HHS Denies Texas’ MLR Waiver Request
The U.S. Department of Health and Human Services (HHS) has denied a request by the Texas Department of Insurance (DOI) to adjust the medical loss ratio (MLR) standard in the individual market in relation to the Affordable Care Act.
The Texas Insurance Commissioner had requested the waiver to give insurers in the state time to meet the ratio requirement of spending 80 percent of premiums in the individual market on direct medical costs and health care quality improvement, and only 20 percent on insurer administrative costs. The Texas DOI requested a tiered implementation of 71 percent, 74 percent, and 77 percent for reporting years 2011, 2012 and 2013, respectively.
The Affordable Care Act allows the HHS Secretary to adjust the MLR standard for a state if the state demonstrates that meeting the 80 percent MLR standard may destabilize its individual market.
HHS announced on Friday that issuers in Texas’ individual market should be able to meet the 80 percent medical loss ratio standard in the near future and that no adjustment to the MLR standard is necessary.
Specifically, HHS determined:
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Texas, if it now chooses, has 10 days to submit a request for reconsideration, to which HHS would then have 20 days to respond.
To date, HHS has rejected 10 states’ requests and approved six requests to varying extents. Two requests are still pending.
As part of the Affordable Care Act, states had until Jan. 1, 2012, to strictly or similarly meet National Association of Insurance Commissions (NAIC) standards. Otherwise, health insurance issuers offering non-grandfathered plans and policies in the state would be required to choose a federally administered process or contract with an accredited independent review organization.
The Texas Department of Insurance (TDI) issued a bulletin in December announcing its strategy to comply with the standards until 2014.
TDI instructed health carriers to continue to utilize the Texas external review process for fully insured business and to voluntarily comply with these temporary standards:
Waive any exhaustion requirement if:
- The internal appeal process timelines are not met; or
- In an urgent care situation, the claimant files for an external review before exhausting the internal appeal process
Independent Review Organizations (IRO) must inform the issuer and the claimant of an urgent care decision within four business days or less from receipt of the request for review and provide written notice of its decision within 48 hours of the oral notification. (BCBSTX will comply with this requirement by contacting TDI if we are aware of a situation where the IRO does not follow the timeframes.)
Revisions to Pre-Existing Conditions for BCBSTX members
By Jorge Hiram Garcia, Your Insurance Advisor | August 18, 2010
| Pre-Existing Condition Exclusions
Blue Cross and Blue Shield of Texas (BCBSTX) has revised the chart published last month defining how pre-existing condition waiting periods will be applied to insured and self-funded (ASO) business. |
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Insured Business Configuration
ASO Configuration Possibilities
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Annuities: What is a Charitable Gift Annuity
By Jorge Hiram Garcia, Your Insurance Advisor | June 17, 2010
A Charitable Gift Annuity is a type of Single Premium Immediate Annuity. Charitable Gift Annuities can be a great way to for the average person to help or contribute a significant amount of money to their favorite charity or church. With a Charitable Gift Annuity, a person can transfer cash, or marketable securities to a charitable organization, and receive a current income tax deduction, and a fixed annual amount guaranteed for life in exchange.
The payouts received from a Charitable Gift Annuity are much lower than those received under other type of annuities. Payouts from Charitable Gift Annuities are deliberately low and non-competitive on purpose because the primary purpose of buying a Charitable Gift Annuity is the giving part. It is not meant to be a competitive investment, and it was established in that way primarily to stem competition between providers in providing this type of annuity.
The low rates offered on Charitable Gift Annuities provide a safety margin for the charity. Under the regulations that set the limits on the payouts, the charity receives twice as much as needed to make payments to the annuitant. Another big difference between charitable gift annuities and other types of annuities is that Charitable Gift Annuities are never considered insurance products. In fact, many states have laws that require the annuity contract to specifically disclose that “a Charitable Gift Annuity is not insurance under the laws of this State, is not subject to regulation by the State’s Insurance Division and is not protected by the State’s Guaranty Fund.”
