Insurance regulation (1 - 10 of 70 items)
Private Health Insurance: Early Experiences Implementing New Medical Loss Ratio Requirements
GAO-11-711: Published: Jul 29, 2011. Publicly Released: Aug 29, 2011.
To help ensure that Americans receive value for their premium dollars, the Patient Protection and Affordable Care Act (PPACA) established minimum "medical loss ratio" (MLR) standards for health insurers. The MLR is a basic financial indicator, traditionally referring to the percentage of premiums spent on medical claims. The PPACA MLR is defined differently from the traditional MLR. Beginning in 2...
Private Health Insurance: State Oversight of Premium Rates
GAO-11-701: Published: Jul 29, 2011. Publicly Released: Aug 2, 2011.
With premiums increasing for private health insurance, questions have been raised about the extent to which increases are justified. Oversight of the private health insurance industry is primarily the responsibility of states. In 2010, the Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to award grants to assist states in their oversight of pre...
Private Health Insurance: State Oversight of Premium Rates and Changes in Response to Federal Rate Review Grants
GAO-11-878T: Published: Aug 2, 2011. Publicly Released: Aug 2, 2011.
This testimony discusses state oversight of health insurance premium rates in 2010 and changes that states that received Department of Health and Human Services (HHS) rate review grants have begun making to enhance their oversight of premium rates. In 2009, about 173 million nonelderly Americans, about 65 percent of the U.S. population under the age of 65, had private health insurance coverage, ei...
Private Health Insurance: Waivers of Restrictions on Annual Limits on Health Benefits
GAO-11-725R: Published: Jun 14, 2011. Publicly Released: Jun 14, 2011.
The Patient Protection and Affordable Care Act (PPACA), which became law in March, 2010, generally prohibits health insurance issuers and group health plan sponsors from imposing annual limits on the dollar value of "essential" covered health benefits beginning on January 1, 2014, but allows restricted annual limits, as defined by the Secretary of Health and Human Services (HHS), on the value of t...
Private Health Insurance: Data on Application and Coverage Denials
GAO-11-268: Published: Mar 16, 2011. Publicly Released: Mar 16, 2011.
The large percentage of Americans that rely on private health insurance for health care coverage could expand with enactment of the Patient Protection and Affordable Care Act (PPACA) of 2010. Until PPACA is fully implemented, some consumers seeking coverage can have their applications for enrollment denied, and those enrolled may face denials of coverage for specific medical services. PPACA requir...
Definitions of Insurance and Related Information
GAO-06-424R: Published: Feb 23, 2006. Publicly Released: Mar 21, 2006.
This letter concerns a variety of issues related to identifying a universal definition of insurance and the challenges associated with doing so. We briefed congressional staff on the preliminary results of our work on June 24, 2005, and on our final results on November 29, 2005. Specifically, we provided information on (1) the elements that are commonly part of definitions of insurance, (2) a few...
Catalogue of Federal Insurance Activities
GAO-05-265R: Published: Mar 4, 2005. Publicly Released: Apr 5, 2005.
The federal government assumes insurance risk for a wide range of activities that are funded through numerous federal budget accounts and administered by a variety of federal organizations. For some activities, such as those funded through the National Flood Insurance account, the federal government assumes the entire insurance risk. The federal government also assumes part of the risk for insuran...
Private Health Insurance: Employers and Individuals Are Vulnerable to Unauthorized or Bogus Entities Selling Coverage
GAO-04-312: Published: Feb 27, 2004. Publicly Released: Mar 3, 2004.
Health insurance premiums have increased at double-digit rates over the past few years. While searching for affordable options, some employers and individuals have purchased coverage from certain entities that are not authorized by state insurance departments to sell this coverage. Such unauthorized entities--also sometimes referred to as bogus entities or scams--may collect premiums and not pay s...
Private Health Insurance: Unauthorized or Bogus Entities Have Exploited Employers and Individuals Seeking Affordable Coverage
GAO-04-512T: Published: Mar 3, 2004. Publicly Released: Mar 3, 2004.
As health insurance premiums have risen at double-digit rates in recent years, employers and individuals who have sought to purchase more affordable coverage have fallen prey to certain entities that may offer attractively priced premiums but do not fulfill the expectations of those buying health insurance. These unauthorized entities--also known as bogus entities or scams--may not meet the financ...
Private Health Insurance: Federal and State Requirements Affecting Coverage Offered by Small Business
GAO-03-1133: Published: Sep 30, 2003. Publicly Released: Oct 2, 2003.
Most employees in the U.S. have health coverage through employers. Small businesses with fewer than 50 employees, however, are less likely to offer coverage than larger businesses. Many say they cannot afford it. When they do provide coverage, small businesses typically purchase insurance policies, while larger businesses are more likely to use their own funds to pay for some of their employees' h...