Business of Insurance
These laws affect the requirements for companies wishing to operate the insurance industry. These laws can vary widely from state to state, but can affect things like ensuring the insurance company will have sufficient liquidity to cover claims in the event of catastrophic events or natural disasters. These laws also govern licensing insurance companies, regulating who insurance companies can turn away from coverage, the types of insurance a company must offer in a jurisdiction if it wishes to offer other policies, and many others Laws related to the content of insurance policies are designed to prevent predatory practices that would essentially let insurers offer worthless or diminished value policies. They also prevent insurers from misleading clauses and titles on policies that would allow an unsophisticated buyer to believe that they are buying one type of insurance but receive another. These laws also govern other provisions, like reasonable cancellation, disclosures to third parties, and delineations of insured and uninsured events.
Handling of Claims
These laws affect how insurance companies must respond when a claim is made. They prevent insurance companies from denying claims unreasonably. They also prevent insurance companies, in certain instances, from canceling policies simply for making claims. They also affect how insureds can make claims and what happens if someone attempts to make a fraudulent claim.
Affordable Care Act / “Obamacare”
The Patient Protection and Affordable Health Care Act, also known simply as the Affordable Care Act or “Obamacare,” is a sweeping set of federal laws designed to increase the quality and affordability of health insurance, lower the rate of uninsured Americans by increasing public and private insurance coverage, and reduce the costs of healthcare for both individual citizens and the government. To do this, it uses a number of mechanisms, like mandates, subsidies, and insurance exchanges, to promote coverage and affordability. The Affordable Care Act also requires insurance companies to cover all applicants, including those with preexisting medical conditions and without regard to gender, provided they meet new minimum standards for coverage.
Although the Affordable Care Act has been a hot button issue for political controversy, the United States Supreme Court upheld the constitutionality of the Affordable Care Act in the case of National Federation of Independent Business v. Sebelius. However, the Court also held in that case that states cannot be forced to participate in the Affordable Care Act’s Medicaid expansion under penalty of losing their current Medicaid funding. Since that ruling, politicians have hotly contested the law’s implementation, including a bid by Congressional conservatives to force a repeal of the law by exercising Congress’s “purse power” and allowing a brief federal government shut down to occur in 2013 rather than pass a budget that included funding for the implementation of the Act.
Business of Insurance