United States. Congress

“ Ensuring Value and Lower Premiums. (a) In General.— A qualified health benefits plan shall meet a medical loss ratio as defined by the Commissioner. For any plan year in which the qualified health benefits plan does not meet such medical loss ratio, QHBP offering entity shall provide in a manner specified by the Commissioner for rebates to enrollees of payment sufficient to meet such loss ratio. ”

“ The types of employers by key characteristics, including size, that purchase insured products versus those that self-insure. (B) The similarities and differences between typical insured and self-insured health plans. (C) The financial solvency and capital reserve levels of employers that self-insure by employer size. (D) The risk of self-insured employers not being able to pay obligations or otherwise becoming financially insolvent. ”

“ 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. ”