NovaRest Works To Improve Puerto Rico’s Rate Review Process
NovaRest, Inc. is looking in the self-insured market for the U.S. Centers for Medicare and Medicaid Services (CMS).
NovaRest has been asked to help CMS look at what company size and stop loss levels that are appropriate for the self-insured market. Self-insurance is a plan offered by employers who directly assume the major cost of health insurance for their employees. Some self-insured plans bear the entire risk. Other self-insured employers insure against large claims by purchasing stop-loss coverage – a form of reinsurance for self-insured employers that limits the amount the employers will have to pay for each person’s health care (individual limit) or for the total expenses of the employer (group limit).
NovaRest’s task to determine what size and stop loss levels are approporate to be considered a self-insured plan comes on the heels of Oregon and New York banning the sale of stop-loss coverage to employers with fewer than 50 enrolled beneficiaries.
A National Association of Insurance Commissioners committee is also looking into self-insurance and stop-loss issues in light of the fact that self-insured plans are exempt from having to offer “essential health benefits” as required in the reform law beginning in 2014.