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Full-Text Articles in Law
The Picture Begins To Assert Itself: Rules Of Construction For Essential Health Benefits In Health Insurance Plans Subject To The Affordable Care Act, Wendy K. Mariner
The Picture Begins To Assert Itself: Rules Of Construction For Essential Health Benefits In Health Insurance Plans Subject To The Affordable Care Act, Wendy K. Mariner
Faculty Scholarship
As the ACA shifts the function of health insurance from voluntary contract to a means of financing health care, it poses some challenges to traditional doctrines for interpreting health plan provisions. This article explores whether and how the doctrine of reasonable expectations and rules of statutory interpretation might apply to Essential Health Benefits coverage. A functional approach linking the two into a doctrine of reasonable statutory expectations could move us toward developing more consistent rules of interpretation within a more realistic conception of contemporary health insurance.
Scaling And Splitting, New Approaches To Health Insurance, Christopher Robertson
Scaling And Splitting, New Approaches To Health Insurance, Christopher Robertson
Faculty Scholarship
In the United States, cost-sharing in health insurance coverage has become the primary mechanism for reducing insurance expenditures and, by extension, maintaining affordable coverage. Cost-sharing involves patients making various out-of-pocket (OOP) payments for their own health care aside from whatever the insurer pays. As a patient’s spending on health care grows month by month in any given year of coverage, she moves through three different “zones” of insurance, from no insurance, to partial insurance, and finally to full insurance.