Author Topic: Plan Funding types  (Read 1066 times)

ste

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Plan Funding types
« on: January 20, 2013, 05:40:13 PM »
Self funded plans are regulated by the feds and allow the plan to pick and choose which specialties will be covered. Fully funded plans are regulated by the state and must comply with state mandates when it comes to deciding if a specialty will or will not be covered. Blanket plans which have become popular with academic institutions are neither self funded nor fully funded. Are Blanket plans regulated by the feds or the state? And more importantly, are they obligated to cover specialties that are consistent with state mandates?

RichardP

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Re: Plan Funding types
« Reply #1 on: January 20, 2013, 06:14:16 PM »
Search Google on "Blanket Health Insurance" + regulation and you will get a multitude of links to various state regulations.  I did not see any reference to Federal regulation.  I'm sure you understand the need to consult with a health-care attorney for a definitive answer if necessary.

Many issues are regulated by the state and Federal regulations.  Whichever regulation is more strict - state or Fed - is allowed to be used by the state.  At least some applications of "blanket" health insurance are shaping up to follow that path.  See the following link:

http://www.gpo.gov/fdsys/pkg/FR-2012-03-21/pdf/2012-6359.pdf

Search the document on "blanket" and you will get some interesting reads.  Including this one:

... some States do not regulate student health insurance as individual health insurance coverage, but rather as a type of association ‘‘blanket coverage’’ or as non-employer group coverage. Under this final rule, student health insurance coverage will be defined as a type of individual health insurance coverage, and will therefore be subject to the individual market provisions of the PHS Act and the Affordable Care Act, with the exception of certain specific provisions that are identified in the final rule. States would continue to apply State laws regarding student health insurance coverage.

However, if any State law or requirement prevents the application of a Federal standard, then that particular State law or requirement would be preempted. Additionally, State requirements that are more stringent than the Federal requirements would be not be preempted by this final rule. Accordingly, States have significant latitude to impose requirements with respect to student health insurance coverage that are more restrictive than the Federal law.