Officials at the Center for Consumer Information & Insurance Oversight (CCIIO) say insurers need not sell individual health insurance outside the new public health insurance exchange system.
Insurers that do deign to sell outside the public exchange program, or marketplace, need not do anything special to accommodate the off-exchange coverage buyers, officials say. CCIIO is the U.S. Department of Health and Human Services (HHS) agency in charge of HHS efforts to implement the Patient Protection and Affordable Care Act of 2010 (PPACA).
CCIIO officials talk about PPACA’s “guaranteed availability standards” for individual “qualified health plans” (QHPs) — health plans that comply with the PPACA major medical benefits, underwriting and pricing rules — in a new batch of informal guidance.
PPACA requires insurers to sell individual major medical coverage on a guaranteed-issue basis. However, issuers “are not required to market any QHP for sale outside of the marketplace,” states de CCIIO.
If an issuer intends to sell a QHP mainly through the public exchange system, and the issuer does sell coverage to consumers who want to enroll outside the exchange system, the issuer will meet the guaranteed availability standard if it enrolls those consumers “using a process employed entirely on an ad hoc basis,” according to officials.
The guidance piece also informs that the issuer of an exchange QHP is not required to create a designated pathway for off-marketplace enrollment.