（Boston Orange編譯）麻州州長奚莉（Maura Healey）麾下的保險署今（6）日宣佈，九家健康與牙科保險公司因未達法定醫療支出比例，將退還共 1450 萬美元保費給數十萬麻州民眾與小企業。麻州因此成為全美首個依法強制執行牙科保險退費的州。
州長奚莉表示：「民眾有權知道，當他們支付健康與牙科保險費時，這些錢確實用於醫療照護。麻州擁有全美最完善的消費者保護法規，並正在保嚴格執行，將 1400 多萬美元放回家庭與小企業的口袋」。
根據麻州健康與牙科保險法規，九家保險業者在過去三年內的理賠支出未達法定標準，應向保戶退還部分保費，總額 1450 萬美元。退款將以支票或抵扣未來保費形式發放，保險公司自本月起陸續執行。每名保戶所得金額，依其保險公司與所繳保費比例計算。
退款分為兩類：
六家牙險公司因未達州定 83％ 的理賠支出率（DLR），合計退還 840 萬美元，涉案公司包括：麻州藍十字藍盾（Blue Cross and Blue Shield of Massachusetts, Inc.）、守護人壽（Guardian Life Insurance Company）、哈佛朝聖者健康保險（Harvard Pilgrim Health Care Insurance Company, Inc.）、信賴標準人壽（Reliance Standard Insurance Company）、標準保險（Standard Insurance Company）及星山人壽（Starmount Life Insurance Company）。
三家健保公司則因個人與小雇主健保保單未達 88％ 的支出標準（高於聯邦 85％ 的要求），退還 610 萬美元，分別為：哈佛朝聖者健康保險Harvard Pilgrim Health Care Insurance Company, Inc.）、麻州綜合布萊根健康計畫（Massachusetts General Brigham Health Plan）與聯合健康保險（UnitedHealthcare Insurance Company）。
麻州保險署署長麥可·卡爾朱（Michael Caljouw）表示，這項機制確保民眾繳納的保費確實用於醫療照護，而非行政成本或公司利潤。這項牙保退費制度為全美首創，是奚莉州長降低醫療費用整體策略之一環。
奚莉政府早前已實施多項降低醫療費用的改革辦法，包括制定全美最嚴格的健保自付額與共付額漲幅上限，取消常規必要護理的事先授權，禁止醫療欠款列入信用報告等。奚莉州長還成立了可負擔醫療工作組（Health Care Affordability Working Group），近期已提出進一步降費建議。
上個月，麻州保險署進一步協商調低七家保險公司原訂 2027 年的保費漲幅，並否決另一項過高調漲案，預計未來可為居民與企業節省逾 7200 萬美元保費支出。
Healey-Driscoll Administration Returns $14.5 Million to Health and Dental Insurance Consumers and Businesses
Massachusetts becomes first state in the nation to require dental insurance rebates
BOSTON — Governor Maura Healey’s Division of Insurance announced today that nine health and dental insurance carriers will return $14.5 million to hundreds of thousands of Massachusetts consumers through rebates required under the state’s health and dental insurance laws.
For the first time, Massachusetts is requiring dental insurance companies to issue rebates after failing to meet the state's Dental Loss Ratio (DLR) standard, making Massachusetts the first state in the nation to require and enforce dental insurance rebates. Six dental insurance companies – Blue Cross and Blue Shield of Massachusetts, Inc., Guardian Life Insurance Company, Harvard Pilgrim Health Care Insurance Company, Inc., Reliance Standard Insurance Company, Standard Insurance Company, and Starmount Life Insurance Company – will return $8.4 million to consumers enrolled in their dental plans. An additional $6.1 million will be returned by three health insurance companies – Harvard Pilgrim Health Care Insurance Company, Inc., Massachusetts General Brigham Health Plan and UnitedHealthcare Insurance Company – to consumers covered by individual and small employer health plans.
“People deserve to know that when they're paying for health and dental insurance, their money is actually going toward care,” said Governor Maura Healey. “Massachusetts has some of the strongest consumer protection laws in the country, and we're making sure they are enforced. We are putting more than $14 million back into the pockets of families and small businesses while implementing nation-leading dental insurance protections that save people money.”
“Our efforts will help families and small business owners across the Commonwealth at a critical time. These rebates are important parts of our overall strategy to root out wasteful spending and reduce costs,” said Insurance Commissioner Michael Caljouw. “Massachusetts has some of the strongest consumer protections in the country to ensure that the money people pay for health and dental insurance is spent on patient care—not administrative costs or profits. State law requires health insurance companies offering individual and small employer plans to spend at least 88 percent of premium dollars on health care services, higher than the federal standard of 85 percent. Massachusetts law also requires dental insurance companies to spend at least 83 percent of premium dollars on dental care services. When insurers fall short of those standards over a three-year period, they are required to return a portion of premiums to consumers.”
The amount each policyholder receives depends on their insurance carrier and the premiums they paid. Rebates are issued as a check or as a credit toward future premium payments, and carriers will begin issuing refunds later this month.
Today's announcement builds on Governor Healey’s ongoing efforts to lower health care costs and hold insurance companies accountable. Her administration has imposed the strongest limits in the country on the growth of health insurance deductibles and co-pays, eliminated prior authorization requirements for routine and essential care, and moved to prevent medical debt from appearing on consumer credit reports. Governor Healey also created the Health Care Affordability Working Group, which recently released recommendations to further lower costs for patients, families and businesses.
Last month, the Division of Insurance negotiated down proposed 2027 health insurance rate increases from seven insurers and rejected another excessive increase, actions projected to save Massachusetts residents and businesses more than $72 million in future premium costs
沒有留言:
發佈留言