Alternative Plan for Year-end Settlement System for Employment-based Health Insurance

2020 ◽  
Vol 38 (3) ◽  
pp. 65-93
Author(s):  
Hyunjae Kim ◽  
Hansil Choi ◽  
Jinhyung Lee
Keyword(s):  
Health Insurance ◽  
Settlement System ◽  
Alternative Plan

scholarly journals Reforming reform: public assessments of the affordability of health insurance policies

2017 ◽  
Author(s):  
Sherry Glied ◽  
Peter Muennig
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Household Income ◽  
Telephone Survey ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Insurance Policies ◽  
Alternative Plan ◽  
Health Insurance Premiums ◽  
Dollar Amount

Background: Republicans have moved rapidly to repeal the Affordable Care Act, replacing progressive elements of the plan with regressive elements. We draw on an earlier affordability exercise to evaluate how Americans might view these elements of health care reform.Methods: Immediately prior to passage of the ACA, we conducted a telephone survey of a representative sample of U.S. households. Respondents were presented vignettes representing different insurance plans, each held by people with differing life characteristics. Respondents were then asked to assess the affordability of the presented plans given the characteristics of the policyholders. Results: Respondents felt that households should be expected to pay about 5% of income for health insurance coverage, irrespective of their income. They also tended to view older households as less able to afford coverage than younger households, and households with sicker occupants as less able to afford healthcare than households with healthy occupants. Results did not differ between respondents in red states and those in blue states.Conclusions: Most Americans, including those who reside in red states, believe that subsidies for health insurance premiums should be based on a fixed percentage of household income, not a fixed dollar amount. These perceptions may make it challenging to replace the ACA with a less costly alternative plan.

scholarly journals Claim Settlement: The Moment of Truth in Health Insurance

2019 ◽  
Vol 8 (2) ◽  
pp. 581-585
Keyword(s):  
Health Insurance ◽  
The Other ◽  
Health Insurance Company ◽  
Insurance Company ◽  
Settlement System ◽  
Medical Expenses ◽  
Health Insurance Market ◽  
Insurance Penetration ◽  
The Moment ◽  
Very High

A customer centric claim settlement system goes a long way in mitigating the anxiety of patients. At the time of buying Health Insurance, a customer is assured that the Health Insurance Company (HIC) will take care of the medical expenses, in case of his hospitalization. But when such an eventuality happens, many times HICs go back on their words based on procedural non-compliance or because of some conditions written in fine prints. Therefore, how HICs respond to the financial needs of the patients during the claim settlement is the real Moment of Truth. Failure on the part of the HICs in honoring their commitment leads to high Out of Pocket (OOP) Expenses and acute financial hardship to the patients. This article is important primarily because a customer always has an apprehension about the claim settlement. Hurdles one faces during claim settlement is a big contributor to the low customer satisfaction (LCS) which in turn contributes to poor Health Insurance penetration. On the other hand, false, ineligible and inflated claims adversely affect the business model of HICs. The article also highlights why the Incurred Claim Ratio (ICR) in Health Insurance is very high in India and why this has become a roadblock towards expansion of Health Insurance Market (HIM).

Health Insurance, Consumer Ads Top AMA Agenda

2006 ◽  
Vol 4 (7) ◽  
pp. 21
Author(s):  
MARY ELLEN SCHNEIDER
Keyword(s):  
Health Insurance
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