Small Market Health Insurance Reform: Hearing Before the Subcommittee on Health and the Environment of the Committee on Energy and Commerce, House of Representatives, One Hundred Second Congress, Second Session, May 14, 1992, Volume 4 |
Other editions - View all
Common terms and phrases
50 percent ALCOHOL AND DRUG alcohol services alcohol treatment ALEX MCMILLAN Americans Association believe benefit packages Bennie L bill carriers Chairman Committee community rating competition comprehensive Congress cost of health detoxification drug and alcohol enacted ERISA Families USA Federal FEEZOR going guaranteed issue health care costs health care reform health care system health insurance market health status high-risk individuals INPATIENT insurance companies insurance industry legislation LEHNHARD limit managed care mandated benefits March of Dimes marketplace Medicaid medical underwriting medically uninsurable mental health mental illness MOTLEY NAIC National NFIB OUTPATIENT plans pregnant women premium increases problems purchasing rate increases reform proposals reinsurance REQUIRED OFFER risk pools Senate Slattery small business small business owners small employer market small firms small group insurance small group market small group reform small market reform subcommittee subsidies SYNAR Thank uninsured WAXMAN workers WYDEN
Popular passages
Page 82 - In addition. Plans have pursued, over the years, aggressive programs to control unnecessary utilization and avoid the provision of services that are not medically necessary.
Page 73 - Vice President of the Blue Cross and Blue Shield Association. The— Association is the coordinating organization for the 73 Blue Cross and Blue Shield Plans throughout the nation. Collectively, the Plans provide health benefit protection for more than 70 million Americans.
Page 74 - On average, only 4 percent of insured individuals generate 50 percent of claims, while 20 percent of enrollees generate 80 percent of claims. As insurers with more liberal enrollment practices adjust their rates to reflect their higher costs, they lose their low-risk enrollees — who can find better-priced coverage elsewhere — and keep their higher-risk enrollees, who have nowhere else to go. These carriers thus are left with risk pools that gradually deteriorate over time. This phenomenon is...
Page 61 - In response, insurers have developed "tier rating". In tier rating, the claims experience of a group is used to select its premium level at renewal. Insurers increase rates more for groups with poor claims experience (eg, high claims frequency, employees with serious or expensive illnesses). In some cases these rate increases have been extremely high. In many cases, insurers also can choose not to renew coverage for a group. For example, an insurer may choose...
Page 96 - These proposals will assure that no small employer, and no employee of a small employer, will be turned down for health insurance because of poor health. They will restore the concept of pooling risk across large groups, greatly limiting how much of the cost of poor health must be borne by the individual employer. Further they will moderate significantly the sometimes dramatic premium increases now experienced by small employers at renewal time and thereby reduce the incentive to change carriers...
Page 60 - Low initial rates are possible because insurers medically underwrite (use health screening) to assure that the group is healthy before they accept it for coverage. A healthy group will generally produce lower than average claims experience, so the insurer can charge lower rates initially. However, the benefit of health underwriting "wears off after...
Page 225 - Montana, Nebraska, Nevada, New Jersey, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Texas, Utah, Vermont, Virginia, Washington, Wisconsin, and Wyoming.
Page 8 - Your prepared statements will be in the record in full. We would like to ask, if you would, to limit your oral presentation to no more than 5 min-utes.
Page 44 - More time will be needed for these state initiatives to develop fully before a conclusive assessment can be made of these issues. The Incentive Effect of Waiving Mandated Benefits Appears to be Modest To encourage Insurance companies to design less costly insurance packages for small businesses, nearly half of the states have passed legislation reducing or eliminating health insurance coverage requirements — "mandated benefits" — and now permit Insurance companies to offer lower-cost "bare bones"...
Page 63 - Arkansas law requires insurers to disclose the following information at the time of purchase: the insurer's right to change rates; any factors, including the group's claims experience, health status, or duration of coverage, that could affect the group's rate; the class of business the group would be placed into; and the conditions that affect renewability of coverage. Disclosure of these factors will enable small...