Nebraska outlines exchange strategy

Bruce Ramge Bruce Ramge

Nebraska and other states are hoping they can persuade the U.S. Department of Health and Human Services (HHS) to allow "one stop filing" for health insurers that want to sell coverage through the new health insurance exchanges.

Bruce Ramge, director of the Nebraska Department of Insurance, talks about the effort in a notice he sent Wednesday to all companies writing health insurance in Nebraska.

HHS officials seem to thinking of having insurers that want to sell "qualified health plan" (QHP) coverage through the exchanges submit filings to state regulators through the regular System for Electronic Rate and Form Filing (SERFF) system, and also submit the filings to HHS through a new "HIOS" system, Ramge said.

The Nebraska department would like to see HHS let insurers stick with submitting filings through the SERFF system, Ramge said.

Ramge made the filing system comments in a discussion of Nebraska department efforts to implement the exchange provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA).

PPACA calls for all 50 states to have exchanges, or Web-based health insurance supermarkets for individuals and small groups, in place by 2014. 

The government of Nebraska has decided against setting up an exchange at this time. HHS is supposed to provide exchange services in Nebraska through a "federally facilitated exchange."

Although the Nebraska department will not be involved with setting up exchange operations, HHS seems to be suggesting in proposed rules and regulations that the department will have to review the products that would go on the HHS exchange menu in Nebraska, Ramge said.

To get on the initial 2014 exchange plan menu, a product may have to get through both a state and federal approval process by July, Ramge said.

"The department expects a high volume of new filings and, due to the existing and proposed statutory and regulatory rules," Ramge said. "Both state and federal review of these filings will take some time. Companies are encouraged to prepare and file their rates and forms as soon as possible."

If HHS does end up requiring health insurers to submit product filings through the HIOS system, the HIOS system might be eligible to accept the filings by April, Ramge said.

Also in the notice, Ramge said:
  • Nebraska would like to keep the risk pools for the individual and small group markets separate and have just one geographic rating area.
  • A Nebraska producer who places business with an insurer through an HHS exchange must still have an appointment with that insurer.
  • The insurers that sell coverage through the federal exchange, not the exchange, will be responsible for compensating producers who sell coverage through the exchange.

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