) improve health outcomes and performance of the health care system. During the design of ACA, children in general and children and youth with special health care needs and disabilities (CYSHCN) were not a priority because before ACA, a higher proportion of children than adults had insurance coverage through private family plans, Medicaid, or the State Children's Health Insurance Programs (CHIP). ACA benefits CYSHCN through provisions designed to make health insurance coverage universal and continuous, affordable, and adequate. Among the limitations of ACA for CYSHCN are the exemption of plans that had been in existence before ACA, lack of national standards for insurance benefits, possible elimination or reductions in funding for CHIP, and limited experience with new delivery models for improving care while reducing costs. Advocacy efforts on behalf of CYSHCN must track implementation of ACA at the federal and the state levels. Systems and payment reforms must emphasize access and quality improvements for CYSHCN over cost savings. Developmental-behavioral pediatrics must be represented at the policy level and in the design of new delivery models to assure high quality and cost-effective care for CYSHCN.

Patient Protection and Affordable Care Act; exchange and insurance market standards for 2015 and beyond. Final rule.

PubMed

2014-05-27

This final rule addresses various requirements applicable to health insurance issuers, Affordable Insurance Exchanges (``Exchanges''), Navigators, non-Navigator assistance personnel, and other entities under 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, the rule establishes standards related to product discontinuation and renewal, quality reporting, non-discrimination standards, minimum certification standards and responsibilities of qualified health plan (QHP) issuers, the Small Business Health Options Program, and enforcement remedies in Federally-facilitated Exchanges. It also finalizes: A modification of HHS's allocation of reinsurance collections if those collections do not meet our projections; certain changes to allowable administrative expenses in the risk corridors calculation; modifications to the way we calculate the annual limit on cost sharing so that we round this parameter down to the nearest $50 increment; an approach to index the required contribution used to determine eligibility for an exemption from the shared responsibility payment under section 5000A of the Internal Revenue Code; grounds for imposing civil money penalties on persons who provide false or fraudulent information to the Exchange and on persons who improperly use or disclose information; updated standards for the consumer assistance programs; standards related to the opt-out provisions for self-funded, non-Federal governmental plans and related to the individual market provisions under the Health Insurance Portability and Accountability Act of 1996 including excepted benefits; standards regarding how enrollees may request access to non-formulary drugs under exigent circumstances; amendments to Exchange appeals standards and coverage enrollment and termination standards; and time-limited adjustments to the standards relating to the medical loss ratio (MLR) program. The majority of the provisions in this rule are being finalized as proposed.

45 CFR 146.145 - Special rules relating to group health plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH CARE ACCESS REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET Preemption and Special Rules § 146... group health insurance coverage) for any plan year, if on the first day of the plan year, the plan has...— (A) Medicare supplemental health insurance (as defined under section 1882(g)(1) of the Social...

12 CFR 330.14 - Retirement and other employee benefit plan accounts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Retirement and other employee benefit plan... STATEMENTS OF GENERAL POLICY DEPOSIT INSURANCE COVERAGE § 330.14 Retirement and other employee benefit plan accounts. (a) “Pass-through” insurance. Any deposits of an employee benefit plan in an insured depository...

Structure of the physical therapy benefit in a typical Blue Cross Blue Shield preferred provider organization plan available in the individual insurance market in 2011.

PubMed

Sandstrom, Robert W; Lehman, Jedd; Hahn, Lee; Ballard, Andrew

2013-10-01

The Affordable Care Act of 2010 establishes American Health Benefit Exchanges. The benefit design of insurance plans in state health insurance exchanges will be based on the structure of existing small-employer-sponsored plans. The purpose of this study was to describe the structure of the physical therapy benefit in a typical Blue Cross Blue Shield (BCBS) preferred provider organization (PPO) health insurance plan available in the individual insurance market in 2011. A cross-sectional survey design was used. The physical therapy benefit within 39 BCBS PPO plans in 2011 was studied for a standard consumer with a standard budget. First, whether physical therapy was a benefit in the plan was determined. If so, then the structure of the benefit was described in terms of whether the physical therapy benefit was a stand-alone benefit or part of a combined-discipline benefit and whether a visit or financial limit was placed on the physical therapy benefit. Physical therapy was included in all BCBS plans that were studied. Ninety-three percent of plans combined physical therapy with other disciplines. Two thirds of plans placed a limit on the number of visits covered. The results of the study are limited to 1 standard consumer, 1 association of insurance companies, 1 form of insurance (a PPO), and 1 PPO plan in each of the 39 states that were studied. Physical therapy is a covered benefit in a typical BCBS PPO health insurance plan. Physical therapy most often is combined with other therapy disciplines, and the number of covered visits is limited in two thirds of plans.

Why not private health insurance? 1. Insurance made easy

PubMed Central

Deber, R; Gildiner, A; Baranek, P

1999-01-01

How realistic are proposals to expand the financing of Canadian health care through private insurance, either in a parallel stream or an expanded supplementary tier? Any successful business requires that revenues exceed expenditures. Under a voluntary health insurance plan those at highest risk would be the most likely to seek coverage; insurers working within a competitive market would have to limit their financial risk through such mechanisms as "risk selection" to avoid clients likely to incur high costs and/or imposing caps on the costs covered. It is unlikely that parallel private plans will have a market if a comprehensive public insurance system continues to exist and function well. Although supplementary plans are more congruous with insurance principles, they would raise costs for purchasers and would probably not provide full open-ended coverage to all potential clients. Insurance principles suggest that voluntary insurance plans that shift costs to the private sector would damage the publicly funded system and would be unable to cover costs for all services required. PMID:10497613

Nonprofit to for-profit conversions by hospitals, health insurers, and health plans.

PubMed

Needleman, J

1999-01-01

Conversion of hospitals, health insurers, and health plans from nonprofit to for-profit ownership has become a focus of national debate. The author examines why nonprofit ownership has been dominant in the US health system and assesses the strength of the argument that nonprofits provide community benefits that would be threatened by for-profit conversion. The author concludes that many of the specific community benefits offered by nonprofits, such as care for the poor, could be maintained or replaced by adequate funding of public programs and that quality and fairness in treatment can be better assured through clear standards of care and adequate monitoring systems. As health care becomes increasingly commercialized, the most difficult parts of nonprofits' historic mission to preserve are the community orientation, leadership role, and innovation that nonprofit hospitals and health plans have provided out of their commitment to a community beyond those to whom they sell services.

Public Health Insurance in Oregon: Underenrollment of Eligible Children and Parental Confusion About Children's Enrollment Status

PubMed Central

Ray, Moira; Graham, Alan

2011-01-01

Objectives. We identified characteristics of Oregon children who were eligible for the Oregon Health Plan (OHP), the state's combined Medicaid–Children's Health Insurance Program (CHIP), but were not enrolled in January 2005. We also assessed whether parents’ confusion regarding their children's status affected nonenrollment. Methods. We conducted cross-sectional analyses of linked statewide Food Stamp Program and OHP administrative databases (n = 10 175) and primary data from a statewide survey (n = 2681). Results. More than 20% of parents with children not administratively enrolled in OHP reported that their children were enrolled. Parents of 11.3% of children who were administratively enrolled reported that they were not. Eligible but unenrolled children had higher odds of being older, having higher family incomes, and having employed and uninsured parents. Conclusions. These findings reveal an important discrepancy between administrative data and parent-reported access to public health insurance. This discrepancy may stem from transient coverage or confusion among parents and may result in underutilization of health insurance for eligible children. PMID:21421944

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.

A description of morbidly obese state employees requesting a bariatric operation.

