The Regulatory Framework Task Force at the National Association of Insurance Commissioners (NAIC) is looking at the idea of including provisions from a 1993 small group health insurance model in a new group health market model.
The NAIC, Kansas City, Mo., asked task force staffers to draft a Group Health Insurance Coverage Model Act to reflect the many changes in the group health market created by the Patient Protection and Affordable Care Act of 2010 (PPACA) and other federal laws.
The current version also incorporates provisions from the 1993 model, the Small Employer Health Insurance Availability Model Act.
The task force expects to discuss the draft Thursday during a session at the NAIC’s fall meeting in Washington.
The draft deals with topics such as restrictions on premium rates, guaranteed availability and renewability of coverage, and coverage of preventive services.
The current draft is clearly a preliminary work and includes many notes and questions from the drafters.
In one place for example, drafters have included provisions derived from Section 5 of the 1993 NAIC model.
Those provisions limit group health insurers to changing premium rates annually, unless the employer has asked for changes in the health plan or enrollment in the plan has changed.
That section states that a health plan with a provider network shall not be considered similar to a plan without a network if using out-of-network providers leads to substantial differences in claim costs.
Elsewhere, the drafters took fair marketing standards from the 1993 model.
The provision prohibits a carrier from discouraging employers with possible health status problems from applying for coverage, or from encouraging employers with possible health status problems to buy coverage from other providers.