Starting in 2011, HHS will require health insurers to spend 80% to 85% of consumers' premiums on direct care for patients and efforts to improve quality.
HHS issues medical-loss ratio rules
The "medical loss ratio" rules were issued as part of the Patient Protection and Affordable Care Act and are intended to give consumers more value for their money. According to HHS, the regulations announced todayannounced today certify and adopt recommendations submitted to HHS Secretary Kathleen Sebelius in October by the National Association of Insurance Commissioners.
Next year, the new rules are intended to protect as many as 74.8 million insured Americans, and in 2012, as many as 9 million Americans could be eligible for rebates worth up to $1.4 billion, according to HHS. The average rebate per person could total $164 in the individual market, according to HHS.
The new provisions also seek to hold insurers accountable by requiring that they report total earned premiums, reimbursement for clinical services, spending on activities to improve quality, and on all nonclaims costs excluding federal and state taxes and fees.
Effective Jan. 1, 2011, the interim final rule includes a 60-day comment period from the time the rule is published in the Federal Register. An HHS spokeswoman said the expected publication date is Dec. 1. -with Melanie Evans
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