PubMed

Martin, Louis F; Lundberg, Anna Paone; Juneau, Francine; Raum, William J; Hartman, Sandra J

2005-10-01

The federal government, the medical insurance industry, and the academic medical community have disagreed over what treatments are appropriate and cost effective for morbid obesity. This debate is hindered by inadequate data regarding the true costs of diseases and who chooses an operation as a treatment option. The purpose of this study was to obtain these costs and to describe this population. Louisiana's managed medical insurance program created primarily for its civil service employees contracted to offer a small random group of morbidly obese employees the option of a bariatric operation. This observational study examined the subpopulation who requested consideration for the operation. We present historic cost data from all medical expenses paid by the insurance company, a telephone survey of the volunteers in the study to determine their medical problems, and diagnostic evaluation data on those employees randomized to proceed for possible bariatric operation. A total of 911 of 189,398 adult members of the insurance plan wanted to be considered for this study. Only 397, however, completed the informed-consent process. Of the 248 employees who met the age requirement, body mass index criteria, and health criteria to be considered for a bariatric operation and were randomized, 20 withdrew before obtaining 40 committed operative candidates. The 773 morbidly obese female members had used a mean of dollar 11,145 in medical insurance expenses in the year 2003 versus a mean of dollar 8,096 for the other 106,908 adult women. Similar values for the men were dollar 16,720 for the 138 morbidly obese men versus dollar 5,943 for the other 82,490 men. The morbidly obese members of this medical insurance plan who requested a bariatric operation are costing their plan 1.4 to 2.8 times the yearly amount of the other adult members in medical expenses. The yearly mean amount the insurance plan spends on these members suggests that operative treatment would pay for itself in a relatively few number of years if it could significantly reduce these costs. Even in those who consider bariatric operation, many withdraw, further limiting the costs of operative therapy.

Connecticut's Value-Based Insurance Plan Increased The Use Of Targeted Services And Medication Adherence.

PubMed

Hirth, Richard A; Cliff, Elizabeth Q; Gibson, Teresa B; McKellar, M Richard; Fendrick, A Mark

2016-04-01

In 2011 Connecticut implemented the Health Enhancement Program for state employees. This voluntary program followed the principles of value-based insurance design (VBID) by lowering patient costs for certain high-value primary and chronic disease preventive services, coupled with requirements that enrollees receive these services. Nonparticipants in the program, including those removed for noncompliance with its requirements, were assessed a premium surcharge. The program was intended to curb cost growth and improve health through adherence to evidence-based preventive care. To evaluate its efficacy in doing so, we compared changes in service use and spending after implementation of the program to trends among employees of six other states. Compared to employees of other states, Connecticut employees were similar in age and sex but had a slightly higher percentage of enrollees with chronic conditions and substantially higher spending at baseline. During the program's first two years, the use of targeted services and adherence to medications for chronic conditions increased, while emergency department use decreased, relative to the situation in the comparison states. The program's impact on costs was inconclusive and requires a longer follow-up period. This novel combination of VBID principles and participation requirements may be a tool that can help plan sponsors increase the use of evidence-based preventive services. Project HOPE—The People-to-People Health Foundation, Inc.

Setting a national minimum standard for health benefits: how do state benefit mandates compare with benefits in large-group plans?

PubMed

Frey, Allison; Mika, Stephanie; Nuzum, Rachel; Schoen, Cathy

2009-06-01

Many proposed health insurance reforms would establish a federal minimum benefit standard--a baseline set of benefits to ensure that people have adequate coverage and financial protection when they purchase insurance. Currently, benefit mandates are set at the state level; these vary greatly across states and generally target specific areas rather than set an overall standard for what qualifies as health insurance. This issue brief considers what a broad federal minimum standard might look like by comparing existing state benefit mandates with the services and providers covered under the Federal Employees Health Benefits Program (FEHBP) Blue Cross and Blue Shield standard benefit package, an example of minimum creditable coverage that reflects current standard practice among employer-sponsored health plans. With few exceptions, benefits in the FEHBP standard option either meet or exceed those that state mandates require-indicating that a broad-based national benefit standard would include most existing state benefit mandates.

Reaching for it. States struggle to gain new money for children's healthcare.

PubMed

Gardner, J

1998-02-02

Last year's balanced-budget act authorized the creation of a state Children's Health Insurance Program and set aside federal funding for state children's healthcare plans. However, states can't get the feds' money unless they pony up some of their own dough. Not only are states worrying about how to come up with the money, they're also wondering how best to structure their children's healthcare plans.

5 CFR 890.702 - Payment to any licensed practitioner.

Code of Federal Regulations, 2011 CFR

2011-01-01

... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Benefits in Medically Underserved Areas..., if a contract between the Office of Personnel Management and a group health insurance carrier offering a health benefits plan subject to this subpart provides for payment or reimbursement of the cost...

5 CFR 890.702 - Payment to any licensed practitioner.

Code of Federal Regulations, 2014 CFR

2014-01-01

... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Benefits in Medically Underserved Areas..., if a contract between the Office of Personnel Management and a group health insurance carrier offering a health benefits plan subject to this subpart provides for payment or reimbursement of the cost...

5 CFR 890.702 - Payment to any licensed practitioner.

Code of Federal Regulations, 2010 CFR

2010-01-01

... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Benefits in Medically Underserved Areas..., if a contract between the Office of Personnel Management and a group health insurance carrier offering a health benefits plan subject to this subpart provides for payment or reimbursement of the cost...

5 CFR 890.702 - Payment to any licensed practitioner.

Code of Federal Regulations, 2013 CFR

2013-01-01

... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Benefits in Medically Underserved Areas..., if a contract between the Office of Personnel Management and a group health insurance carrier offering a health benefits plan subject to this subpart provides for payment or reimbursement of the cost...

[Spending on private health insurance plans of Brazilian families: a descriptive study with data from the Family Budget Surveys 2002-2003 and 2008-2009].

PubMed

Garcia, Leila Posenato; Ocké-Reis, Carlos Octávio; de Magalhães, Luís Carlos Garcia; Sant'Anna, Ana Claudia; de Freitas, Lúcia Rolim Santana

2015-05-01

Spending on health insurance represents an important share of private expenditure on health in Brazil. The study aimed to describe the evolution of spending on private health insurance plans of Brazilian families, according to their income. Data from the Family Budget Surveys (POF) 2002-2003 and 2008-2009 were used. To compare the spending figures among the surveys, the Consumer Price Index (IPCA) was applied. The proportion of families with private health insurance expenses remained stable in both surveys (2002-2003 and 2008-2009), around 24%. However, the household spending on health insurance plans increased. Among those families who spent money oh health insurance plans, the average spending increased from R$154.35 to R$183.97. The average spending on health insurance plans was greater with increasing household income, as well as portions of the family income and total expenditure committed to these expenses. Spending on health insurance is concentrated among higher-income families, for which it was the main component of total health expenditure.

41 CFR 60-250.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 41 Public Contracts and Property Management 1 2011-07-01 2009-07-01 true Health insurance, life insurance and other benefit plans. 60-250.25 Section 60-250.25 Public Contracts and Property Management... SEPARATED VETERANS, AND OTHER PROTECTED VETERANS Discrimination Prohibited § 60-250.25 Health insurance...

41 CFR 60-250.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 41 Public Contracts and Property Management 1 2013-07-01 2013-07-01 false Health insurance, life insurance and other benefit plans. 60-250.25 Section 60-250.25 Public Contracts and Property Management... SEPARATED VETERANS, AND OTHER PROTECTED VETERANS Discrimination Prohibited § 60-250.25 Health insurance...

