Commercial Health Insurance Primer

Commercial health insurance, also referred to as private insurance, is the most common form of health insurance in the United States, covering nearly two-thirds of Americans, most of whom receive coverage through their employer. This paper, prepared for the AHA by Faegre Drinker Biddle & Reath LLP, provides an overview of commercial health insurance, including a description of comprehensive health insurance as opposed to other commercially available products and the key elements of a commercial health insurance product. It goes on to describe how commercial health insurance is regulated at the state and federal levels, and how requirements differ for different types of health insurance. Finally, it outlines major utilization management approaches used by insurers and providers.