The Center for Consumer Information and Insurance Oversight (CCIIO)
Helps to implement many health reform provisions of the Affordable Care Act. This act is the notable health reform bill promoted by President Obama and signed into law on March 23, 2010.
It is the CCIIO which oversees the application of provisions in relation to private health insurance.
There are a number of areas of emphasis in which The Center for Consumer Information & Insurance Oversight oversees this process.
They are as follows:
Ensuring compliance with new insurance market rules (i.e. the Patient’s Bill of Rights)
In 2010, President Obama introduced the Patient’s Bill of Rights, a set of protections that apply to health coverage starting on or after September 23, 2010, six months after the enactment of the Affordable Care Act. It started with children and extended to all Americans – with pre-existing conditions.
They were able to have and keep coverage as well as a choice of physicians. Lifetime limits were abolished, creating an all-important foundation of patients’ rights in the private health insurance market. With the Patient’s Bill of Rights, Americans could once again be in charge of their own health care oversight.
Helping states review unreasonable rate increases and overseeing new Medical Loss Ratio rules:
• Review of Insurance Rates – Over the years, health insurance premiums have increased rapidly, without explanation, justification, or regulation. Consumers rarely receive any notification.
Therefore, the Affordable Care Act brings an unprecedented level of inquiry and transparency to rate increases. Experts will evaluate according to reasonable cost assumptions and tangible evidence. This will help moderate premium hikes and give customers added value.
Plus, insurance companies will be required to provide easy-to-follow information to customers regarding rate increases.
• Medical Loss Ratio – It is common for insurance companies to spend a large portion of premium dollars on administrative costs including executive salaries, advertising, and overhead.
The Affordable Care Act requires all health insurance companies to submit specific revenue reports detailing what was spent on clinical services and quality improvement. These are known as the Medical Loss Ratio (MLR). At least 80% or 85% of premium dollars will need to be spent on medical care or a rebate will need to be sent to customers.
Providing oversight for the State-Based Health Insurance Exchanges and compiling data for Health Insurance Marketplaces
The Affordable Care Act promotes a competitive private health insurance market with the implementation of Health Insurance Marketplaces. These State-based will launch in 2014 and give Americans a “one-stop shopping” experience to find affordable coverage.
Administering the Consumer Assistance Program, Pre-Existing Condition Insurance Plan and Early Retiree Reinsurance Program
• Consumer Assistance Program (CAP Grants) – CAP Grants offer necessary resources to educate and provide accurate information to consumers when facing difficult health care decisions.
The CAP Grants program delivers approximately $30 million in new resources to establish consumer assistance programs. These programs will offer everything from direct services to health insurance questions. States need to apply for CAP Grants.
• Pre-Existing Condition Insurance Plan – The Affordable Care Act purposed the Pre-Existing Condition Insurance Plan (PCIP) to provide health insurance to those who have been denied coverage by private insurance companies due to a pre-existing condition.
PCIP covers primary and specialty care, hospital care, and prescription drugs. It will not charge a higher premium because of a medical condition and is not based on income.
This program will run until 2014 when all Americans will have access to affordable health insurance choices.
PCIP health coverage could help those:
1. Who have been uninsured for at six months or more
2. With a pre-existing condition
3. Who have been denied health coverage because of a health condition
4. Are a U.S. citizen or are residing here legally
• Early Retiree Reinsurance Program – This program, established by the Affordable Care Act, gives reimbursements to employers and union sponsors who participate in an employment-based plan.
They will receive a portion of the cost of health benefits for early retirees and their spouses, surviving spouses, and dependents. This Center for Consumer Information & Insurance Oversight program ends no later than January 1, 2014.
To learn more, visit http://www.cms.gov/cciio/index.html.