Federal push for greater price transparency would likely affect insurers less, Fitch analyst says…

The federal government’s push for greater price transparency in healthcare would likely affect insurers less than other industry players, said Brad Ellis, senior director of health insurance at Fitch Ratings.

“The health insurance business model is less exposed to risk from price transparency than other parts of the healthcare system. Under the Affordable Care Act, health insurers are required to spend between 80-85 percent of their premium dollars on claims, which has kept their margins range-bound,” he said in a statement. “More transparency may serve to enhance healthcare consumers’ understanding of the mechanisms that drive insurance premiums higher, including increasing healthcare unit costs and the growing use of healthcare services. Longer term, the goal may be to reduce premium rate increases by reigning in drug prices, standardizing healthcare costs and exposing the cost effect of healthcare decisions, but this is a downstream issue.”

Mr. Ellis’ comments come as President Donald Trump’s administration seeks to require disclosures of the patient’s total price of care up front, as well as the rates that insurers negotiate with providers in the private-employer market for services.

Informational Source

Types of Health Insurance

Health insurance, also called, medical insurance or simply mediclaim, covers the cost of an individual’s medical and surgical expenses. The individual pays a fixed sum (premium), every year for the health cover. 

There are broadly three types of health insurance in USA:

  1. Hospitalization Plans
    Hospitalization plans reimburse the hospitalization and medical costs of the insured subject to the sum insured. For this reason, the plans are also known as indemnity plans.

    The sum assured can be fixed – 
    i- For a member of the family in case of individual health policies or 
    ii- For a family as a whole in case of a family health insurance policy

    For instance, consider a three-member family with an individual cover of Rs 1 lakh each. Each member can claim reimbursement for a maximum of Rs 1 lakh as all three policies are independent.

    If the family applies for a family health plan cover of Rs 3 lakhs, then any family member can claim medical benefit for more than Rs 1 lakh so long as it is within the overall sum assured of Rs 3 lakhs.
  2. Hospital Daily Cash Benefit Plans
    The daily cash benefit plan is a defined benefit policy. As evident from the name,the policy pays out a defined sum of money for every day of hospitalization regardless of actual costs. For instance, the hospitalization costs for a day may be Rs 2,000/day and the defined daily limit of the policy could be Rs 1,500/day, in which case the insured receives the latter. On the other hand, if the hospitalization cost is Rs 1,000/day, he still receives Rs 1,500/day.
  3. Critical Illness Plans
    These are benefit-based health insurance plans which pay a lumpsum amount on diagnosis of predefined critical illnesses and medical procedures. The illnesses are specified at the outset. By nature, critical illnesses are high severity and low frequency and cost of treatment is higher compared to regular medical problems like heart attack, stroke, among others.

Informational Source

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