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The Henry J. Kaiser Family Foundation

Health Insurance Market Reforms: Pre-Existing Condition Exclusions

Insurers pursue multiple strategies to reduce the cost of covering enrollees with pre-existing conditions, or medical conditions and health problems that existed before the individual enrolled in a health plan. One strategy, the pre-existing condition exclusion, allows insurers to refuse to cover any costs associated with care for a pre-existing…

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The Henry J. Kaiser Family Foundation

Quantifying the Effects of Health Insurance Rate Review

This report from the Kaiser Family Foundation analyzes the effect of government efforts to ensure that insurance premium increases are justifiable and provide value to consumers and small businesses. Rate review programs require insurers in the small group and individual markets to submit proposed rate increase requests to state or…

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The Henry J. Kaiser Family Foundation

Summary of Coverage Provisions in the Patient Protection and Affordable Care Act

This short summary describes the health coverage provisions contained in the final version of the Affordable Care Act signed into law in March 2010, including the individual mandate requirements, expansion of public programs, health insurance exchanges, changes to private insurance and employer requirements.

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The Henry J. Kaiser Family Foundation

Explaining Health Care Reform: Questions About Health Insurance Subsidies

This brief describes the subsidies available in the Affordable Care, signed into law in March 2010, including premium subsidies that would be provided in the form of tax credits, as well as other subsidies that would lower cost sharing to eligible Americans.

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The Henry J. Kaiser Family Foundation

The High and Rising Costs Of Health Care: What Can Be Done?

The Alliance for Health Reform, the Kaiser Family Foundation, and several cosponsors held the final event in a three-part series of discussions on costs, the factors driving them up and what (if anything) can be done about them. This briefing and others in the series take an in-depth look at…

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The Henry J. Kaiser Family Foundation

Health Insurance Market Reforms: Rate Restrictions

Rate restrictions limit how much insurance companies can vary premiums charged to individuals and businesses based on factors such as health status, age, tobacco use and gender. Currently, federal law does not place any limits on the ways that insurance companies set their premium rates. However, beginning January 1, 2014,…

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The Henry J. Kaiser Family Foundation

Health Insurance Market Reforms: Guaranteed Issue

Guaranteed issue laws require insurance companies to issue a health plan to any applicant – an individual or a group – regardless of the applicant’s health status or other factors. Currently, in most states, insurance companies can deny nongroup coverage to people based on their health status or their medical…

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The Henry J. Kaiser Family Foundation

Survey of Health Insurance Agents: Assessing Trends in the Individual and Small Group Insurance Markets

This nationally representative survey of 500 health insurance agents and brokers working in the individual and small group markets explores their outlook on market trends and views on the Affordable Care Act (ACA). The survey finds that many agents are seeing steep increases in premiums and deductibles for individuals and…

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The Henry J. Kaiser Family Foundation

Kaiser Analysis: Estimated Health Insurance Rebates Under the Health Reform Law Total $1.3 Billion in 2012

NEWS RELEASE April 26, 2012 Rebates Expected to Vary Significantly by State MENLO PARK, Calif. – Consumers and businesses are expected to receive an estimated $1.3 billion by this August in rebates from health insurers who spent more on administrative expenses and profits than allowed by the Affordable Care Act…

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The Henry J. Kaiser Family Foundation

Explaining Health Care Reform: Medical Loss Ratio (MLR)

This fact sheet explains the Medical Loss Ratio requirement under the Affordable Care Act (ACA). The MLR provision limits the portion of premium dollars health insurers may spend on administration, marketing, and profits. Under health care reform, health insurers must publicly report the portion of premium dollars spent on health care and quality improvement and other activities in each state they operate. Insurers failing to meet the applicable standard must pay rebates to consumers and businesses.

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