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July 08, 2010 at 08:00 PM
Commenters are asking where provider capitation payments and travel medical insurance will fit in when states are enforcing new medical loss ratio standards.
An actuarial subgroup at the National Association of Insurance Commissioners, Kansas City, Mo., has been considering proposals for fine-tuning efforts to come up with a definition for “medical expense.”
State regulators need a definition to implement a provision of the Affordable Care Act – the federal legislative package that includes the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act – that will set minimum medical loss ratio requirements.
The provision will require insurers to spend 85% of large group premiums and 80% of individual and small group premiums and medical care and quality improvement activities.
A capitation payment is a payment that a health plan makes to a physician, hospital or other health care provider on a “per patient” basis, rather than paying the provider separately for each service rendered.
