Dive Brief:
- New York state officials are considering imposing new requirements demanding that insurers provide out-of-network benefits on all plans sold on the state health exchange.
- Insurers, for their part, say that requiring out-of-network coverage could increase premiums by as much as 30%.
- State officials say they're not sure exactly how the out-of-network benefits would work, and that they're open to suggestions as to how to proceed.
Dive Insight:
With insurers struggling to avoid being crushed by unexpected expenses on health marketplace plans, it's inevitable that they would push back on this out-of-network issue. After all, they are already moving into uncharted waters even if they're not required to cover out-of-network benefits. That being said, most observers think that marketplace plans will generally be a financial positive for health insurance companies. Imposing out-of-network payment requirements probably isn't enough to absorb any profit that would already be coming in through the ACA.