Medical Loss Ration will have no impact to self funded plans. For fully insured plans only: Insurers must provide rebates if their MLR (percent of premium spent on medical claims and quality improvement) for policies issued in a state is less than 80% in the small group and individual markets (or 85% in the large group market). The MLR is determined on a state-by-state basis for the state where the policies are sitused, and not on the experience of any single policy.
Women's Preventive Health Services Employers will impact employers with non-grandfathered plans. This will include adding a variety of women’s preventive care services to their coverage, with no individual customer cost sharing. Well-woman visits, screening for gestational diabetes, and HPV testing are among the basic services to be covered. Coverage will include contraceptives for non-religious, non-exempt employers. Religiously affiliated employers that do not cover contraceptives today due to religious objections will have a one-year delay until the first plan year beginning on or after Aug. 1, 2013. Prior to that date, Health and Human Services (HHS) will develop a plan to provide this coverage through some other means.
Please discuss these changes and the many others that will be occurring over the next few years with your insurance agent. If you have questions or concerns that are not being answered please contact us and our experienced life and health team will be happy to assist you.