Bang for the Buck: Medical Loss Ratio Rules

Beginning in 2012, Georgia consumers who purchase individual health insurance policies will have access to more information about how their premium dollars are being spent AND will be eligible for rebates if their insurance company fails to provide sufficient value for the premium dollar.


These new standards, known as medical loss ratio (MLR) rules, are part of the Affordable Care Act and are designed to spur insurance companies to operate more transparently and to ensure that consumers get the most value for their premium dollars. Consumers will receive rebates if their insurance company fails to spend at least 80 percent of collected premiums on medical care or quality improvement activities, as compared to profits, administration, and marketing. It is estimated that Georgia consumers will receive approximately $42 million in rebates over the next three years.

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New Issue Brief: Building Georgia’s Health Insurance Exchange

Georgia is currently weighing options to determine whether it should establish a health insurance exchange.  Authorized by the Affordable Care Act, the goal behind these competitive health insurance marketplaces is to better facilitate competition and choice for health care consumers. Today, Georgians for a Healthy Future is releasing an issue brief entitled Building Georgia’s Health Insurance Exchange that outlines how a health insurance exchange can benefit Georgia consumers and makes recommendations for our policymakers as they weigh design options for an exchange.


Building Georgia’s Health Insurance Exchange addresses the following questions:

  • Who is eligible for the health insurance exchange?
  • What types of insurance plans will be available on the exchange?
  • How will consumers afford the products offered on the exchange?
  • What will Georgia’s exchange look like?
  • How will the exchange benefit Georgia consumers?
  • What should policymakers focus on to build a successful exchange?
  • What is the timeline for implementing an exchange?


Building Georgia’s Health Insurance Exchange recommends the following policy goals for an exchange:

  • Create a governance structure that can transparently and effectively oversee the exchange without any conflict of interests; insurance companies or other businesses that have a direct financial stake should not serve on the governing body


  • Provide structured choices that supply the information and tools consumers need to make optimal purchasing decisions, including quality and customer satisfaction ratings as well as information about price and benefits


  • Create incentives for insurance companies to compete based on value rather than by selecting the healthiest applicants:  consider leveraging volume within the exchange to drive better deals with insurance companies; consider crafting exchange participation rules to allow the highest quality and value plans to participate; and align regulations inside and outside the exchange to eliminate incentives to steer consumers outside the exchange


  • Serve as an easy-to-use, one-stop-shop and provide navigation assistance to programs like PeachCare for KidsTM and Medicaid where appropriate to ensure that all individuals and families eligible for these programs enroll


  • Develop a robust outreach and enrollment mechanism to ensure that low-income and minority communities that historically have had the highest rates of uninsurance are engaged and that consumers in rural areas, without internet access, or with limited English proficiency can still enroll in the plan that best meets their needs


The full issue brief is available here.


Building a Consumer Friendly Health Insurance Exchange

By Cindy Zeldin


This article originally appeared in the Atlanta Journal-Constitution.


Earlier this month, Gov. Nathan Deal signed an executive order creating the Georgia Health Insurance Exchange Advisory Committee, which is charged with determining whether Georgia should establish a state-based health exchange.


If well crafted, a Georgia insurance exchange has the potential to increase transparency, present clear and meaningful choices, and promote better value for consumers who don’t have access to a health plan at work.


The Affordable Care Act authorized state-level health insurance exchanges, providing a basic framework and initial funding. By 2014, each state’s exchange must be able to enroll individuals and small businesses into health insurance plans and certify that plans meet certain requirements, such as an adequate provider network and an essential benefits package. Within this framework, Georgia has considerable flexibility to fashion a structure that best meets our state’s individual needs.


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Nearly two million Georgians are uninsured.Source: CPS data
Georgia’s infant mortality rate is among the worst in the nation.Source: KidsCount
Georgia ranks 38th in health system performance.Source: Commonwealth Fund State Scorecard
2012 is a critical year for health care advocacy--your voice matters!Source: GHF

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Atlanta, GA 30303

Phone: 404-567-5016
Fax: 404-935-9885
E-Mail: info@healthyfuturega.org

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