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PPACA: NAIC Task Force OKs Model

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The Regulatory Framework Task Force at the National Association of Insurance Commissioners (NAIC) has endorsed a preexisting conditions exclusions model.

The task force at the NAIC, Kansas City, Mo., recently advanced model language on the new ban on health insurance preexisting condition exclusions for children and young adults up to age 19.

The ban is part of the Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA).

The task force is part of the NAIC’s Health Insurance and Managed Care Committee, and the model language is still subject to review by the committee and by the NAIC as a whole.

State regulators, federal regulators, health insurers and others have been debating whether states can let insurers control antiselection by eliminating the preexisting conditions exclusion only during designated open enrollment periods, to eliminate the temptation for parents to pay for coverage only when their children are sick, then drop coverage when the children appear to be healthy.

The draft endorsed by the task force would let states permit sellers of individual health insurance to discourage adverse selection by using open enrollment periods during which children could be enrolled on a guaranteed-issue basis.

The Blue Cross and Blue Shield Association, Chicago, wants the model language to let states prohibit insurers from imposing waiting periods on children enrolled outside open-enrollment periods. If the association proposal makes it into the final model, a state could allow insurers to discourage “patient dumping” by adopting eligibility criteria that would apply to children who are enrolled in or eligible to be enrolled in employer-sponsored group health plans or government health programs, such as a Medicaid plan or a state or federal high risk pool.

- Allison Bell


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