41 CFR 60-250.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 41 Public Contracts and Property Management 1 2012-07-01 2009-07-01 true Health insurance, life insurance and other benefit plans. 60-250.25 Section 60-250.25 Public Contracts and Property Management... SEPARATED VETERANS, AND OTHER PROTECTED VETERANS Discrimination Prohibited § 60-250.25 Health insurance...

Marketplace Plans With Narrow Physician Networks Feature Lower Monthly Premiums Than Plans With Larger Networks.

PubMed

Polsky, Daniel; Cidav, Zuleyha; Swanson, Ashley

2016-10-01

The introduction of health insurance Marketplaces under the Affordable Care Act has been associated with growth of restricted provider networks. The value of this plan design strategy, including its association with lower premiums, is uncertain. We used data from all silver plans offered in the 2014 health insurance exchanges in the fifty states and the District of Columbia to estimate the association between the breadth of a provider network and plan premiums. We found that within a market, for plans of otherwise equivalent design and controlling for issuer-specific pricing strategy, a plan with an extra-small network had a monthly premium that was 6.7 percent less expensive than that of a plan with a large network. Because narrow networks remain an important strategy available to insurance companies to offer lower-cost plans on health insurance Marketplaces, the success of health insurance coverage expansions may be tied to the successful implementation of narrow networks. Project HOPE—The People-to-People Health Foundation, Inc.

Health insurance and use of medical services by men infected with HIV.

PubMed

Katz, M H; Chang, S W; Buchbinder, S P; Hessol, N A; O'Malley, P; Doll, L S

1995-01-01

Among 178 HIV-infected men from the San Francisco City Clinic Cohort (SFCCC), we examined the association between health insurance and use of outpatient services and treatment. For men with private insurance, we also assessed the frequency of avoiding the use of health insurance. Men without private insurance reported fewer outpatient visits than men with fee-for-service or managed-care plans. Use of zidovudine for eligible men was similar for those with fee-for-service plans (74%), managed-care plans (77%), or no insurance (61%). Use of Pneumocytstis carinii pneumonia prophylaxis was similar for those with fee-for-service (93%) and managed-care plans (83%) but lower for those with no insurance (63%). Of 149 men with private insurance, 31 (21%) reported that they had avoided using their health insurance for medical expenses in the previous year. In multivariate analysis, the independent predictors of avoiding the use of insurance were working for a small company and living outside the San Francisco Bay Area. Having private insurance resulted in higher use of outpatient services, but the type of private insurance did not appear to affect the use of service or treatment. Fears of loss of coverage and confidentiality may negate some benefits of health insurance for HIV-infected persons.

Affordable Care Act risk adjustment: overview, context, and challenges.

PubMed

Kautter, John; Pope, Gregory C; Keenan, Patricia

2014-01-01

Beginning in 2014, individuals and small businesses will be able to purchase private health insurance through competitive marketplaces. The Affordable Care Act (ACA) provides for a program of risk adjustment in the individual and small group markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge and the incentive for plans to avoid sicker enrollees. This article--the first of three in the Medicare & Medicaid Research Review--describes the key program goal and issues in the Department of Health and Human Services (HHS) developed risk adjustment methodology, and identifies key choices in how the methodology responds to these issues. The goal of the HHS risk adjustment methodology is to compensate health insurance plans for differences in enrollee health mix so that plan premiums reflect differences in scope of coverage and other plan factors, but not differences in health status. The methodology includes a risk adjustment model and a risk transfer formula that together address this program goal as well as three issues specific to ACA risk adjustment: 1) new population; 2) cost and rating factors; and 3) balanced transfers within state/market. The risk adjustment model, described in the second article, estimates differences in health risks taking into account the new population and scope of coverage (actuarial value level). The transfer formula, described in the third article, calculates balanced transfers that are intended to account for health risk differences while preserving permissible premium differences.

12 CFR 745.9-2 - Retirement and other employee benefit plan accounts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Retirement and other employee benefit plan... Coverage § 745.9-2 Retirement and other employee benefit plan accounts. (a) Pass-through share insurance. Any shares of an employee benefit plan in an insured credit union shall be insured on a “pass-through...

75 FR 76950 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-10

... number. Risk Management Agency Title: Standard Reinsurance Agreement Plan of Operations. OMB Control... insurance providers that insure producers of any agricultural commodity under one or more plans acceptable... provide subsidy and reinsurance on eligible crop insurance. The Plan of Operation provides the information...

76 FR 53492 - Agency Information Collection Activities; Submission for OMB Review; Comment Request...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-26

... for OMB Review; Comment Request; Unemployment Insurance State Quality Service Plan ACTION: Notice...) sponsored information collection request (ICR) titled, ``Unemployment Insurance State Quality Service Plan... (ETA). Title of Collection: Unemployment Insurance State Quality Service Plan. OMB Control Number: 1205...

Financing to meet community needs: a guide for small hospitals.

PubMed

Wilson, Bill

2009-03-01

To succeed in the current financial markets, small hospitals need flexible project and financing plans. Many small local banks today can offer small hospitals financing solutions on par with what was previously offered only by the country's strongest investment-grade rated banks. Federal assistance through programs such as HUD's Section 242 mortgage insurance program is also a viable option for small hospitals.

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

[Complaints by private health insurance policy-holders to the Consumer Protection Bureau in Argentina, 2000-2008].

PubMed

Luzuriaga, María José; Spinelli, Hugo

2014-05-01

This paper analyzes problems experienced by policy-holders of voluntary private health insurance plans in Argentina when insurance companies fail to comply with the Consumer Protection Code. The sample consisted of consumer complaints filed with the Consumer Protection Bureau and rulings by the Bureau from 2000 to 2008. One striking issue was recurrent non-compliance with services included in the Mandatory Medical Program and the companies' attempts to blame policy-holders. According to the study, the lack of an information system hinders scientific studies to adequately address the problem. Thus, a comparison with studies on health insurance in other Latin American countries highlighted the importance of such research, the relationship to health systems, constraints on use and denial of citizens' rights to healthcare, and the increasing judicialization of healthcare provision.

Medicaid: Legislation Needed to Improve Collections From Private Insurers

DTIC Science & Technology

1990-11-01

health care coverage include health and liability insurers, ERISA plans, employee welfare benefit plans, workers ’ compen- sation plans, and Medicare. Up to...your office, we focused our Dint SPeaial review on out-of-stabc insurers and employee health benefit plans cov- ered under the Employee Retirement...labor organizations, and other employee organizations that wish to4 .establish welfare benefit plans, which may include health benefits, must meet

Redefining private insurance in a changing market structure.

PubMed

Chollet, D J

1996-01-01

This discussion on likely changes and challenges for the health insurance industry over the coming decade assumes that significant national reform of health care financing for the privately insured population will not occur--or, if it does, that it will mirror the insurance market reforms that many states already have undertaken. First, the changes in private insurance coverage during the past several years are considered, with particular attention to the erosion of employer-based coverage and to the rising influence of public insurance programs--especially Medicaid--on the private insurance market. Next is a description of the changing web of state laws and regulations governing private health insurance. At this writing, virtually every state has enacted or is considering reforms of the small group market to limit what many perceive as unfair or destructive insurer practices and to set new ground rules for competition among insurance arrangements. The changing nature of private insurance contracts in the United States is considered next. Evolving from conventional fee-for-service contracts, private insurance is increasingly a complex mixture of capitation, partial capitation, and reinsurance of capitated arrangements. Finally, this chapter discusses three issues of increasing importance in shaping the marketplace for private insurers: (1) the federal preemption of states' regulatory authority over self-insured employer plans; (2) emerging state regulation to restructure competition in the health insurance and health care markets; and (3) the growing interest of both federal and state governments in medical savings accounts to finance health insurance and health care spending.

