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Weakened Insurance Legislation Likely to Pass

Legislation that would force more accountability from health plans is moving through the General Assembly, although in a weaker form than state regulators wanted.

The bill, approved last week by the state Senate, aims at increasing protections for those who have insurance, particularly in the individual market where policies tend to be more expensive than in the group market.

Out-of-state carriers that offer stripped-down policies in Maryland would be required to notify residents who sign up that their plan is not regulated by the state and may not cover procedures required by Maryland plans. The Maryland Insurance Administration had pushed for language requiring the carriers to offer equivalent coverage to what's required here.

The "look-back" period during which insurers who find pre-existing medical conditions that can trigger higher premiums or deny coverage would be reduced to five years from the current seven.

If a carrier does not discover a medical condition while it reviews a patient's history, the company can exclude coverage of the condition for up to a year as long it was treated in the last year.

The bill now goes to the House of Delegates, where it is likely to pass. But it does not include what would have been its most far-reaching change: to raise what's referred to as the "medical loss ratio" or percentage of premium dollars used on medical care to 85 cents on the dollar from the 60 cents used for individual policies and 75 cents for those purchased by small employers.

Insurance Commissioner Ralph Tyler and health advocates in the legislature said Maryland's ratio was too low and has contributed to higher premiums than other states have, but the insurance industry successfully fought the idea. It said requiring the industry to increase the ratio would hurt patients by stifling competition.

By Lisa Rein  |  April 6, 2009; 1:38 PM ET
Categories:  General Assembly , Lisa Rein  
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Comments

Are you uninsured in America? You should check out the website http://UninsuredAmerica.blogspot.com - John Mayer, California

Posted by: johnmayer76 | April 8, 2009 12:30 AM | Report abuse

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