President | Founder, CLM Insurance Group, Delray Beach, FL
Health insurance is regulated by multiple governing bodies including, but not limited to:
Department of Insurance (DOI) in each state
Securities and Exchange Commission (SEC), assuming the carrier is a public entity
The Federal Government (ACA)
Other organizations such as NAHU, AHIP and others don't regulate, but strongly influence decisions. The majority of the regulation happens at the state level causing a different set of rules and regulations depending on where the plans are created & offered.
The answer to this question was much simpler prior to passage of the Affordable Care Act. Insurance was primarily regulated at the state level, but now a variety of federal government departments are involved.
The Centers for Medicaid and Medicare (CMS) regulate the administration of those two programs in combination with the states. The Department of Health and Human Services issues many interpretations of the law, and was responsible for rolling out the exchange marketplaces. The Internal Revenue Service (IRS) will be involved in collecting the penalty from those not purchasing coverage, and determining and validating the income-based subsidies.
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Department of Insurance (DOI) in each state
Securities and Exchange Commission (SEC), assuming the carrier is a public entity
The Federal Government (ACA)
Other organizations such as NAHU, AHIP and others don't regulate, but strongly influence decisions. The majority of the regulation happens at the state level causing a different set of rules and regulations depending on where the plans are created & offered.
The Centers for Medicaid and Medicare (CMS) regulate the administration of those two programs in combination with the states. The Department of Health and Human Services issues many interpretations of the law, and was responsible for rolling out the exchange marketplaces. The Internal Revenue Service (IRS) will be involved in collecting the penalty from those not purchasing coverage, and determining and validating the income-based subsidies.
Other departments are involved as well.