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 Role of the Orthopaedic Surgeon in Workers' Compensation Cases.

PubMed

Daniels, Alan H; Kuris, Eren O; Palumbo, Mark A

2017-03-01

Workers' compensation is an employer-funded insurance program that provides financial and medical benefits for employees injured at work. Because many occupational injuries are musculoskeletal in nature, the orthopaedic surgeon plays an important role in the workers' compensation system. Along with establishing the correct diagnosis and implementing an appropriate treatment plan, the clinician must understand the fundamental components of the workers' compensation system to manage an injured employee. Ultimately, effective claim management requires collaboration among the employer, the employee, the legal representatives, the insurance company, and the orthopaedic surgeon.

48 CFR 1228.307-1 - Group insurance plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Group insurance plans. 1228.307-1 Section 1228.307-1 Federal Acquisition Regulations System DEPARTMENT OF TRANSPORTATION... basis on proposed purchases of group insurance plans. Legal advice should be sought where necessary on...

Sources of health insurance and characteristics of the uninsured: analysis of the March 2001 Current Population Survey.

PubMed

Fronstin, P

2001-12-01

This Issue Brief provides summary data on the insured and uninsured populations in the nation and in each state. It discusses the characteristics most closely related to an individual's health insurance status. Based on EBRI estimates from the March 2001 Current Population Survey (CPS), it represents 2000 data--the most recent available. Between 1999 and 2000, the percentage of Americans with health insurance increased: 84.1 percent of nonelderly Americans were covered by some form of health insurance in 2000, up from 83.8 percent in 1999. The percentage of nonelderly Americans without health insurance coverage declined from 16.2 percent in 1999 to 15.9 percent in 2000, continuing a trend that started between 1998 and 1999. The main reason for the decline in the number of uninsured Americans was the strong economy and low unemployment. Between 1999 and 2000, the percentage of nonelderly Americans covered by employment-based health insurance increased from 66.6 percent to 67.3 percent, continuing a longer-term trend that started between 1993 and 1994. In 2000, 34.3 million Americans received health insurance from public programs, and an additional 16.1 million purchased it directly from an insurer. More than 25 million Americans participated in Medicaid or the State Children's Health Insurance Program, and 6.1 million received their health insurance through the Tricare and CHAMPVA programs and other government programs designed to provide coverage for retired military members and their families. Even though the number and percentage of uninsured declined substantially between 1998 and 2000, more than 38 million Americans remain uninsured. While an increasing percentage of Americans were being covered by employment-based health plans, this trend may not continue because of the combined re-emergence of health care cost inflation and the weak economy. As long as the economy is strong and unemployment is low, employment-based health insurance coverage will expand and the uninsured will decline gradually. However, the combination of the current weak economy and the rising cost of providing health benefits will likely result in more Americans without health insurance coverage. Should the uninsured remain unchanged and continue to represent 15.9 percent of the nonelderly population, 40 million would be uninsured by 2005. If the uninsured represented 25 percent of the population, 63 million would be uninsured in 2005 and 65 million nonelderly Americans would be uninsured by 2010.

75 FR 44810 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-29

... techniques or other forms of information technology, e.g., permitting electronic submission of responses... 4, 2009, President Obama signed the Children's Health Insurance Program Reauthorization Act of 2009... XIX of the Social Security Act (SSA), or child health assistance under a State child health plan under...

42 CFR 457.630 - Grants procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Payments to States § 457.630 Grants procedures. (a) General provisions. Once CMS has approved a State child health plan, CMS makes quarterly grant awards to the State to cover the Federal share of expenditures for child...

45 CFR 146.117 - Special enrollment periods.

Code of Federal Regulations, 2010 CFR

2010-10-01

... coverage under any group health plan or health insurance coverage; and (C) The employee satisfies the... REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET Requirements Relating to Access and Renewability of Coverage... health insurance issuer offering health insurance coverage in connection with a group health plan, is...

Can health insurance improve employee health outcome and reduce cost? An evaluation of Geisinger's employee health and wellness program.

PubMed

Maeng, Daniel D; Pitcavage, James M; Tomcavage, Janet; Steinhubl, Steven R

2013-11-01

To evaluate the impact of a health plan-driven employee health and wellness program (known as MyHealth Rewards) on health outcomes (stroke and myocardial infarction) and cost of care. A cohort of Geisinger Health Plan members who were Geisinger Health System (GHS) employees throughout the study period (2007 to 2011) was compared with a comparison group consisting of Geisinger Health Plan members who were non-GHS employees. The GHS employee cohort experienced a stroke or myocardial infarction later than the non-GHS comparison group (hazard ratios of 0.73 and 0.56; P < 0.01). There was also a 10% to 13% cost reduction (P < 0.05) during the second and third years of the program. The cumulative return on investment was approximately 1.6. Health plan-driven employee health and wellness programs similarly designed as MyHealth Rewards can potentially have a desirable impact on employee health and cost.

7 CFR 407.8 - The application and policy.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Differences,” the insured certifies that: (i) He or she understands the terms of the Group Risk Plan; (ii) An..., DEPARTMENT OF AGRICULTURE GROUP RISK PLAN OF INSURANCE REGULATIONS § 407.8 The application and policy. (a... insurance provider to immediately discontinue acceptance of applications. (c) Since this Group Risk Plan...

48 CFR 1352.228-76 - Approval of group insurance plans.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Approval of group....228-76 Approval of group insurance plans. As prescribed in 48 CFR 1328.310-70(i), insert the following clause: Approval of Group Insurance Plans (APR 2010) Under cost-reimbursement contracts, before buying...

48 CFR 1352.228-76 - Approval of group insurance plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Approval of group....228-76 Approval of group insurance plans. As prescribed in 48 CFR 1328.310-70(i), insert the following clause: Approval of Group Insurance Plans (APR 2010) Under cost-reimbursement contracts, before buying...

42 CFR 440.350 - Employer-sponsored insurance health plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Employer-sponsored insurance health plans. 440.350 Section 440.350 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Benchmark-Equivalent Coverage § 440.350 Employer-sponsored insurance health plans. (a) A State may provide...

42 CFR 440.350 - Employer-sponsored insurance health plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Employer-sponsored insurance health plans. 440.350 Section 440.350 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Benchmark-Equivalent Coverage § 440.350 Employer-sponsored insurance health plans. (a) A State may provide...

Family income and crowd out among children enrolled in Massachusetts Children's Medical Security Plan.

PubMed

Feinberg, E; Swartz, K; Zaslavsky, A; Gardner, J; Klein Walker, D

2001-12-01

To assess whether participation in a state publicly financed health insurance program, Massachusetts Children's Medical Security Plan (CMSP) , which is open to children regardless of income, was associated with disenrollment from private insurance. A survey of participants in CMSP who were enrolled as of April 1998 was used. We conducted analyses to detect differences in access to and uptake of private insurance between Medicaid-eligible and in eligible children, and between children eligible for the State Children's Health insurance Program (SCHIP) and in eligible children. A stratified sample of children was drawn from administrative files. the sampling strategy allowed us to examine crowd out among children based on in come and eligibility for publicly funded coverage: those who were Medicaid-eligible (income pound 133 percent of the federal poverty level [FPL]) , those who were SCHIP-eligible (134-200 percent of FPL) , and those with family in comes that exceed SCHIP eligibility criteria (> 200 percent of FPL). The majority of telephone interviews were conducted with the child's parent/guardian between November 1998 and March 1999. The overall response rate was 61.8 percent , yielding a sample of 996 children. Of the children in our sample whose recent health coverage was employer-sponsored insurance (59 percent), 70 percent were no longer eligible. Few children who had employer-sponsored insurance at enrollment dropped this coverage to enroll in CM SP (1 percent, 4 percent, and 2 percent by income). Compared to Medicaid-eligible children, children with incomes > 133 percent of FPL were significantly more likely to be eligible for employer-sponsored insurance but they were no more likely to have purchased offered coverage. Access to employer-sponsored insurance was limited (19 percent), and uptake was low (13 percent). We found no significant difference between SCHIP-eligible children and those whose family incomes exceeded SCHIP guidelines. The Massachusetts experience suggests that (1) coverage could be expanded to children with incomes up to 200 percent of FPL with little direct substitution of public coverage for private insurance, and (2) substitution among children with incomes > 200 percent of FPL, who paid a premium that may have restrained crowd out, did not differ from that among SCHIP-eligible children.

