LAW7691 - Life Insurance and Health Care Financing

LAW7691 - Life Insurance and Health Care Financing

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This course reviews the economics, legal and regulatory principles of individual life and group health and accident insurance and will focus on the Patient Protection and Affordable Care Act of 2010. The course examines the similarities and differences between individual and group coverage with respect to key insurance concepts (e.g., insurable interest, anti-selection, and moral hazard), coverage provisions and limitations of each type of insurance (e.g., incontestability, medical necessity, experimental treatment and coordination of benefits), coverage defenses (e.g., misrepresentation, incontestability), regulatory priorities (e.g., disclosure, permitted groups, solvency, and rating options such as community rating), and the relationship of these private coverages to various public insurance programs (e.g., Medicare, Medicaid and Social Security Disability). The course will trace the evolution of traditional health insurance from passive indemnity financing to managed care, the transition from experience-rating to self-insurance and regulatory and judicial and regulatory responses to these changes (e.g., ERISA, DOJ/FTC Provider Network Antitrust Guidelines and State Utilization Review regulation). The remedies available to consumers, employees and health care providers in today's changing health care environment will also be considered.