Nationally, 9 million people would be eligible for rebates averaging
$164 for individual policies, according to the U.S. Health and Human
Services Department. Group plan figures weren't available, nor were
Florida rebate values.
The new rules announced Monday apply to 75 million Americans. Self-insured plans aren't included.
Currently, Florida requires insurers to operate at 65 to 70 percent loss ratios. The insurance office plans to ask for a waiver for the small group and individual markets, though it said it needs at least two more weeks to finish the request. U.S. Health and Human Services Secretary Kathy Sebelius would decide whether to grant it.
After months of federal review, insurers won breaks but failed to get a broader array of business costs factored into medical spending. For example, plans with fewer than 75,000 members will get adjustments to help them comply, and ones with fewer than 1,000 members will be exempt from the rebates.
Nearly all taxes can be figured into the ratio, as well as spending to improve health care.
And states can win waivers to use lower rates if they show insurance would be disrupted by higher requirements.
Florida insurance executives complained the tougher requirements will disrupt their finances and limit their ability to insure people.
Without a waiver, some insurers could be forced to lower their rates to meet the threshold or find a creative way to pay for rebates, said Blue Cross Blue Shield of Florida executive Randy Kammer, a member of the industry-dominated Florida Health Insurance Advisory Board, which endorsed a waiver in September.
Blue Cross Blue Shield of Florida, the state's largest insurer, expects to meet the requirement. A nonprofit, the insurer faces less financial pressure from Wall Street, said Kammer, vice president for regulatory affairs and public policy.
But others face steeper costs. About 45 percent of people nationally who buy their own insurance are in plans exceeding the limits, according to federal officials
An analyst for Citigroup estimated last month that Golden Rule, a subsidiary of United Healthcare, would face $38.1 million in rebates for its 119,000 insured Floridians, based on 2009 figures.
That's a $319 average rebate in Golden Rule's biggest state.
At a Sept. 24 state hearing to gather evidence for the waiver, Golden Rule vice president Mike Corne warned that customers could face fewer options for insurance because of the crunch imposed by tougher profit limits.
Customers, who often seek Golden Rule individual policies absent a workplace plan, could find fewer companies willing to add new policies, and fewer businesses seeking a place in the market, said Corne, arguing for a phased approach.
The new rules announced Monday apply to 75 million Americans. Self-insured plans aren't included.
Currently, Florida requires insurers to operate at 65 to 70 percent loss ratios. The insurance office plans to ask for a waiver for the small group and individual markets, though it said it needs at least two more weeks to finish the request. U.S. Health and Human Services Secretary Kathy Sebelius would decide whether to grant it.
After months of federal review, insurers won breaks but failed to get a broader array of business costs factored into medical spending. For example, plans with fewer than 75,000 members will get adjustments to help them comply, and ones with fewer than 1,000 members will be exempt from the rebates.
Nearly all taxes can be figured into the ratio, as well as spending to improve health care.
And states can win waivers to use lower rates if they show insurance would be disrupted by higher requirements.
Florida insurance executives complained the tougher requirements will disrupt their finances and limit their ability to insure people.
Without a waiver, some insurers could be forced to lower their rates to meet the threshold or find a creative way to pay for rebates, said Blue Cross Blue Shield of Florida executive Randy Kammer, a member of the industry-dominated Florida Health Insurance Advisory Board, which endorsed a waiver in September.
Blue Cross Blue Shield of Florida, the state's largest insurer, expects to meet the requirement. A nonprofit, the insurer faces less financial pressure from Wall Street, said Kammer, vice president for regulatory affairs and public policy.
But others face steeper costs. About 45 percent of people nationally who buy their own insurance are in plans exceeding the limits, according to federal officials
An analyst for Citigroup estimated last month that Golden Rule, a subsidiary of United Healthcare, would face $38.1 million in rebates for its 119,000 insured Floridians, based on 2009 figures.
That's a $319 average rebate in Golden Rule's biggest state.
At a Sept. 24 state hearing to gather evidence for the waiver, Golden Rule vice president Mike Corne warned that customers could face fewer options for insurance because of the crunch imposed by tougher profit limits.
Customers, who often seek Golden Rule individual policies absent a workplace plan, could find fewer companies willing to add new policies, and fewer businesses seeking a place in the market, said Corne, arguing for a phased approach.
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