Comparing Types of Health Insurance for Children

PubMed Central

DeVoe, Jennifer E.; Tillotson, Carrie J.; Wallace, Lorraine S.; Selph, Shelley; Graham, Alan; Angier, Heather

2015-01-01

Background Many states have expanded public health insurance programs for children, and further expansions were proposed in recent national reform initiatives; yet the expansion of public insurance plans and the inclusion of a public option in state insurance exchange programs sparked controversies and raised new questions with regard to the quality and adequacy of various insurance types. Objectives We aimed to examine the comparative effectiveness of public versus private coverage on parental-reported children’s access to health care in low-income and middle-income families. Methods/Participants/Measures We conducted secondary data analyses of the nationally representative Medical Expenditure Panel Survey, pooling years 2002 to 2006. We assessed univariate and multivariate associations between child’s full-year insurance type and parental-reported unmet health care and preventive counseling needs among children in low-income (n =28,338) and middle-income families (n = 13,160). Results Among children in families earning <200% of the federal poverty level, those with public insurance were significantly less likely to have no usual source of care compared with privately insured children (adjusted relative risk, 0.79; 95% confidence interval, 0.63–0.99). This was the only significant difference in 50 logistic regression models comparing unmet health care and preventive counseling needs among low-income and middle-income children with public versus private coverage. Conclusions The striking similarities in reported rates of unmet needs among children with public versus private coverage in both low-income and middle-income groups suggest that a public children’s insurance option may be equivalent to a private option in guaranteeing access to necessary health care services for all children. PMID:21478781

48 CFR 28.307-1 - Group insurance plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... requirement. Under cost-reimbursement contracts, before buying insurance under a group insurance plan, the... other refunds to which the contractor may be entitled in the future shall be taken into account. ...

7 CFR 457.139 - Fresh market tomato (dollar plan) crop insurance provisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Fresh market tomato (dollar plan) crop insurance provisions. 457.139 Section 457.139 Agriculture Regulations of the Department of Agriculture (Continued) FEDERAL CROP INSURANCE CORPORATION, DEPARTMENT OF AGRICULTURE COMMON CROP INSURANCE REGULATIONS § 457.139...

7 CFR 457.128 - Guaranteed production plan of fresh market tomato crop insurance provisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Guaranteed production plan of fresh market tomato crop insurance provisions. 457.128 Section 457.128 Agriculture Regulations of the Department of Agriculture (Continued) FEDERAL CROP INSURANCE CORPORATION, DEPARTMENT OF AGRICULTURE COMMON CROP INSURANCE REGULATIONS...

26 CFR 46.4377-1 - Definitions and special rules.

Code of Federal Regulations, 2013 CFR

2013-04-01

...) MISCELLANEOUS EXCISE TAXES EXCISE TAX ON CERTAIN INSURANCE POLICIES, SELF-INSURED HEALTH PLANS, AND OBLIGATIONS NOT IN REGISTERED FORM Fees on Insured and Self-insured Health Plans § 46.4377-1 Definitions and...(d) of the Indian Health Care Improvement Act). (c) Effective/Applicability date. This section...

Reimbursement for Supportive Cancer Medications Through Private Insurance in Saskatchewan

PubMed Central

Forte, Lindy; Olson, Colleen; Atchison, Carolyn; Gesy, Kathy

2009-01-01

Background: As demand for cancer treatment grows, and newer, more expensive drugs become available, public payers in Canada are finding it increasingly difficult to fund the full range of available cancer drugs. Objective: To determine the extent of private drug coverage for supportive cancer treatments in Saskatchewan, preparatory to exploring the potential for cost-sharing. Methods: Patients who presented for chemotherapy and who provided informed consent for participation were surveyed regarding their access to private insurance. Insurers were contacted to verify patients' level of coverage for supportive cancer medications. Groups with specified types of insurance were compared statistically in terms of age, income bracket, time required to assess insurance status, and amount of deductible. Logistic regression was used to determine the effect of patients' age and income on the probability of having insurance. Results: Of 169 patients approached to participate, 156 provided consent and completed the survey. Their mean age was 58.5 years. About two-fifths of all patients (64 or 41%) were in the lowest income bracket (up to $30 000). Sixty-three (40%) of the patients had private insurance for drugs, and 36 (57%) of these plans included reimbursement for supportive cancer medications. A deductible was in effect in 31 (49%) of the plans, a copayment in 28 (44%), and a maximum payment in 8 (13%). Income over $50 000 was a significant predictor of access to drug insurance (p = 0.003), but age was not significantly related to insurance status. Conclusions: A substantial proportion of cancer patients in this study had access to private insurance for supportive cancer drugs for which reimbursement is currently provided by the Saskatchewan Cancer Agency. Cost-sharing and optimal utilization of the multipayer environment might offer a greater opportunity for public payers to cover future innovative and supportive therapies for cancer, but further study is required to determine whether a cost-sharing program would be cost-effective and in the best interest of patients. PMID:22478895

42 CFR 457.1110 - Privacy protections.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Privacy protections. 457.1110 Section 457.1110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Applicant and Enrollee Protections §...

42 CFR 457.1110 - Privacy protections.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Privacy protections. 457.1110 Section 457.1110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Applicant and Enrollee Protections §...

42 CFR 457.1110 - Privacy protections.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Privacy protections. 457.1110 Section 457.1110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Applicant and Enrollee Protections §...

42 CFR 457.1110 - Privacy protections.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Privacy protections. 457.1110 Section 457.1110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Applicant and Enrollee Protections §...

42 CFR 457.1110 - Privacy protections.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Privacy protections. 457.1110 Section 457.1110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Applicant and Enrollee Protections §...

42 CFR 457.320 - Other eligibility standards.

Code of Federal Regulations, 2011 CFR

2011-10-01

... State, if the child is physically located in that State, including as a result of the parent's or... State is the State of residence of the child's custodial parent's or caretaker at the time of placement... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan...

42 CFR 457.320 - Other eligibility standards.

Code of Federal Regulations, 2010 CFR

2010-10-01

... State, if the child is physically located in that State, including as a result of the parent's or... State is the State of residence of the child's custodial parent's or caretaker at the time of placement... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan...

Selected Audio-Visual Materials for Consumer Education.

ERIC Educational Resources Information Center

Oppenheim, Irene

This monograph provides an annotated listing of suggested audiovisual materials which teachers should consider as they plan consumer education programs. The materials are divided into a general section on consumer education and a section on specific topics, such as credit, decision making, health, insurance, money management, and others. The…

45 CFR 152.45 - Transition to the exchanges.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Transition to the exchanges. 152.45 Section 152.45...-EXISTING CONDITION INSURANCE PLAN PROGRAM Transition to Exchanges § 152.45 Transition to the exchanges... the Exchanges, established under sections 1311 or 1321 of the Affordable Care Act, to ensure that...

