Health Reform News

On March 23, 2010, President Obama signed into law the comprehensive health reform legislation, the Patient Protection and Affordable Care Act. BlueCross BlueShield of the U.S. Virgin Islands is committed to implement these provisions on the timeline required by law.

We are providing a summary of the most important provisions of the law, and any changes made by subsequent legislation that will apply to BCBS-USVI Plans.

Private Insurance Provisions

  • Medical Loss Ratio (MLR): Require health insurance carriers to report the proportion of premium dollars spent on clinical services, quality, and other costs and provide rebates to consumers for the amount of the premium spent that is less than 85% for plans in the large group market and 80% for plans in the individual and small group markets.
  • Rate review: Establish a process for reviewing increases in health plan premiums and require plans to justify increases over the 10% benchmark. Dependent Coverage: Provide dependent coverage for children up to age 26 for all individual and group policies.
  • Insurers fees: establishes fees to health insurance plans and sef-insured group plans to fund the Patient Centered Outcomes Researh Insititute. This insititute was created to evaluate and assist, through research, patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence-based medicine through the synthesis and dissemination of comparative clinical effectiveness research findings.

Consumer Protections

  • External Appeals: give consumers the right to appeal adverse determinations, including claims denials and rescissions.
  • Summary Benefits Coverage (SBC): Develop standards for insurers to use in providing information on benefits and coverage.

Preventive

  • Require insurance carriers to provide at a minimum coverage without cost-sharing for preventive services rated A or B by the U.S. Preventive Services Task Force, recommended immunizations, preventive care for infants, children, and adolescents, and additional preventive care and screenings for women including approved FDA contraceptives. This provision applies to non-grandfathered plans.

There are other provisions in the law that may affect other areas in the health care industry and employers. For more information, visit www.healthcare.gov.