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60 percent Accident actions addition advertising agents Aging American amount annual anticipated approved association Baucus amendment beneficiary benefits blood Blue Cross Blue Cross/Blue Shield certified charges coinsurance Committee complaints costs cover coverage Cross/Blue Shield plans Cumulative loss ratio deductible determine discussed District Earned Incurred earned premiums Education elderly established example expenses Experience of Medigap federal federal standards hcfa Health Insurance Home hospital House individual individual policies inpatient insurance companies June least licenses limited Loss Ratio Experience Maryland Medicare Supplemental Insurance Medigap insurance Medigap policies meet million minimum standards monitor naic model nationwide nursing obtain offices paid panel Penalties Pennsylvania percent period pints policies sold policyholders practices premium claims protection Public purchase reasonable received regulations regulatory programs Representatives requested reserve responsible reviewed Sales Abuse Select state's Table targets tion visited Washington
Page 26 - ... to return to policyholders in the form of aggregate benefits provided under the policy, at least 75 percent of the aggregate amount of premiums collected in the case of group policies and at least 60 percent of the aggregate amount of premiums collected in the case of individual policies.
Page 25 - Medicare supplement policies shall be expected to return to policyholders in the form of aggregate benefits under the policy, as estimated for the entire period for which rates are computed to provide coverage, on the basis of incurred claims experience and earned premiums for such period...
Page 2 - I960, the Congress amended the Social Security Act to provide standards for policies marketed as Medigap insurance. These amendments, known as the Baucus amendments, incorporated by reference the Medigap standards contained in a model regulatory program developed by the National Association of Insurance Commissioners (NAIC). If a State has adopted laws and/or regulations at least as stringent as those of the NAIC, policies regulated by the State are deemed to meet Federal requirements.
Page 8 - During each benefit period (which begins when an insured person enters a hospital and ends when he or she has been out of a hospital or skilled nursing facility for 60 consecutive days), Hospital Insurance will pay for: Ninety days of inpatient hospital care subject to a deductible ($520 in 1987).
Page 30 - ... analysis. Loss ratios must be interpreted with care because of the factors that may affect the computations. Early policy experience may result in a relatively low loss ratio because during the waiting periods for preexisting conditions, the policies will not cover services.
Page 9 - Abuses in the Sale of Health Insurance to the Elderly in Supplementation of Medicare: A National Scandal...
Page 10 - ... goal for the percentage of insurance premiums to be returned to policyholders in the form of benefits. Medigap policies must be expected to pay benefits at least equal to 60 percent of the earned premiums for individual policies and 75 percent for group policies. There are Federal sanctions, consisting of fines and/or imprisonment, for (1) furnishing false information to obtain the Secretary's certification, (2) posing as a Federal agent to sell Medigap policies, (3) knowingly selling policies...
Page 8 - ... income. The program was enacted July 30, 1965, as Title XVIII, Health Insurance for the Aged of the Social Security Act, and became effective on July 1, 1966. It consists of two separate but coordinated programs, hospital insurance (Part A) and supplementary medical insurance (Part B).
Page 8 - For any benefit period, part A pays for all covered services for the first 60 days of inpatient hospital care except for the inpatient deductible ($520 in 1987) and the first three pints of blood used.