45 CFR 152.27 - Fraud, waste, and abuse.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Fraud, waste, and abuse. 152.27 Section 152.27 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS PRE-EXISTING CONDITION INSURANCE PLAN PROGRAM Oversight § 152.27 Fraud, waste, and abuse. (a) Procedures. The...

45 CFR 152.27 - Fraud, waste, and abuse.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Fraud, waste, and abuse. 152.27 Section 152.27 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS PRE-EXISTING CONDITION INSURANCE PLAN PROGRAM Oversight § 152.27 Fraud, waste, and abuse. (a) Procedures. The...

45 CFR 152.27 - Fraud, waste, and abuse.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Fraud, waste, and abuse. 152.27 Section 152.27 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS PRE-EXISTING CONDITION INSURANCE PLAN PROGRAM Oversight § 152.27 Fraud, waste, and abuse. (a) Procedures. The...

45 CFR 152.27 - Fraud, waste, and abuse.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Fraud, waste, and abuse. 152.27 Section 152.27 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS PRE-EXISTING CONDITION INSURANCE PLAN PROGRAM Oversight § 152.27 Fraud, waste, and abuse. (a) Procedures. The...

45 CFR 152.27 - Fraud, waste, and abuse.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Fraud, waste, and abuse. 152.27 Section 152.27 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS PRE-EXISTING CONDITION INSURANCE PLAN PROGRAM Oversight § 152.27 Fraud, waste, and abuse. (a) Procedures. The...

10 CFR 1042.440 - Health and insurance benefits and services.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Section 1042.440 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex..., policy, or plan to any of its students, a recipient shall not discriminate on the basis of sex, or...

Shopping for Health Benefits.

ERIC Educational Resources Information Center

Natale, Jo Anna

1992-01-01

Among the ways school districts can obtain the best possible health benefits at the lowest possible cost are the following: (1) reduce the number of full-time employees; (2) set up a utilization review committee; (3) enlist a preferred provider organization; (4) offer wellness programs; (5) develop a self-insurance plan; and (6) consider a…

45 CFR 146.113 - Rules relating to creditable coverage.

Code of Federal Regulations, 2010 CFR

2010-10-01

... State, the U.S. government, a foreign country, or any political subdivision of a State, the U.S... XXI of the Social Security Act (State Children's Health Insurance Program). (2) Excluded coverage... generally is determined by using the standard method described in paragraph (b) of this section. A plan or...

29 CFR 2590.701-4 - Rules relating to creditable coverage.

Code of Federal Regulations, 2010 CFR

2010-07-01

... foreign country, or any political subdivision of a State, the U.S. government, or a foreign country that... Children's Health Insurance Program). (2) Excluded coverage. Creditable coverage does not include coverage... standard method described in paragraph (b) of this section. A plan or issuer may use the alternative method...

78 FR 30218 - Pre-Existing Condition Insurance Plan Program

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-22

..., Department of Health and Human Services, Attention: CMS-9995-IFC3, P.O. Box 8010, Baltimore, MD 21244-8010... for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9995-IFC3... Secretary shall make such adjustments as are necessary to eliminate such deficit.'' We have codified this...

42 CFR 457.310 - Targeted low-income child.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Targeted low-income child. 457.310 Section 457.310... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Eligibility, Screening, Applications, and Enrollment § 457.310 Targeted low-income child. (a...

42 CFR 457.402 - Definition of child health assistance.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Definition of child health assistance. 457.402... SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Coverage and Benefits § 457.402 Definition of child health assistance. For the...

42 CFR 457.310 - Targeted low-income child.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Targeted low-income child. 457.310 Section 457.310... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Eligibility, Screening, Applications, and Enrollment § 457.310 Targeted low-income child. (a...

42 CFR 457.310 - Targeted low-income child.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Targeted low-income child. 457.310 Section 457.310... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Eligibility, Screening, Applications, and Enrollment § 457.310 Targeted low-income child. (a...

42 CFR 457.310 - Targeted low-income child.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Targeted low-income child. 457.310 Section 457.310... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Eligibility, Screening, Applications, and Enrollment § 457.310 Targeted low-income child. (a...

42 CFR 457.310 - Targeted low-income child.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Targeted low-income child. 457.310 Section 457.310... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan Requirements: Eligibility, Screening, Applications, and Enrollment § 457.310 Targeted low-income child. (a...

5 CFR 894.601 - When does my FEDVIP coverage stop?

Code of Federal Regulations, 2010 CFR

2010-01-01

... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Termination or Cancellation of...) If you are enrolled with a combination dental and vision carrier with a restricted service area, and... carrier and you change to a dental only or vision only carrier, your existing combination plan coverage...

5 CFR 894.601 - When does my FEDVIP coverage stop?

Code of Federal Regulations, 2011 CFR

2011-01-01

... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Termination or Cancellation of...) If you are enrolled with a combination dental and vision carrier with a restricted service area, and... carrier and you change to a dental only or vision only carrier, your existing combination plan coverage...

Golden Rule: Living Up to Its Name.

ERIC Educational Resources Information Center

Rooney, J. Patrick

1992-01-01

Discusses the Golden Rule Insurance Company's educational choice program which assists lower-income families in sending children to private/church schools. Identifies benefits (e.g., introduction of public school choice plan, and families' sense of control over future). Answers criticisms (e.g., destroying public school system, racial motivation,…

77 FR 23451 - Funding Opportunity Title; Risk Management Education and Outreach Partnerships Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-19

... DEPARTMENT OF AGRICULTURE Federal Crop Insurance Corporation Funding Opportunity Title; Risk.... Content and Form of Application Submission The title of the application must include the (1) RMA Region... Plan includes a list of all partners working on the project, their titles, and how they will be...

45 CFR 152.35 - Insufficient funds.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Insufficient funds. 152.35 Section 152.35 Public... CONDITION INSURANCE PLAN PROGRAM Funding § 152.35 Insufficient funds. (a) Adjustments by a PCIP to eliminate... data, that its allocated funds are insufficient to cover projected PCIP expenses, the PCIP shall report...

45 CFR 152.35 - Insufficient funds.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Insufficient funds. 152.35 Section 152.35 Public... CONDITION INSURANCE PLAN PROGRAM Funding § 152.35 Insufficient funds. (a) Adjustments by a PCIP to eliminate... data, that its allocated funds are insufficient to cover projected PCIP expenses, the PCIP shall report...

Choice Inconsistencies Among the Elderly: Evidence from Plan Choice in the Medicare Part D Program

PubMed Central

Abaluck, Jason; Gruber, Jonathan

2010-01-01

We evaluate the choices of elders across their insurance options under the Medicare Part D Prescription Drug plan, using a unique data set of prescription drug claims matched to information on the characteristics of choice sets. We document that elders place much more weight on plan premiums than on expected out of pocket costs; value plan financial characteristics beyond any impacts on their own financial expenses or risk; and place almost no value on variance reducing aspects of plans. Partial equilibrium welfare analysis implies that welfare would have been 27% higher if patients had all chosen rationally. PMID:21857716

Medicare Advantage Plans Pay Hospitals Less Than Traditional Medicare Pays.

PubMed

Baker, Laurence C; Bundorf, M Kate; Devlin, Aileen M; Kessler, Daniel P

2016-08-01

There is ongoing debate about how prices paid to providers by Medicare Advantage plans compare to prices paid by fee-for-service Medicare. We used data from Medicare and the Health Care Cost Institute to identify the prices paid for hospital services by fee-for-service (FFS) Medicare, Medicare Advantage plans, and commercial insurers in 2009 and 2012. We calculated the average price per admission, and its trend over time, in each of the three types of insurance for fixed baskets of hospital admissions across metropolitan areas. After accounting for differences in hospital networks, geographic areas, and case-mix between Medicare Advantage and FFS Medicare, we found that Medicare Advantage plans paid 5.6 percent less for hospital services than FFS Medicare did. Without taking into account the narrower networks of Medicare Advantage, the program paid 8.0 percent less than FFS Medicare. We also found that the rates paid by commercial plans were much higher than those of either Medicare Advantage or FFS Medicare, and growing. At least some of this difference comes from the much higher prices that commercial plans pay for profitable service lines. Project HOPE—The People-to-People Health Foundation, Inc.

