SAN ANTONIO — The list of major medical insurers courting producers at this year’s National Association of Health Underwriters (NAHU) annual convention included WellPoint, Aetna, UnitedHealth, Humana – and the U.S. Department of Health and Human Services (HHS).
Jay Angoff, a senior advisor to HHS Secretary Kathleen Sebelius and the founding head of what is now the HHS’ Center for Consumer Information and Insurance Oversight, appeared here at a general session to give members of NAHU, Arlington, Va., an update on HHS progress at implementing the Patient Protection and Affordable Care Act of 2010 (PPACA) – and drum up sales of federal Pre-existing Condition Insurance Plan (PCIP) risk pool coverage.
HHS is focusing on setting up the new health insurance exchanges that are supposed to start distributing subsidized health coverage in 2014, and it will do what it can, within the limits of the law, to help health insurance agents and brokers cope with the new PPACA minimum medical loss ratio (MLR) rules, Angoff said.
The rules require health insurers to spend 85% of large group revenue and 80% of individual and small group revenue on health care and quality improvement efforts, and producers report insurers are using the MLR rules as a reason to slash commissions.
“We know how controversial [MLR] is,” Angoff said.
When HHS is reviewing state applications for waivers from the MLR rules, one of the factors officials look at is the effects of the rules on agents and brokers, Angoff said.
Angoff spent most of the session talking about PCIP, a program created by PPACA to provide a coverage option for uninsured people with serious health problems between the 2010 and 2014, when PPACA is supposed to create a new system of health insurance subsidies and require insurers to sell coverage on a guaranteed issue, mostly community-rated basis.
The coverage comes with a $2,000 deductible, but it offers comprehensive coverage with no preexisting condition exclusions for rates that are supposed to be comparable to what ordinary individual coverage in a state would cost, Angoff said.
Typical rates are “in the 200s” per month for younger insureds and in the 300s or 400s for older insureds,