1. © 2009 Cengage Learning. All Rights Reserved State and Federal Regulation of Insurance

2. © 2009 Cengage Learning. All Rights Reserved. Agenda  State Regulation Business of insurance Role of NAIC  Types of Health Insurance  Federal Regulation ERISA COBRA HIPAA

3. © 2009 Cengage Learning. All Rights Reserved. State Regulation  McCarran-Ferguson Act and the Business of Insurance Elements of insurance contract Criteria for business of insurance

4. © 2009 Cengage Learning. All Rights Reserved. Role of the NAIC  State commissioners

5. © 2009 Cengage Learning. All Rights Reserved. Types of Insurers  Indemnity contracts Coverage is usually for catastrophic illnesses, not preventative care  Preferred provider organizations Beneficiaries choose from panel of providers at different payment levels

6. © 2009 Cengage Learning. All Rights Reserved. Types of Insurers contd.  Health maintenance organizations (or managed care organizations) Many types exist  Point of service plans Similar to PPO  Third party administrator

7. © 2009 Cengage Learning. All Rights Reserved. Federal Regulations

8. © 2009 Cengage Learning. All Rights Reserved. Employment Retirement Income Security Act 29 U.S.C. 1001-1461  Established standards for pension and welfare plans

9. © 2009 Cengage Learning. All Rights Reserved. Consolidated Omnibus Budget Reconciliation Act 29 U.S.C. 1161  COBRA amended ERISA and other statutes  Provides for extended health insurance coverage

10. © 2009 Cengage Learning. All Rights Reserved. Health Insurance Portability and Accountability Act  Extended scope of ERISA  Changed limitations of pre-existing conditions