January 12, 2011 – As reported last week, a SIIA delegation met with senior officials from the U.S. Department of Labor and the Health and Human Services Agency to discuss separate studies on self-insured health plans as mandated by the Patient Protection and Affordable Care Act (PPACA).

This meeting has since prompted additional consultation with SIIA in order for the regulators to better understand self-insurance. Yesterday, a teleconference meeting was held with SIIA representatives and researchers from Rand Corporation, which has been engaged as a private independent contractor to collect and analyze information about the self-insurance marketplace, and more specifically why employers choose to self-insure.

Specific questions asked by the Rand researchers included:

*Do stop-loss carriers ever exclude individual plan participants from coverage?

*Are there best practices standards for TPA contracts?

*What are the top reasons that employers choose to self-insurer?

*Do Stop-loss carriers and TPAs coordinate on high dollar claims?

*What are the biggest risk factors for a self-insured health plan becoming insolvent?

*Are TPAs ever compensated on an “at-risk” basis?

*How is stop-loss insurance regulated at the state level?

*How involved are employers in making claim payment decisions?

“Apparently SIIA made a very positive impression last week during our meeting with the HHS and DOL officials since they almost immediately decided it was important to connect us with their contracted researchers,” said SIIA Chief Operating Officer Mike Ferguson. “We feel confident that the input provided to Rand effectively described the benefits of self-insurance while correcting common misconceptions.”

The DOL-produced study is intended to assess the financial solvency of self-insured health plans generally, while HHS looking to compare self-insured health plans with fully insured plans and to determine the extent to which new insurance market reforms are likely to cause adverse selection in the large group market or to encourage small and midsized employers to self-insurer.

Both reports are scheduled to be published by the end of March and will be referred to committees of jurisdiction in the House and Senate, which could prompt future legislation affecting self-insurance.

This is a developing story so watch for additional updates from SIIA as we stay engaged in the process.

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This entry was posted by cmonfils on Wednesday, January 12th, 2011 at 8:03 pm and is filed under Health Care Legislation, News. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.