Health
Hippo: Health Insurance
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For the latest on the Health Insurance Portability and
Accountability Act, visit Health Hippo's
HIPAA page.
Is your health insurance coverage eroding?
Pursuant to a congressional request, GAO reviewed major trends in the
private health insurance market, during the 1980s and 1990s, focusing
on: (1) the decline in private health insurance coverage and factors
contributing to this decline; (2) trends in health insurance premiums
and reasons for these trends; and (3) employer's efforts to control
health benefits costs.
Private
Health Insurance: Continued Erosion of Coverage Linked to Cost
Pressures. HEHS-97-122. July 24, 1997.
Courts are beginning to pierce ERISA preemption that shields MCOs from liability
for negligent decisions in conjunction with employee benefit plans.
See
Jass
v. Prudential Health Care Plan.
The August 21, 1996 signing of the Health Insurance
Portability and Accountability Act represents the first major
health reform legislation signed into law. What impact will this law
have on business, insurance companies and the public? For a look at
what the Clinton Administration is saying, click to the
HHS Fact Sheet,
Remarks by the President,
Statement by the President
and Press Briefing.
Viatical settlements -- contracts where an
investor acquires an interest in the life insurance policy of a
terminally ill person -- have been hailed both as blessings to the
terminally ill and the epitome of greed in America. One thing is sure
(for now) -- in
SEC
v. Life Partners Inc the U.S. Court of Appeals for the District
of Columbia Circuit held that the SEC cannot regulate viatical
settlements.
U.S. Code
- HEALTH INSURANCE PORTABILITY AND
ACCOUNTABILITY ACT OF 1996 (Public Law 104-191, 104th Congress)
(with revisor's notes)
Code of Federal Regulations
Legislation/Testimony
Cases
- SEC
v. Life Partners Inc (D.C. Cir. July 5, 1996) (SEC cannot
regulate viatical settlements-- investment contracts where an
investor acquires an interest in the life insurance policy of a
terminally ill person).
- Curtiss-Wright
Corp. v. Schoonejongen (U.S., March 6, 1995) (standard
provision in many employer-provided benefit plans stating that
company reserves the right at any time to amend the plan- sets
forth an amendment procedure that satisfies ERISA requirements)
- New
York State Conference of Blue Cross & Blue Shield Plans v.
Travelers Ins. Co., 115 S. Ct.1671, 131 L. Ed. 2d 695 (1995).
(surcharges that indirectly impact ERISA plans not preempted)
- Safeco
Life Ins. Co. v. Musser (7th Cir., September 12, 1995) (Wisc.
fees on health insurers to subsidize health care for the poor not
preempted by ERISA)
- Varity
Corporation v. Howe (U.S. March 19, 1996) (Varity and
Massey-Ferguson, acting as ERISA fiduciaries, harmed plan
beneficiaries through deliberate deception violating ERISA's
404(a)'s fiduciary obligation)
News & Reports
- Retiree
Health Insurance: Erosion in Retiree Health Benefits Offered by
Large Employers. T-HEHS-98-110. 12 pp. March 10, 1998.
Discusses the erosion in employer-based health benefits for
retirees, especially early retirees, focusing on: (1) trends in
access to employer-sponsored retiree health benefits; (2) the
impact on retirees of an employer's decision to terminate health
benefits; and (3) federal safeguards that protect the rights of
retirees who have health benefits.
- Medigap
Insurance: Compliance With Federal Standards Has Increased.
HEHS-98-66. 13 pp. plus 7 appendices (23 pp.) March 6, 1998.
Reviews insurers' compliance with Medigap loss ratios and
standards, focusing on: (1) the overall Medigap market; (2) which
Medigap policies had loss ratios below the standards in 1994 and
1995; and (3) which policies resulted in refunds or credits, or,
if not, why.
- Health
Insurance Standards: New Federal Law Creates Challenges for
Consumers, Insurers, Regulators. HEHS-98-67. 30 pp. plus 6
appendices (18 pp.) February 25, 1998. Reviews the implementation
of the Health Insurance Portability and Accountability Act
(HIPAA), focusing on issues affecting: (1) consumers; (2) issuers
of health coverage, including employers and insurance carriers;
(3) state insurance regulators; and (4) federal regulators.
- Medical
Savings Accounts: Findings From Insurer Survey. HEHS-98-57.
