Adjusted community rating - ANSWERNot giving credit to a plan for favorable risk attributes associated with a healthy population. This makes health insurance more affordable for those with higher risk.
Administrative enhancements when opting to self-fund - ANSWERMore transparency and use of bund...
Adjusted community rating - ANSWERNot giving credit to a plan for favorable risk attributes
associated with a healthy population. This makes health insurance more affordable for those with
higher risk.
Administrative enhancements when opting to self-fund - ANSWERMore transparency and use of
bundled pricing and direct contracting to reduce claims costs
Aggregate stop-loss insurance - ANSWERThis policy caps how much an employer is obligated to pay
for all its claims across a full plan year.
Arguments countering substantial exodus of healthy risks from insured marketplace - ANSWERSimilar
health risks; transition costs and barriers; and additional compliance, financial, and plan
management obligations
Attachment point - ANSWERStop-loss insurance reimburses the plan sponsor for health payments in
excess of this pre-determined level.
Contractual provisions to examine when opting for a level-funded plan - ANSWER"Minimum
premium" language, which requires employer payments even if workers are laid off, and a 12/18
clause.
Determinants of the viability to self-fund - ANSWERThe employer's economic condition, financial risk
tolerance, and desire for plan flexibility and lower administrative costs.
HIPAA non-discrimination prohibitions for group health plans - ANSWERThey prohibit a plan from
denying an individual eligibility for benefits based on a health factor & from charging a person a
higher premium than a similarly situated person based on a health factor.
Individual specific stop-loss insurance - ANSWERThis policy caps how much an employer pays for any
one person's claims during the policy period.
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