Rate Development, Filing and Review – A Compilation of Guidance and Expectations for 2015 Rates Webinar
Departments of insurance and insurers are currently preparing for the next round of rate development, filing and review. Rates for 2014 were developed based on considerable speculation on the expected impact of the ACA market reforms on the number and health risk of individuals who would enroll. Early enrollment information will be available for the 2015 rate development and review process, however, robust health risk information may still be unavailable.
With the first open enrollment period having come to an end, states are immediately gearing back up to ensure that consumers again have strong plan options available on the Marketplace for 2015. Insurers will soon be filing forms and rates with state insurance departments, and regulators will be working through those filings to certify products to be offered on the Marketplace during the next open enrollment period.
The Mental Health Parity and Addiction Equity Act (MHPAEA) Issuer Checklist and Certification has been developed by the Georgetown University Health Policy Institute for use by insurance regulators in reviewing products filed by issuers for compliance with MHPAEA.
The Issuer Essential Health Benefits (EHB) Crosswalk and Certification has been developed by the Georgetown University Health Policy Institute to help insurance regulators ensure that product filings include the required EHBs as set forth in the applicable state benchmark plan. Regulators can use the tool provided here, requiring issuers to complete the Crosswalk and Certification
As part of a series on “Helping Consumers Understand the Marketplaces,” Manatt Health Solutions led a webinar reviewing a primer on the reconciliation of advance premium tax credits (APTC), explaining how reconciliation will work when consumers file their taxes, and strategies consumers can use to minimize the risk of repayment.
This brief, prepared by the Georgetown University Health Policy Institute, explores some of the discrepancies that can arise with varying network adequacy standards and provides examples of how some states have resolved such issues. Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all health care services included under the terms of the contract.
The Oregon Health Policy Board met on August 6, 2013 to present updates on the 2013 legislative recap, the Coordinated Care Model Alignment workgroup, Health System Transformation Quarterly Report, and rate review and transparency opportunities.
The following brief, prepared by experts at the University of Minnesota, provides background on data collected by the National Association of Insurance Commissioners (NAIC), including new types of data being collected for health reform monitoring purposes.
The State Coverage Initiatives program, in coordination with the State Network, hosted a webinar Tuesday, July 23 from 1:30 – 3:00 p.m. EDT to discuss Small Business Health Option Programs (SHOP) notices and appeals. Sharon Woda and Adam Block from Manatt Health Solutions, and Lisa Sbrana and Kelly Smith from the New York Health Benefit Exchange (NYHBE) facilitated this event.
Impact of National Health Reform and State-Based Exchanges on the Level of Competition in the Nongroup Market
This brief, prepared by Wakely Consulting Group, analyzes health plan participation in 10 state-based exchanges to provide an early indicator of the level of competition that market reforms and state-based exchanges are generating. In sum, carrier participation increased by 35 percent (52 to 70 issuers) when comparing the number of issuers applying to nongroup exchanges versus the number in the pre-reform base year.