Government Sets Complicated Fixed Indemnity Rules

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Government interference in heath care continues unabated. Citizens continue to lose freedom of choice. – “Insurers may have a chance to sell fixed indemnity health insurance to workers who get weak “minimum essential coverage” (MEC) from self-funded employee health plans.”

By Allison Bell

Insurers may have a chance to sell fixed indemnity health insurance to workers who get weak “minimum essential coverage” (MEC) from self-funded employee health plans.

States cannot paralyze navigators by wrapping them in red tape — but they may be able to put some red tape around “certified application counselors” and other “non-navigator assistance personnel.”

The Small Business Health Options Program (SHOP) exchange divisions run by the U.S. Department of Health and Human Services (HHS) will start their 2015 exchange plan “election periods” Nov. 15 — the same day that the 2015 individual exchange qualified health plan” (QHP) open enrollment period is set to start — but states with state-based exchanges can begin their SHOP election periods earlier, if they want.

Officials at the Centers for Medicare & Medicaid Services (CMS), an arm of HHS, have included regulations regarding those matters and many more in a new batch of final regulations.

HHS is preparing to publish the regulations, which are based on draft regulations released in March, in the Federal Register.

Fixed indemnity

The fixed indemnity provisions in the regulation apply to hospital indemnity insurance policies and other policies that qualified as “excepted benefits” — benefits exempt from the provisions in the Health Insurance Portability and Accountability Act and the Patient Protection and Affordable Care Act (PPACA) that normally apply to major medical policies.

Originally, HHS had suggested that it might permit only the sale of fixed indemnity policies that pay a fixed amount of benefits for a specified period of time.

In the draft regulations, HHS said it would let an insurer sell a fixed indemnity policy that pays either a fixed benefit per period of time or a specified amount when a triggering event, such as a hospitalization, happens. But HHS said it would let an insurer sell a fixed indemnity policy only to consumers who have MEC — enough major medical coverage to get the consumers out of having to pay the penalty PPACA is supposed to impose on taxpayers who lack a minimum amount of coverage.

 

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