Industry News

Out-of-Network Claims Mediation

One of the services you may offer as a life and health agent is assisting your clients with the claims process. They may call you after they receive that rather large emergency room bill and question why one of the doctors they saw was out-of-network when the hospital was in-network. You can offer the typical advice, such as matching up the explanation of benefits with the itemized bill, but did you know that you can suggest mediation for certain out-of-network claims?

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Amendment to Regulation on “Grandfathered” Health Plans

On June 17th, the Departments of Health and Human Services, Labor, and the Treasury (the Departments) issued the “grandfather” regulation which, by addressing how health plans can retain a “grandfathered” exemption from certain new requirements, helps protect Americans’ ability to keep their current plan if they like it. At the same time, Americans in grandfathered plans will receive many of the added benefits that the new law provides. The regulation also minimizes market disruption and helps put us on a path toward the competitive, patient-centered market of the future.

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Healthy Texas Program

The Texas Department of Insurance (TDI) is excited to announce that it has signed contracts with Celtic Insurance Company and United Healthcare to be participating health plans for the Healthy Texas program. Once enrollment begins, interested employers will make application directly to one of these participating plans, or apply through an insurance agent.

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Hancock Plans to Raise LTC Rates 40%

John Hancock Life Insurance Company is telling distributors it plans to raise rates for in-force long term care insurance policies 40%. Hancock, Boston, also is suspending sales of group long term care insurance (LTC) policies as it undertakes a review of claims in that market, says Marianne Harrison, president of John Hancock Long Term Care, a division of Manulife Financial Corp., Toronto (NYSE:MFC).

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Contact Your Insurance Commissioner About MLR Today!

NAHU is asking all members to weigh in with their state insurance commissioners, urging them to exempt “pass-through” fees from Medical Loss Ratio (MLR) calculations, as well as to adhere to the statutory language of the health reform law in exempting most federal taxes from the MLR equation. Contact Your Insurance Commissioner About MLR Today!

Contact Your Insurance Commissioner About MLR Today! Read More »

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