Carriers thinking about selling plans through the Covered California health insurance exchange program “don’t want Covered California to be a ‘third regulator.’”
Staffers on the board of Covered California — the California Patient Protection and Affordable Care Act (PPACA) health insurance exchange — have included a discussion of that issue in the third draft of a model plan contract the exchange is developing.
The board is set to discuss a presentation on the model contract Tuesday at a meeting.
Carriers have concerns about how Covered California would go about handling matters such as network adequacy, provider credentialing and utilization review, staffers said in comments included in the draft.
Similarly, the staffers found that insurers believe the current draft of the model contract is too one-sided.
The staffers are recommending that the exchange address the insurer concerns by deferring to regulators on areas such as financial solvency and credentialing.
“Keep areas where [the] exchange must also be concerned with direct consumer impacts,” the staffers said.