December 19, 1997. Pursuant to a legislative requirement, GAO
competitively awarded four contracts to study Medical Savings
Accounts (MSA), including consumer choice and the scope of
high-deductible plans purchased in conjunction with MSAs.
- Health
Insurance: Coverage Leads to Increased Health Care Access for
Children. HEHS-98-14. 27 pp. plus 2 enclosures (13 pp.)
November 24, 1997. Reports on the relationship between health
insurance and health care access, focusing on: (1) what effect
health insurance has on children's access to health care; (2)
whether expanding publicly funded insurance improves their access;
and (3) barriers besides lack of insurance that might deter
children from getting health care.
- Health
Insurance: Management Strategies Used by Large Employers to
Control Costs (Chapter Report, 05/06/97, GAO/HEHS-97-71).
Pursuant to a congressional request, GAO reviewed the strategies
of large, innovative purchasers who have attempted to stem the
rapid escalation in health insurance costs while maintaining or
enhancing the quality of care for their employees.
- Health
Insurance: How Health Care Reform May Affect State Regulation
(Testimony, 11/05/93, GAO/T-HRD-94-55). Most health care reform
proposals before Congress expect the states to implement and
enforce new requirements on private health insurers--a
responsibility that may require states to undertake new regulatory
tasks and regulate new organizations.
- Health
Insurance Portability: Reform Could Ensure Continued Coverage for
Up to 25 Million Americans (Letter Report, 09/19/95,
GAO/HEHS-95-257). Pursuant to a congressional request, GAO
provided information on: (1) the protections offered by current
state and federal health insurance portability reforms; (2) the
number of people who could be affected by broader national
portability standards; and (3) other issues related to the design
of national portability standards.
- Health
Insurance Regulation: Variation in Recent State Small Employer
Health Insurance Reforms (Fact Sheet, 06/12/95,
GAO/HEHS-95-161FS). Pursuant to a congressional request, GAO
provided information on state legislation to improve portability,
access, and rating practices for the small-employer and individual
health insurance markets.
- Access
to Health Insurance: Public and Private Employers' Experience With
Purchasing Cooperatives (Letter Report, 05/31/94,
GAO/HEHS-94-142). One of the few areas of widespread agreement in
the health care debate is that small businesses and other small
organizations have a tough time buying and keeping health
insurance for their employees.
- Medicare/Medicaid:
Data Bank Unlikely to Increase Collections From Other Insurers
(Letter Report, 05/06/94, GAO/HEHS-94-147). The Department of
Health and Human Services has been directed to establish a data
bank, beginning in February 1995, that would contain information
on all workers, spouses, and dependents who are covered by
employer-provided health insurance.
- Health
Insurance for the Elderly: Owning Duplicate Policies Is Costly and
Unnecessary (Letter Report, 08/03/94, GAO/HEHS-94-185). Owning
multiple health insurance policies to supplement Medicare is both
costly and unnecessary. GAO estimated that about 3 million elderly
Medicare beneficiaries paid about $1.8 billion in 1991 for
policies that probably involved duplicate coverage.
- Medigap
Insurance: Insurers' Compliance with Federal Minimum Loss Ratio
Standards, 1988-93 (Letter Report, 08/23/95, GAO/HEHS-95-151).
Pursuant to a congressional request, GAO reviewed benefit payments
by Medigap policies between 1988 and 1994, focusing on trends in
Medigap insurers' aggregate loss ratio performance.
- Private
Health Insurance: Millions Relying on Individual Market Face Cost
and Coverage Tradeoffs (Chapter Report, 11/25/96,
GAO/HEHS-97-8). Pursuant to a congressional request, GAO provided
information on the private individual health insurance market.
- Health
Insurance Regulation: Variation in Recent State Small Employer
Health Insurance Reforms (Fact Sheet, 06/12/95,
GAO/HEHS-95-161FS). Pursuant to a congressional request, GAO
provided information on state legislation to improve portability,
access, and rating practices for the small-employer and individual
health insurance markets.
- Health
Insurance for Children: Many Remain Uninsured Despite Medicaid
Expansion (Letter Report, 07/19/95, GAO/HEHS-95-175). Pursuant
to a congressional request, GAO reviewed the status of health
insurance for children.
