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Incorrect, I know of several TPA's that offer Qualified ACA plans that operate below 80% MLR.

I can provide proof for my statement, can you do the same?




What is a TPA?

You are always welcome, even encouraged, to provide proof. I am getting my information from:

https://www.healthcare.gov/health-care-law-protections/rate-...

>Does this apply to my plan?

>It depends.

>For Rate Review: These requirements don’t apply to grandfathered plans. Check your plan’s materials or ask your employer or your benefits administrator to find out if your health plan is grandfathered.

>For the 80/20 Rule: These rights apply to all individual, small group, and large group health plans, whether your plan is grandfathered or not.

I assume grandfathered plans are not ACA compliant, and hence do not have all the provisions that make health insurance worth having (such as out of pocket maximums and zero cost preventative care and appeals processes and other things that set a floor on the quality of healthcare covered by the insurance).


>>What is a TPA?

Third Party Administrator.

>>I assume grandfathered plans are not ACA compliant,

Correct.

>>hence do not have all the provisions that make health insurance worth having

Not necessarily. Some have broader benefits that maybe you would want.

https://www.healthcare.gov/health-care-law-protections/rate-...

Some states are 85/15. Did you know that? However, the plans you are referring to are Marketplace plans. I am not referring to Marketplace plans, nor community rated employer plans. I'm referring to self funded employer based commercial plans. These same type of plans are commonly offered not only in the US, but UK, Canada and Germany.

Edit: I get downvoted for providing proof.




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