Feds list exchange plan review standards

Officials put notes about health- and disability-related discrimination in the participation standards, plan design and plan notice sections.

In addition to saying that a plan issuer cannot discriminate based on factors such as race, color, disability and age, officials say the issuer cannot employ “market practices or benefit designs that will have the effect of discouraging enrollment of individuals with significant health needs.”

The issuer also must ensure that “delegated and downstream entities,” such as producers, don’t discourage enrollment of individuals with “significant health needs.”

Plan documents must be accessible to people with disabilities. 

Elsewhere in the guidance, CMS officials say a plani issuer should:

• Submit justifications of rate increases to the exchange before implementing increases and prominently post justifications of the increases on its own website.
• Verify agents and brokers have met exchange registration and training standards, and signed any necessary agreements, such as privacy and security agreements.

See also:

• Exchange plans to get reviews
• Feds tell plans to fix their own problems
• Exchange board hears customer service complaints