- Health
Insurance for Children: State and Private Programs Create New
Strategies to Insure Children (Letter Report, 01/16/96,
GAO/HEHS-96-35). Pursuant to a congressional request, GAO reviewed
state and private efforts to insure children who are not eligible
for Medicaid and whose parents cannot purchase private insurance.
- Health
Insurance for Children: Private Insurance Coverage Continues to
Deteriorate (Letter Report, 06/17/96, GAO/HEHS-96-129).
Pursuant to a congressional request, GAO provided information on
the number of uninsured Medicaid-eligible children in 1994.
- Medigap
Insurance: Alternatives for Medicare Beneficiaries to Avoid
Medical Underwriting (Letter Report, 09/10/96,
GAO/HEHS-96-180). Pursuant to a legislative requirement, GAO
reviewed Medigap policies, focusing on: (1) the extent to which
Medicare beneficiaries are subject to medical underwriting when
they change Medigap policies; and (2) options for modifying
federal Medigap requirements to ensure that medical underwriting
is not a problem in such cases.
- Employment-Based
Health Insurance: Costs Increase and Family Coverage Decreases
(Letter Report, 02/24/97, GAO/HEHS-97-35). Pursuant to a
congressional request, GAO provided information on the decline in
employment-based health insurance.
- Health
Insurance: Coverage of Autologous Bone Marrow Transplantation for
Breast Cancer (Letter Report, 04/24/96, GAO/HEHS-96-83).
Although many insurers now cover the cost of autologous bone
marrow transplantation, a new and expensive treatment for breast
cancer, issues surrounding the procedure have put several goals of
the U.S. health care systems in conflict: access to the best, most
advanced care; cost containment; and research adequate to assess
the value of new treatments.
- Tax
Policy: Health Insurance Tax Credit Participation Rate Was Low
(Letter Report, 05/02/94, GAO/GGD-94-99). This report provides
information on the health insurance tax credit, which was
established to encourage low-income workers to buy private health
insurance for their families.
- Health
Insurance: California Public Employees' Alliance Has Reduced
Recent Premium Growth (Letter Report, 11/22/93,
GAO/HRD-94-40). As part of the ongoing debate over health care
reform, policy makers have been weighing the pros and cons of
alternative ways to purchase care.
- Access
to Health Insurance: Public and Private Employers' Experience With
Purchasing Cooperatives (Letter Report, 05/31/94,
GAO/HEHS-94-142). One of the few areas of widespread agreement in
the health care debate is that small businesses and other small
organizations have a tough time buying and keeping health
insurance for their employees.
- Health
Care Reform: Proposals Have Potential to Reduce Administrative
Costs (Letter Report, 05/31/94, GAO/HEHS-94-158). Americans
today receive health insurance from a multitude of sources,
including more than 1,200 commercial insurers; 550 health
maintenance organizations; 69 Blue Cross and Blue Shield plans;
thousands of self-insured plans run by private employers; and
government programs, such as Medicaid and Medicare.
- Health
Insurance Regulation: Varying State Requirements Affect Cost of
Insurance. GAO/HEHS-96-161 (8/19/96) Focusing on: (1) premium
taxes on insured health plans; (2) mandated health benefits; (3)
financial solvency standards; and (4) state health insurance
reforms affecting small employers.
- Medicare:
Private-Sector and Federal Efforts to Assess Health Care Quality
(Testimony, 09/19/96, GAO/T-HEHS-96-215). GAO discussed the
Health Care Financing Administration's (HCFA) efforts to provide
health care quality information to Medicare beneficiaries joining
health maintenance organizations (HMO).
- HCFA:
Physician's Bills
- HCFA: HIPAA
Questions - Consumers
- HCFA Assures
Medicare Beneficiaries of Rights to Advice from Physicians
Related Links
~
ADA
Online: ERISA ~
ADA
Online: The Travelers Case ~
Articles
about Benefits ~
Clark & Mascaro Health
Insurance Denials ~
Clark &
Mascaro Newsletter ~
COBRA
Online ~
EMTALA.COM
~
International Foundation of Employee
Benefit Plans ~
Insurance
Career ~
National
Medical Savings Account Network ~
Medigap
Insurance Home Page ~
National Association of
Insurance Commissioners ~
NAIC:
White paper ~
NML:
The Longevity Game ~
RAND
REPORTS: INSURANCE, HEALTH ~
SafeTnet
~
SeniorLaw
~
FTC:
Viatical Settlements ~
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