Insurance companies will have to spend 80 cents of every premium dollar on medical care for individuals and 85 cents for group health insurance plans. If an insurance company fails to comply with these regulations, they will have to pay consumers rebates.
That the medical service and welfare programs are medical or administrative costs have yet to be defined. According to the Wall Street Journal, the National Association of Insurance Commissioners (NAIC) has the task of determining what will be defined as medical costs in the report of the medical loss (MLR). The MLR calculates the percentage of premium dollars used for patient care.
The NAIC establish definitions for medical expenses before June 1, then the Health and Human Services Secretary Kathleen Sebelius certify the guidelines that come into effect at the end of the year. Typically the health insurance companies have nonprofit MLR of which are in the high 80s while insurers are profit have MLR is in the 80 lower.
It is unclear whether WellPoint Inc. jumped the gun or the hotlines and welfare programs ultimately be considered a medical cost.
The President of the Health Insurance NAIC and Managed Care Committee, Sandy Praeger said, "You could say that nurses hotlines with disease management for diabetes, according to how it is used, which could potentially be treated as the cost of medical care. "
hotlines nurses and welfare programs have become popular among many health insurance companies. Insurers have been able to provide additional benefits to consumers that may have a direct effect on consumer health and medical services, we hope new rules will not change that.
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