The Connecticut Insurance Department is getting its health product form and rate filing system ready for the day when the Patient Protection and Affordable Care Act (PPACA) is supposed to start taking full effect.
The department has given the form and rate filing rules in Bulleti HC-90.
The department wants to get the policies and certificates for the plans to be sold through the Connectic Health Insurance Exchange — HIX — this month.
The form number for an exchange plan should start with the prefix HIX, officials said in the bulletin.
If an insurer is selling the same plan outside HIX, the non-exchange form should use the same number as the HIX form, but without the HIX prefix, officials said.
The department “will provide some flexibility regarding the timing of health filings subject to this bulletin to facilitate the process and meet the needs of HIX,” officials said.
PPACA calls for the states and the U.S. Department of Health and Human Services (HHS) to set up a system of health insurance exchanges, or Web-based health insurance supermarkets, for individuals and small groups by Jan. 1, 2014.
Insurers are supposed to start selling coverage on a guaranteed issue, mostly community-rated basis on that date, and they’re also supposed to use a standardized “essential health benefits” (EHB) package as the basis for the benefits that they offer.
To help consumers shop for coverage, carriers must classify a plan as a bronze, silver, gold or platinum plan. The plan’s “metal level” will depend on the percentage of the actuarial value of the EHB package that the plan provides.
The Center for Consumer Information and Insurance Oversight (CCIIO) — the agency responsible for implementing much of PPACA — has been developing an actuarial value calculator that’s supposed to simplify the process of estimating a plan’s actuarial value, but the calculator is not yet available.
The Connecticut department wants an insurer to indicate whether a form is for a bronze, silver, gold or platinum product by using a B, S, G or P.
The department is not saying whether the HIX prefix should come before the metal level prefix or if the metal level prefix should come before the HIX prefix.
“The filing should include a certification by a member of the American Academy of Actuaries regarding the calculation of the actuarial values of the metal levels,” department officials said.
Because the CCIIO has not yet published a calculator for determining the actuarial value of the EHB package, “policy forms and certificates may be filed without the schedule of benefits so as not to delay the review and approval of these forms,” officials said. “The schedules of benefits may be filed at a later date with a target date not later than January, 2013.”
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