Patient Protection and Affordable Care Act of 2010 and Children and Youth With Special Health Care Needs

PubMed Central

Buysse, Christina A.; Hubner, Lauren M.; Huffman, Lynne C.; Loe, Irene M.

2015-01-01

ABSTRACT: The Patient Protection and Affordable Care Act (ACA) was designed to (1) decrease the number of uninsured Americans, (2) make health insurance and health care affordable, and (3) improve health outcomes and performance of the health care system. During the design of ACA, children in general and children and youth with special health care needs and disabilities (CYSHCN) were not a priority because before ACA, a higher proportion of children than adults had insurance coverage through private family plans, Medicaid, or the State Children's Health Insurance Programs (CHIP). ACA benefits CYSHCN through provisions designed to make health insurance coverage universal and continuous, affordable, and adequate. Among the limitations of ACA for CYSHCN are the exemption of plans that had been in existence before ACA, lack of national standards for insurance benefits, possible elimination or reductions in funding for CHIP, and limited experience with new delivery models for improving care while reducing costs. Advocacy efforts on behalf of CYSHCN must track implementation of ACA at the federal and the state levels. Systems and payment reforms must emphasize access and quality improvements for CYSHCN over cost savings. Developmental-behavioral pediatrics must be represented at the policy level and in the design of new delivery models to assure high quality and cost-effective care for CYSHCN. PMID:25793891

Show Me My Health Plans: Using a Decision Aid to Improve Decisions in the Federal Health Insurance Marketplace

PubMed Central

Politi, Mary C.; Kuzemchak, Marie D.; Liu, Jingxia; Barker, Abigail R.; Peters, Ellen; Ubel, Peter A.; Kaphingst, Kimberly A.; McBride, Timothy; Kreuter, Matthew W.; Shacham, Enbal; Philpott, Sydney E.

2017-01-01

Introduction Since the Affordable Care Act was passed, more than 12 million individuals have enrolled in the health insurance marketplace. Without support, many struggle to make an informed plan choice that meets their health and financial needs. Methods We designed and evaluated a decision aid, Show Me My Health Plans (SMHP), that provides education, preference assessment, and an annual out-of-pocket cost calculator with plan recommendations produced by a tailored, risk-adjusted algorithm incorporating age, gender, and health status. We evaluated whether SMHP compared to HealthCare.gov improved health insurance decision quality and the match between plan choice, needs, and preferences among 328 Missourians enrolling in the marketplace. Results Participants who used SMHP had higher health insurance knowledge (LS-Mean = 78 vs. 62; P < 0.001), decision self-efficacy (LS-Mean = 83 vs. 75; P < 0.002), confidence in their choice (LS-Mean = 3.5 vs. 2.9; P < 0.001), and improved health insurance literacy (odds ratio = 2.52, P <0.001) compared to participants using HealthCare.gov. Those using SMHP were 10.3 times more likely to select a silver- or gold-tier plan (P < 0.0001). Discussion SMHP can improve health insurance decision quality and the odds that consumers select an insurance plan with coverage likely needed to meet their health needs. This study represents a unique context through which to apply principles of decision support to improve health insurance choices. PMID:28804780

45 CFR 146.180 - Treatment of non-Federal governmental plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH CARE ACCESS REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET Exclusion of Plans and Enforcement... plan is not provided through health insurance coverage, (that is, it is self-funded), from any or all... regulated as group health insurance under an applicable State law, then for purposes of this section, a non...

The Status of Group Life Insurance Plans.

ERIC Educational Resources Information Center

Cook, Thomas J.

1981-01-01

Information on provisions of group life insurance plans and the tendency of colleges and universities to provide this coverage is considered. There has been an increase in the percentage of institutions adopting group life insurance plans over the last decade. Absence of coverage is concentrated among smaller two-year and four-year institutions…

The potential and peril of health insurance tobacco surcharge programs: evidence from Georgia's State Employees' Health Benefit Plan.

PubMed

Liber, Alex C; Hockenberry, Jason M; Gaydos, Laura M; Lipscomb, Joseph

2014-06-01

A rapidly growing number of U.S. employers are charging health insurance surcharges for tobacco use to their employees. Despite their potential to price-discriminate, little systematic empirical evidence of the impacts of these tobacco surcharges has been published. We attempted to assess the impact of a health insurance surcharge for tobacco use on cessation among enrollees in Georgia's State Health Benefit Plan (GSHBP). We identified a group of enrollees in GSHBP who began paying the tobacco surcharge at the program's inception in July 2005. We examined the proportion of these enrollees who certified themselves and their family members as tobacco-free and no longer paid the surcharge through April 2011, and we defined this as implied cessation. We compared this proportion to a national expected annual 2.6% cessation rate. We also compared our observation group to a comparison group to assess surcharge avoidance. By April 2011, 45% of enrollees who paid a tobacco surcharge starting in July 2005 had certified themselves as tobacco-free. This proportion exceeded the expected cessation based on 3 times the national rate (p < .001). The length of enrollment was not statistically different between our observation and comparison groups (p = .427). The reported rates of tobacco cessation among GSHBP enrollees resulting from a tobacco surcharge substantially exceed national rates. These surcharges appear to be effective, but the value of these results, and the effectiveness of health insurance surcharges in changing behavior, are tempered by the important limitation that enrollees' certification of quitting was self-reported and not subject to additional, clinical verification.

Birth plans and health insurance enrolment of pregnant women: a cross-sectional survey at two secondary health facilities in Lagos, Nigeria.

PubMed

Okusanya, Babasola O; Roberts, Alero A; Akinsola, Oluwatosin J; Oye-Adeniran, Boniface A

2016-01-01

We evaluated birth plans and health insurance enrolment of pregnant women at secondary health care level as a strategy for post-2015 goals. This was a cross-sectional study at two secondary health facilities in Lagos state, Nigeria. A pre-tested questionnaire was used to collect data that were analysed and results presented with frequencies. An overall estimate with 95% confidence interval was used at significant p values of less than 0.05. Five hundred and twenty-four women, with a mean age of 3 0 ± 4.1 years, participated. Most women chose hospital delivery (84%) and had plan for transportation (86.3%) during labour. Few women were well prepared for birth (9.7%) and had health insurance (10.1%). Compared with women without insurance, more health-insured women had plans for transport in labour (p = 0.1383) and identified a place of birth (p = 0.2294), but did not have as much plan for someone to accompany them in the case of an emergency (p = 0.3855) and donate blood (p = 0.5065). Few health insured women saved money for delivery (p = 0.7439). Health insured women did not have better birth plans and expanding pregnant women's access to health insurance may be an insufficient strategy to achieve post MDG 2015 goals.

Pilot study of enhanced tobacco-cessation services coverage for low-income smokers.

