Filed Under:Health Insurance, Individual Health

Feds: Our exchanges will work with producers

CCIIO Director Gary Cohen (CMS photo)
CCIIO Director Gary Cohen (CMS photo)

The Centers for Consumer Information and Insurance Oversight (CCIIO) wants the health insurance exchanges it runs to work with insurance agents and brokers.

CCIIO officials emphasize their interest in working with producers in a batch of draft guidance for insurers that may end up selling "qualified health plan" (QHP) coverage through the new Patient Protection and Affordable Care Act (PPACA) exchanges.

The Centers for Medicare & Medicaid Services (CMS), the parent of CCIIO, "will work with agents and brokers, including web brokers, to facilitate enrollment in an ...  exchange, to the extent permitted by state law," CCIIO officials said in the draft.

Agents and brokers must agree to comply with federal and exchange requirements, and insurers that sell coverage through an exchange must make sure any agents, brokers or web brokers selling their products comply with applicable federal and state requirements, officials said.

A health insurer's agreement with an exchange will include requirements for any exchange plan marketing materials that the insurer, agents and brokers will be using, officials said.

Comments on the draft guidance are due March 15.

PPACA calls for the U.S. Department of Health and Human Services (HHS), the parent of CMS, to work with states to make exchanges, or Web-based health insurance supermarkets, available to individuals and small groups in all states and the District of Columbia by Oct. 1.

Some states will be running their exchanges on their own. In other states, HHS will be providing exchange services on its own, through "federally facilitated exchanges" (FFEs), or working with state agencies to run federal-state "partnership exchanges."

In addition to the comments about producers, the draft QHP certification standards document includes comments about topics such as certification of stand-alone dental plans, multi-state plans, CO-OP plans, premium payments, consumer support, the QHP application process, and other matters.

In a section on rates, for example, CCIIO officials noted that they will be watching for proposed rates that seem to be too low as well as rates that appear to be too high.

"Rates that are too high or too low could have undesirable consequences for consumers," officials said. "If rates  are too high, consumers may be overpaying or services. If rates are too low, consumers may  purchase a plan whose pricing is not sustainable over time, potentially leading to significant rate  increases in future years. Such increases could be disruptive to consumers who remain in the  plan and to consumers who switch to more effectively priced plans but experience changes in  covered benefits or provider networks."

In a section on stand-alone dental plans offered through the FFEs and partnership exchanges, CCIIO officials have noted that a PPACA provision banning use of annual and lifetime benefits limits applies to the pediatric dental benefits included in the PPACA-mandated "essential health benefits" (EHB) package as well as to the other EHB benefits.

To be considered, the annual limit on cost-sharing costs for the pediatric dental benefits must be $1,000 or below, officials said.

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