Q:

Does an American insurance company have to follow specific rules to offer health plans?

A:

Quick Answer

Health insurance companies in the United States must follow guidelines and laws at the state and federal level, as the American Cancer Society reports. The Health Insurance Marketplace also sets rules that apply to plans offered through the Marketplace, as the U.S. Centers for Medicare and Medicaid report.

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Does an American insurance company have to follow specific rules to offer health plans?
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Full Answer

A variety of different state and federal agencies govern health care plans, including the plans offered by private insurers, as the American Cancer Society explains. Rules governing private health plans are typically set and enforced by state insurance commissioners. Plans purchased through the marketplace may have other rules that govern their plans depending on state marketplace boards. Insurance plans must comply with all federal, state and local regulations that apply.

Other rules are governed federally, according to the U.S. Centers for Medicare and Medicaid. Insurance companies may not exclude patients with pre-existing conditions from purchasing insurance. Plans must offer free preventative care and not set lifetime benefit limits or yearly limits for basic health care. Coverage of children must include young adults under age 26 and provide a choice of health care providers. Plan benefits should be easy to understand and must make a glossary of health care terms available with the explanation of benefits so that patients may understand their coverage.

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