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May 16, 2014 at 11:21 AM
Insurers may have a chance to sell fixed indemnity health insurance to workers who get weak “minimum essential coverage” (MEC) from self-funded employee health plans.
States cannot paralyze navigators by wrapping them in red tape — but they may be able to put some red tape around “certified application counselors” and other “non-navigator assistance personnel.”
The Small Business Health Options Program (SHOP) exchange divisions run by the U.S. Department of Health and Human Services (HHS) will start their 2015 exchange plan “election periods” Nov. 15 — the same day that the 2015 individual exchange qualified health plan” (QHP) open enrollment period is set to start — but states with state-based exchanges can begin their SHOP election periods earlier, if they want.
Officials at the Centers for Medicare & Medicaid Services (CMS), an arm of HHS, have included regulations regarding those matters and many more in a new batch of final regulations.
HHS is preparing to publish the regulations, which are based on draft regulations released in March, in the Federal Register.
Fixed indemnity
The fixed indemnity provisions in the regulation apply to hospital indemnity insurance policies and other policies that qualified as “excepted benefits” — benefits exempt from the provisions in the Health Insurance Portability and Accountability Act and the Patient Protection and Affordable Care Act (PPACA) that normally apply to major medical policies.
Originally, HHS had suggested that it might permit only the sale of fixed indemnity policies that pay a fixed amount of benefits for a specified period of time.
In the draft regulations, HHS said it would let an insurer sell a fixed indemnity policy that pays either a fixed benefit per period of time or a specified amount when a triggering event, such as a hospitalization, happens. But HHS said it would let an insurer sell a fixed indemnity policy only to consumers who have MEC — enough major medical coverage to get the consumers out of having to pay the penalty PPACA is supposed to impose on taxpayers who lack a minimum amount of coverage.
In the new final regulations, HHS has decided that consumers who buy fixed indemnity coverage must have MEC.
But insurers need not verify whether or not the buyers actually have MEC. Insurers simply must have the buyers state that they have MEC, CMS officials write in a preamble to the regulations.
Self-insured employers apparently can provide MEC with plans that provide coverage for a basic package of preventive services, such as checkups and mammograms, without imposing deductibles, co-payments or other out-of-pocket costs on the enrollees.
Some PPACA watchers say self-insured MEC plans need not cover the “essential health benefits” (EHB) that other PPACA-compliant plans must cover and need not meet the “minimum value” standards that other PPACA-compliant plans must meet.
Some commenters had suggested that HHS should let an insurer sell fixed indemnity coverage to a consumer only if the consumer has MEC that covers the essential health benefits.