As with all other annuity types, care must be taken to ensure that the annuity is sound, and not fraudulent. Because state’s do not regulate Charitable Gift Annuities, the potential for fraud exists, and consumers must be on guard. Despite the extra care that must be taken when buying a Charitable Gift Annuity, these types of annuities are a great way to fund a favorite charity while providing a stable income stream in retirement.
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Annuities: How Does A Single Premium Immediate Annuity Work?
By Jorge Hiram Garcia, Your Insurance Advisor | June 3, 2010
When you buy an annuity, you pay a certain amount of money called an insurance premium. This premium can be paid all at once in the beginning (called a single premium annuity), or it can be paid in installments (a flexible premium annuity). When an insurance company receives the premium from you, the premium is gathered and collected, or pooled, with the premium paid by all of the other people that buy annuities from the insurance company.
Annuities: What is A Single Premium Immediate Annuity?
By Jorge Hiram Garcia, Your Insurance Advisor | May 24, 2010
A Single Premium Immediate Annuity (SPIA), out of all of the annuities that we have talked about, is the one that is most insurance-like of all annuities. As we discussed before an annuity protects you from running out of income, or money, before you die. When you buy a single premium immediate annuity you are protecting yourself by assuring yourself a source of income for the rest of your life.
Auto Accident Personal Injury Car Insurance Claims
By Jorge Hiram Garcia, Your Insurance Advisor | May 24, 2010
E
ight out of ten Americans will have an accident in the next seven years. Auto Accident Personal Injury Insurance Claim: How to Evaluate and Settle Your Loss delivers over three decades of personal injury, insurance claim experience in an easy-to-read book. Learn how to settle your “pain and suffering” for top dollar from an expert.
This book covers every single step of what you need to do, from the initial telephone calls to the medical examination and then finally the actual settlement, that a claimant should employ to obtain the best possible settlement of their auto accident insurance claim.
But the most important part of this revolutionary and helpful book is the introduction of The BASE Formula – The Baldyga Auto Accident Settlement Evaluation Formula. BASE is a never before publicized settlement process that the author has created through long years of personal experience in settling claims. Auto accident insurance claim professionals are calling BASE “spectacular” and “amazing” because it explains, in simple, easy to understand language, exactly, right down to the last hundred dollar bill, how much ones “pain and suffering” is worth.
This book is easy-to-read, comprehensive and most importantly contains outstanding instructions in addition to the innovative BASE Formula and helps the reader place an accurate value on “pain and suffering.” With the advice provided in this book the reader will get all the help they need to settle their claim for a much higher amount than they ever expected.
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Annuities: Flexible or Single Premium Annuity
By Jorge Hiram Garcia, Your Insurance Advisor | May 23, 2010
Annuities create income security for consumers by providing guaranteed income for life, or for a predetermined period of time. This period of time is set at the time of purchase in the annuity contract between the purchaser and the insurance company. The money used to fund the annuity purchase is called the premium.
When the annuity contract allows the annuity buyer, or annuity owner to add additional funds or money to the annuity, then the annuity is called a flexible premium annuity. When an annuity contract allows only one single investment, then that annuity is referred toa s a single premium annuity.
Annuity owners wishing to add additional funds to a single premium annuity are not able to do so to an existing annuity and must create a new contract or purchase a new annuity. Single premium annuities are mainly purchased as fixed rate annuities because the annuity buyer is able to lock in a set rate of return for a specific period of time that is similar to a Bank CD.
Consumers purchase annuities to protect themselves from running out of income during their lifetime. When selecting an annuity care should be taken to decide at what point in time that income is desired. There are two possible choices for consumers to make: Immediate or Deferred.
Variable Annuities: What is a Variable Annuity?
By Jorge Hiram Garcia, Your Insurance Advisor | May 21, 2010
A variable annuity is a type of annuity that resembles a mutual fund. A variable annuity provides a consumer with some of the safety that a regular annuity provides, but offers a rate of return that can vary dependent on what happens in the market.
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