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Life Health > Health Insurance > Your Practice

PPACA Roundup: ICD-10; Expat Programs; Child-Only Policies

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America’s Health Insurance Plans (AHIP) estimates shifting to the International Classification of Diseases, Tenth Revision (ICD-10), standard will cost plans about $11 to $38 per enrollee.

AHIP, Washington, has been asking the National Association of Insurance Commissioners (NAIC), Kansas City, Mo., to let health carriers count ICD-10 conversion expenses as quality improvement expenses Caduceuswhen they are doing the calculations needed to comply with the new minimum medical loss ratio (MLR) standards.

The minimum MLR standards, part of the Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA), will require that the percentage of revenue going to medical care and quality improvement be at least 80% for individual and small group coverage and 85% for large group coverage.

Individuals picked to represent consumer interests in NAIC proceedings have told the NAIC that ICD-10 conversion expenses are necessary but should counted as an administrative expense, not a quality improvement expense.

AHIP staffers say, based on results from a survey of 20 health carriers, that the ICD-10 implementation expense will hurt small plans more than big plans.

The cost will be only about $11 per member at large plans, but it could be as much as $38 per member at large plans, AHIP says.

In many years, a health carrier’s profits amount to less than $50 per plan member.


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