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PPACA: NAIC Releases Model Drafts

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The National Association of Insurance Commissioners (NAIC) has posted draft model language for health coverage provisions concerning preventive services, rescissions and lifetime and annual benefits limits.

The task force also has posted utilization review and grievance procedure model draft provisions.

The exposure drafts are on the website section of the Regulatory Framework Task Force, an arm of the Health Insurance and Managed Care Committee at the NAIC, Kansas City, Mo.

The task force is helping the NAIC and state insurance regulators implement provisions of the new Affordable Care Act, the federal legislative package that includes the Patient Protection and Affordable Care Act.

Federal agencies released batches of regulatory documents implementing the preventive services, rescission and benefits limits provisions this summer.

The NAIC’s rescission model draft, for example, is less than 3 pages long. It states that “a health carrier shall not rescind coverage under a health benefit plan with respect to an individual, including a group to which the individual belongs or family coverage in which the individual is included, after the individual is covered under the plan,” unless the “individual or a person seeking coverage on behalf of the individual…performs an act, practice or omission that constitutes fraud,” or “the individual makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan.”

The proposal would require a health carrier to give individuals affected by proposed rescissions at least 30 days advance written notice.

In related news, the NAIC commissioned a poll of 1,000 U.S. adults ages 18 and older in August to gauge awareness of PPACA implementation dates. When pollsters asked survey participants to choose from a list of four dates for which PPACA provisions start to take effect, only 14% correctly picked Sept. 23, officials say.

But the NAIC found that most participants knew provisions concerning children would take effect in September: 72% knew that plans no longer can exclude children with pre-existing conditions from coverage, and 70% knew that plans that offer dependent coverage will have to offer coverage to enrollees’ adult children up to age 26.

But 47% incorrectly thought that all health plans must cover approved preventive care and checkups without requiring co-payments, and half mistakenly thought that employers with fewer than 50 employees will have to offer health coverage to employees, officials say.


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