Complex Insurance Regulations Deciphered in Issue Briefs from California HealthCare Foundation; Rules for Individual and Small Group Insurance Markets Explained.Business Editors/Health/Medical Writers OAKLAND, Calif.--(BUSINESS WIRE)--June 17, 2003 As part of an ongoing series on insurance markets, the California HealthCare Foundation (CHCF CHCF California HealthCare Foundation CHCF Committee for Hispanic Children and Families CHCF California High Cost Fund CHCF Capitol Hill Community Foundation CHCF Community Health & Care Forum CHCF Complementary Healthcare Consultative Forum ) today released three issue briefs on health insurance regulation in California. Two of the briefs bring into focus the rules that apply when health coverage is purchased by small employers or by individuals. The third brief describes the overall framework for regulation of health insurance in California, including how federal ERISA See Employee Retirement Income Security Act. ERISA See Employee Retirement Income Security Act (ERISA). requirements compare with regulation by the state Departments of Managed Health Care and Insurance. According to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. Marian Mulkey, program officer for CHCF, "The business of health insurance in California is subject to a complex patchwork of federal and state rules and regulations. Different rules apply depending on whether insurance coverage is purchased directly by individuals or on behalf of a group, as in job-based health insurance. Consumer protections vary depending the type of product purchased and the way that it is funded. These briefs help to simplify and clarify these complex rules." Rules Governing California's Small Group Health Insurance Market describes the rationale for having special rules that apply to the small group health insurance market, summarizes California's small group market rules, and puts these rules in the broader context of other market forces. Highlights from the brief include: -- Small group market rules seek to balance the health insurance carrier goal of avoiding adverse selection with the broader social goal of allowing small groups access to coverage. -- California law California Law consists of 29 codes, covering various subject areas, the State Constitution and Statutes. See also
guaranteed issue, rating protections, portability, and fair marketing provisions. When individuals buy health coverage on their own, they have limited protections, especially if they do not have recent coverage under a group plan. Rules Governing California's Individual Health Insurance Market underscores the need for consumers to avoid breaks in coverage whenever possible. Highlights from the brief include: -- An overview of the differences between individual and group insurance; -- Basic rules for individual coverage including limits on pre-existing conditions, guaranteed renewability, and protections for higher-risk individuals who maintain individual coverage; and -- Rules when changing from group to individual coverage, including COBRA cobra, name for African and Asian snakes of the family Elapidae that are equipped with inflatable neck hoods. The family also includes the African mambas, the Asian kraits, the New World coral snakes and a large number of Australian snakes. and Cal-COBRA, HIPAA (Health Insurance Portability & Accountability Act of 1996, Public Law 104-191) Also known as the "Kennedy-Kassebaum Act," this U.S. law protects employees' health insurance coverage when they change or lose their jobs (Title I) and provides standards for patient health, , and conversion coverage. Regulatory Oversight
Oversight may refer to:
Highlights from the brief include: -- Pertinent PERTINENT, evidence. Those facts which tend to prove the allegations of the party offering them, are called pertinent; those which have no such tendency are called impertinent, 8 Toull. n. 22. By pertinent is also meant that which belongs. Willes, 319. highlights of the federal ERISA law and California laws regulating employee health benefit plans; and -- An examination of the impact of different regulatory frameworks in the areas of solvency The ability of an individual to pay his or her debts as they mature in the normal and ordinary course of business, or the financial condition of owning property of sufficient value to discharge all of one's debts. solvency n. standards, mandated benefits, and dispute resolution. All three issue briefs and additional related resources (Making Sense of Managed Care Regulation in California, Regulation of ERISA Plans: The Interplay in·ter·play n. Reciprocal action and reaction; interaction. intr.v. in·ter·played, in·ter·play·ing, in·ter·plays To act or react on each other; interact. of ERISA and California Law, and Independent Medical Review Experiences in California, Phase II: Cases Including Medical Necessity) are available at www.chcf.org. About the California HealthCare Foundation The California HealthCare Foundation (CHCF) is an independent philanthropy philanthropy, the spirit of active goodwill toward others as demonstrated in efforts to promote their welfare. The term is often used interchangeably with charity. committed to improving California's health care delivery and financing systems. For more information, visit www.chcf.org. About the Authors Deborah Reidy Kelch conducted the analysis for Rules Governing California's Individual Health Insurance Market and Regulatory Oversight of Health Insurance in California. Kelch is an independent health researcher and president of Kelch Associates Consulting. Debra L. Roth conducted the analysis for Rules Governing California's Small Group Health Insurance Market. At the time of writing, Roth was an attorney and health care policy consultant with Ruderman & Roth in Sacramento. |
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