Replies

Straight from the bill:

•HR 3200 IH Page 21
1 SEC. 113. INSURANCE RATING RULES.
2 (a) IN GENERAL.—The premium rate charged for an
3 insured qualified health benefits plan may not vary except
4 as follows:
5 (1) LIMITED AGE VARIATION PERMITTED.—By
6 age (within such age categories as the Commissioner
7 shall specify) so long as the ratio of the highest such
8 premium to the lowest such premium does not ex9
ceed the ratio of 2 to 1.
10 (2) BY AREA.—By premium rating area (as
11 permitted by State insurance regulators or, in the
12 case of Exchange-participating health benefits plans,
13 as specified by the Commissioner in consultation
14 with such regulators).
15 (3) BY FAMILY ENROLLMENT.—By family en16
rollment (such as variations within categories and
17 compositions of families) so long as the ratio of the
18 premium for family enrollment (or enrollments) to
19 the premium for individual enrollment is uniform, as
20 specified under State law and consistent with rules
21 of the Commissioner.
22 (b) STUDY AND REPORTS.—
23 (1) STUDY.—The Commissioner, in coordina24
tion with the Secretary of Health and Human Serv25
ices and the Secretary of Labor, shall conduct a
26 study of the large group insured and self-insured
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22
•HR 3200 IH PAGE 22
1 employer health care markets. Such study shall ex2
amine the following:
3 (A) The types of employers by key charac4
teristics, including size, that purchase insured
5 products versus those that self-insure.
6 (B) The similarities and differences be7
tween typical insured and self-insured health
8 plans.
9 (C) The financial solvency and capital re10
serve levels of employers that self-insure by em11
ployer size.
12 (D) The risk of self-insured employers not
13 being able to pay obligations or otherwise be14
coming financially insolvent.
15 (E) The extent to which rating rules are
16 likely to cause adverse selection in the large
17 group market or to encourage small and mid
18 size employers to self-insure
19 (2) REPORTS.—Not later than 18 months after
20 the date of the enactment of this Act, the Commis21
sioner shall submit to Congress and the applicable
22 agencies a report on the study conducted under
23 paragraph (1). Such report shall include any rec24
ommendations the Commissioner deems appropriate
25 to ensure that the law does not provide incentives
PAGE 23
1 for small and mid-size employers to self-insure or
2 create adverse selection in the risk pools of large
3 group insurers and self-insured employers. Not later
4 than 18 months after the first day of Y1, the Com5
missioner shall submit to Congress and the applica6
ble agencies an updated report on such study, in7
cluding updates on such recommendations.

Please point out where it says “Mandatory Audit of all self insuring businesses”

Thanks

>>> do you need someone to read it for you and act it out as well?

My reading of page 22 (using context from 21 and 23) is that this page(s) of the bill authorizes nothing more than a study for the purposes of recommending changes... (For Closing loopholes and discouraging self insurers)

Page 21, Line 25:shall conduct a study of the large group insured and self-insured employer health care markets. Such study shall examine the following:

Page 22, line 19: (2) REPORTS.—Not later than 18 months after the date of the enactment of this Act, the Commissioner shall submit to Congress and the applicable gencies a report on the study conducted under paragraph (1). Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mid-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers. Not later than 18 months after the first day of Y1, the Commissioner shall submit to Congress and the applicable agencies an updated report on such study, including updates on such recommendations.