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Life Health > Health Insurance > Health Insurance

NAIC Implements Health Models

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The National Association of Insurance Commissioners has published a definitive list of the Affordable Care models that passed during the recent plenary conference call meeting.

The plenary is the group that includes all voting members of the NAIC, Kansas City, Mo.

The NAIC plenary voted last week to approve the American Health Benefit Exchange Model Act, which will help implement provisions in the Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA).

The exchange provisions will require states to create a system of state-based health insurance exchanges in 2014. The exchanges are supposed to help individuals and small groups buy standardized, federally subsidized health insurance packages that meet exchange program quality standards.

The NAIC also approved a Rate Filing Disclosure Form and Project Summary, which will help implement PPACA medical loss ratio (MLR) rules.

The MLR rules will require that 85% of large group premium revenue and 80% of individual and small group premium revenue go to medical care and quality improvement efforts.

Here is a list of the other PPACA-related models that the NAIC approved:

  • Model Language for Prohibition on Preexisting Condition Exclusions for Individuals under the Age of 19.
  • Model Language for Lifetime and Annual Limits.
  • Model Language for Preventive Services.
  • .Model Language for Prohibition on Rescissions of Coverage.
  • Model Language for Dependent coverage for Individuals to Age of 26.
  • Model Language for Choice of Health Care Professional.
  • Standard Definitions and Summary of Benefits Coverage.

- Allison Bell


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