Condopak Case Study

Question 1 – Should coverage provisions be construed broadly and exclusion clauses narrowly? If so, why? If not, why not?

Closing out the meeting was John Connolly who serves as Associate Director of Insure the Uninsured. Connolly detailed the Covered California healthcare exchange as a commercial insurance provider. Connolly spent the majority of his time speaking addressing the improvements to coverage, and eligibility changes to applicable California residents. Making a repeated and substantial effort to state how the commercial insurance exchange would work, Connolly showed the various healthcare providers that would be available to certain individuals, and an estimation of the average cost per provider. The most significant aspect of Connolly’s presentation was his outline of the new health insurance plan tier levels, ranging from “Bronze” to “Platinum”. Bronze tier coverage represented the tier with the smallest amount of payment made by the plan and highest amount of payment made by the consumer, and Platinum tier coverage representing the highest amount of payment made by the plan and lowest amount paid by consumer.

Program Management activities will include handling all facilitator and partner program contracts, participant recruitment and program evaluation and any mid-course adjustments. The program shares space with the other DCPNI programs so the management team will ensure

There are providers, of public hospitals community and rural health centers, and local health department considered to be safety net providers that service the uninsured. But the result of increased demand has caused limited capacity and decreased treatment options due to eroding finances (KFF, 2013). In order to improve the well beings of Americans, it is imperative to establish a health care policy that will deliver comprehensive coverage for all.

While there are provisions within the law that provide for some safeguards for an insurance company accepting a higher percentage of higher risk patients compared to others, the insurance company is no longer in control of the amount of risk it accepts and these safeguards may be limited in time (American Academy of Actuaries, 2013).

1. Two programs running in windsor by some government agencies and some private agencies and those are :

Maximum: Total yearly premium for the national average price of a Bronze plan sold through the Marketplace.

|Indemnity Plan |Able to choose hospital and doctor, Fee for service, deductible, |Individuals and Families |

What is the status of the program today? If it is still active, what goals does it now have? If it has ended, when and why did it end?

Furthermore, firms with 50 or more workers will be required to contribute at least 60% of the cost for individual minimum essential coverage. Using the grandfathered plans, many small businesses are able avoid the costly mandated and new regulations by renewing less-expensive

You cannot be dropped from a marketplace plan, so an insurance carrier cannot single you out based on health or anything of that nature and exclude you from the plan going forward. There is no annual or lifetime maximum from a benefit standpoint. So previously plans used to have maybe a million dollar lifetime maximum which would rarely ever come into play. But now there in maximum, so insurance company is on the hook for whatever may transpire down the road. Children can be covered up to age 26. Children whether they are living with the parents, living in another state, or have their own families they can stay in the plan until they’re 26 years of

Another fee required by employers who have self-insured group health plans is the state established transitional “reinsurance program,” which is to be paid between the years 2014 through 2016 (Grant Thornton LLP, 2013). The hope of this fee is to stabilize premiums in the individual insurance market. The Transitional Reinsurance Fee will be determined by multiplying the average number of individual employees covered by the plan and multiplied by the contribution rate for the relevant year (Grant Thornton LLP, 2013). Per the U.S. Department of Health and Human Services (HHS), self-insured group health plans that provide major medical coverage will be charged a contribution rate of $63 per plan participant (Grant Thornton LLP, 2013).

In December 1999, the PC unveiled the SuperBuild grant program which encouraged private partnerships and mostly supported water and wastewater projects as a result of the Walkerton tragedy. This initiative was to ensure that municipalities had the necessary funding to upgrade or ensure their facilities were complaint with today's standards. Several of my local municipalities were successful in obtaining such funding as their existing wastewater treatment facilities were at capacity. Further the SuperBuild Sports, Culture and Tourism Partnership was introduced to renew, improve and expand these

Millions of insurance plans have annual payout limits, though the more typical plans purchased by employers usually set those limits at $500,000 or $750,000 -- which can also quickly be consumed by a catastrophic illness.

Insurance (general liability, workers' compensation and property casualty) coverage at a total premium of $2,400.