PubMed

Doescher, Mark P; Whinston, Melicent A; Goo, Alvin; Cummings, Diane; Huntington, Jane; Saver, Barry G

2002-01-01

This study explored the feasibility of covering nicotine replacement therapy (NRT) and paying for pharmacist-delivered smoking cessation counseling at the time of NRT pick-up for low-income, managed Medicaid and Basic Health Plan (a state insurance program) enrollees. A prospective pilot intervention was used at two community health centers (CHCs) and two community pharmacies. Participants were adult managed-Medicaid or Basic Health Plan enrollees who attended the pilot CHCs and smoked. An innovative insurance benefit that included coverage for NRT and $15 payment to the pharmacist to deliver cessation counseling with each prescription fill. Proportion of eligible patients who used the cessation benefit and patient and pharmacist satisfaction with the intervention. During the 9-month intervention, 32 patients at the pilot clinics were referred for NRT and pharmacist-delivered counseling. This number represented roughly 5% of eligible smokers. Of these, 26 received NRT with concomitant pharmacist-delivered cessation counseling at least once. Recipients reported a high level of satisfaction with this intervention. Pharmacists indicated they would continue providing counseling if reimbursement remained adequate and if counseling lasted no longer than 5-10 min. However, 12 (38%) who were referred were no longer insured by the sponsoring plan by the end of the 9-month pilot period. Pharmacist-delivered cessation counseling may be feasible and merits further study. More importantly, this pilot reveals two key obstacles in our low-income, culturally diverse setting: low participation and rapid turnover of insureds. Future interventions will need to address these barriers.

7 CFR 400.705 - Contents required for a new submission or changes to a previously approved submission.

Code of Federal Regulations, 2010 CFR

2010-01-01

... duration and scope of the plan of insurance; (8) A marketing plan; (9) Any known or anticipated future... related to the marketing of the policy or plan of insurance, including, as applicable: (1) A list of... submission is actuarially appropriate and consistent with appropriate insurance principles and practices. (i...

Revised Fifth Five Year Economic and Social Development Plan, 1984-1986.

PubMed

1987-01-01

This document contains provisions of chapter 6 (Promoting Social Development) of the Revised Fifth Five-Year Economic and Social Development Plan (1984-86) of the Republic of Korea. The plan calls for the efficient control of population growth by targeting intensive efforts to women 20-30 years old, eradicating the traditional preference for male children, providing incentives to foster a small family norm, and discouraging couples from having too many children. Family planning (FP) programs will be expanded to increase the contraceptive prevalence rate and improve the quality of contraceptive services. Emphasis will be placed on women 34 years or younger residing in poor urban and remote rural areas. The emphasis of the evaluations of FP guidance and evaluation teams will be on the actual prevention of birth rather than on the contraceptive use ratio, and the FP program will be linked to other health and medical schemes. Families with 2 children or less will receive extended medical services and free kindergarten tuition. Families with 3 or more children may face discriminatory policy measures. The Family Law will be amended to allow daughters to inherit, the Medical Insurance Law will be changed to allow family members dependent upon female workers to be insured, and social institutions hindering female participation in the work force will be banned. The dissemination of FP information and population education will be expanded.

Mandatory universal drug plan, access to health care and health: Evidence from Canada.

PubMed

Wang, Chao; Li, Qing; Sweetman, Arthur; Hurley, Jeremiah

2015-12-01

This paper examines the impacts of a mandatory, universal prescription drug insurance program on health care utilization and health outcomes in a public health care system with free physician and hospital services. Using the Canadian National Population Health Survey from 1994 to 2003 and implementing a difference-in-differences estimation strategy, we find that the mandatory program substantially increased drug coverage among the general population. The program also increased medication use and general practitioner visits but had little effect on specialist visits and hospitalization. Findings from quantile regressions suggest that there was a large improvement in the health status of less healthy individuals. Further analysis by pre-policy drug insurance status and the presence of chronic conditions reveals a marked increase in the probability of taking medication and visiting a general practitioner among the previously uninsured and those with a chronic condition. Copyright © 2015 Elsevier B.V. All rights reserved.

The Affordable Care Act permits greater financial rewards for weight loss: a good idea in principle, but many practical concerns remain.

PubMed

Cawley, John

2014-01-01

The Patient Protection and Affordable Care Act of 2010 (ACA) increased the maximum rewards that group health insurance plans (including employers who self-insure) may offer in their wellness programs, with the goal of incentivizing healthy behaviors such as weight loss among the obese and smoking cessation. In this essay, I describe the history and intention of such programs, and make the following three points: (1) In principle, incentivizing healthy behavior can reduce external costs and help people with time-inconsistent preferences stick to their resolutions; (2) there are problems with the design of this portion of the ACA that will limit its effectiveness in achieving these goals; and (3) financial rewards for healthy behaviors have a mixed record to date, and thus many practical design features need to be resolved to improve the effectiveness of such programs.

The feasibility of a public-private long-term care financing plan.

PubMed

Arling, G; Hagan, S; Buhaug, H

1992-08-01

In this study, the feasibility of a public-private long-term care (LTC) financing plan that would combine private LTC insurance with special Medicaid eligibility requirements was assessed. The plan would also raise the Medicaid asset limit from the current $2,000 to the value of an individual's insurance benefits. After using benefits the individual could enroll in Medicaid. Thus, insurance would substitute for asset spend-down, protecting individuals against catastrophic costs. This financing plan was analyzed through a computer model that simulated lifetime LTC use for a middle-income age cohort beginning at 65 years of age. LTC payments from Medicaid, personal income and assets, Medicare, and insurance were projected by the model. Assuming that LTC use and costs would not grow beyond current projections, the proposed plan would provide asset protection for the cohort without increasing Medicaid expenditures. In contrast, private insurance alone, with no change in Medicaid eligibility, would offer only limited asset protection. The results must be qualified, however, because even a modest increase in LTC cost growth or use of care (beyond current projections) could result in substantially higher Medicaid expenditures. Also, private insurance might increase personal LTC expenditures because of the added cost of insuring.

20 CFR 323.1 - Introduction.

Code of Federal Regulations, 2010 CFR

2010-04-01

...' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.1 Introduction. (a) This part defines the phrase nongovernmental plan for unemployment or sickness insurance and sets forth the procedure by which...

20 CFR 323.1 - Introduction.

Code of Federal Regulations, 2013 CFR

2013-04-01

...' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.1 Introduction. (a) This part defines the phrase nongovernmental plan for unemployment or sickness insurance and sets forth the procedure by which...

20 CFR 323.1 - Introduction.

Code of Federal Regulations, 2012 CFR

2012-04-01

...' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.1 Introduction. (a) This part defines the phrase nongovernmental plan for unemployment or sickness insurance and sets forth the procedure by which...

20 CFR 323.1 - Introduction.

Code of Federal Regulations, 2011 CFR

2011-04-01

...' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.1 Introduction. (a) This part defines the phrase nongovernmental plan for unemployment or sickness insurance and sets forth the procedure by which...

20 CFR 323.1 - Introduction.

Code of Federal Regulations, 2014 CFR

2014-04-01

...' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT NONGOVERNMENTAL PLANS FOR UNEMPLOYMENT OR SICKNESS INSURANCE § 323.1 Introduction. (a) This part defines the phrase nongovernmental plan for unemployment or sickness insurance and sets forth the procedure by which...

How to develop a tele-ICU model?

PubMed

Rogove, Herb

2012-01-01

The concept of the tele-ICU (intensive care unit) is about 30 years old and more hospitals are utilizing it to cover multiple hospitals in their system or for hospitals that lack on-site critical care coverage such as in the rural setting. Doing a needs analysis, picking the appropriate committee to oversee development of the correct model, choosing quality metrics to measure, and designing an implementation plan that has a timeline is how the process should begin. Research including visitation to established programs and connecting with professional societies are helpful. Developing both a business and financial plan will optimize the value of a tele-ICU program. The innovative ICU nursing director will help to integrate a telemedicine program seamlessly with the on-site program to insure a successful program that benefits patients, their families, the ICU staff, and the hospital.