Insurance

Insurance Law is the body of law about insurance. This encompasses the entirety of insurance, from the insurance business to the content of insurance policies and the handling of claims.

The insurance industry is changing. So are the ways that people choose to buy insurance. It used to be that they could only buy insurance through an agent.

Now, they can buy directly from a carrier or through various online sources. Insurance carriers must also compete in this increasingly crowded space, offering new ways to buy, interact with customers, and use new tools for agents.

But no matter what they choose to purchase, consumers still want the same things from their insurance:

Choice and value.

Today, I'll talk about how the industry is changing and the ways that carriers are giving consumers more choice and better value.

These are the laws that regulate the insurance market on a state-by-state basis. They can vary widely and dictate things like the requirements a company must meet to operate in that state or protect the consumer from being turned away for coverage. These laws also set legal requirements for insurance companies that want to offer other policies, such as life insurance or car insurance policies, on top of health insurance or generalized health insurance policies.

This insurance policy contains information about policy coverage, exclusions, limitations, and terms that govern the insured's relationship with us.

Laws like the Unfair Trade Practices Act and the Unfair Claims Practices Act in the US were enacted to prevent predatory practices by insurers. These laws also govern other provisions such as reasonable cancellation to a full refund, disclosures to third parties (such as creditors and banks), and delineations of insured versus uninsured or non-insurable events.

Handling of Claims

Many laws and regulations in the insurance space determine what can and can't be done when it comes to selling and insurance. These laws also ensure that insurance companies are fair, to begin with, when they choose those who are insurable and determine how much they must pay out.

These laws can be highly complex, so I encourage you (and your clients!) to consult with a professional in your area to ensure you are compliant. But, here is a list of some of the laws that insurers must abide by.

Obamacare

Through several mechanisms, including premium subsidies, government health insurance exchanges, mandates, and other insurance reforms, their affordability and access to health insurance are two key drivers of a healthy population.

The Affordable Care Act of 2010 went into effect in 2014, with goals and objectives which affected health care coverage in the United States. Among the most significant reforms of the Act was the creation of what was termed the "Patient Protection and Affordable Care Act (PPACA)," which greatly expanded the availability of health care coverage to millions of Americans, including ensuring continuing medical coverage for individuals who were temporarily between jobs or had exhausted their eligibility for public assistance previously.

Black, J., in National Fed. of Independent Business v. Sebelius (2012), held that portions of the PPACA which required states to expand their Medicaid programs or else suffer a diminution in their previously existing Medicaid funding exceeded Congress' authority under the Spending Clause of Article I of the United States Constitution. And therefore, that portion of the PPACA was unconstitutional. This case was known as National Federation of Independent Business v. Sebelius.

However, the Court also held that states could not be forced to participate in the Affordable Care Act's expansion under penalty for 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.