Feds: Our exchanges will work with producers

Some states will be running their exchanges on their own. In other states, HHS will be providing exchange services on its own, through “federally facilitated exchanges” (FFEs), or working with state agencies to run federal-state “partnership exchanges.”

In addition to the comments about producers, the draft QHP certification standards document includes comments about topics such as certification of stand-alone dental plans, multi-state plans, CO-OP plans, premium payments, consumer support, the QHP application process, and other matters.

In a section on rates, for example, CCIIO officials noted that they will be watching for proposed rates that seem to be too low as well as rates that appear to be too high.

“Rates that are too high or too low could have undesirable consequences for consumers,” officials said. “If rates  are too high, consumers may be overpaying or services. If rates are too low, consumers may  purchase a plan whose pricing is not sustainable over time, potentially leading to significant rate  increases in future years. Such increases could be disruptive to consumers who remain in the  plan and to consumers who switch to more effectively priced plans but experience changes in  covered benefits or provider networks.”

In a section on stand-alone dental plans offered through the FFEs and partnership exchanges, CCIIO officials have noted that a PPACA provision banning use of annual and lifetime benefits limits applies to the pediatric dental benefits included in the PPACA-mandated “essential health benefits” (EHB) package as well as to the other EHB benefits.

To be considered, the annual limit on cost-sharing costs for the pediatric dental benefits must be $1,000 or below, officials said.

See also:

• Federal exchanges attracting 3 to 9 dental carriers each
• Official: Federal exchange plan bids due April 30
• CCIIO head: federal health care exchanges to be ready to enroll on time