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New Year, New Health Care Rules

January 3, 2011

DENVER - It's a new year, and there are new regulations for health insurers which benefit consumers. As of January 1, insurers must spend a minimum of 80 cents of every health-care dollar on patient care, with a maximum of 20 cents going to things like administration and profits.

Jo Donlin, director of external affairs with the Colorado Division of Insurance, says that doesn't mean insurance companies won't make money.

"The insurance companies will still make profits, but this is to ensure that an appropriate amount of every premium dollar goes back to taking care of that insured patient. "

The new regulation is part of the Affordable Care Act, and affects all insurance plans except those underwritten by a large employer.

Dede de Percin, executive director of the Colorado Consumer Health Initiative, says the new insurance regulations are good for consumers.

"It means that they have the peace of mind of knowing that their premium dollars are going to be spent actually on health care for people in Colorado, and not necessarily on overhead and profit."

This year could also bring another insurance regulation aimed at protecting the consumer. The federal government is proposing a review process for increases in health insurance premiums that top ten percent.

Jo Donlin of the Colorado Division of Insurance says this policy echoes one already in place in Colorado.

"We do not have to start from ground zero. But what we will have to do, if this proposed rule takes place, is we will have to send to the Department of Health and Human Services a justification of why we made our decision. "

Donlin says the federal regulations are only minimums, and states will be free to implement stricter standards. The federal government is taking comments on this new proposal through February 22, and if approved it will go into effect July 1.

For a full timeline of health care reform implementation go to
healthreform.kff.org

If you're concerned that your health insurance policy may not be following these rules, call the state at 1-800-930-3745.

Kathleen Ryan, Public News Service - CO