Federal health insurance regulators are trying to give the remaining Affordable Care Act exchange plan issuers a little help with compliance.
Officials at the Center for Consumer Information & Insurance Oversight, the agency in charge of the public health insurance exchange system, say they will ease customer service standards a bit for HealthCare.gov plan issuers that receive a big increase in enrollment in 2017 because of decisions by competitors to leave the health insurance exchange market.
CCIIO is the arm of the Centers for Medicare & Medicaid Services (CMS) that oversees all ACA exchanges. It’s directly in charge of running the HealthCare.gov federal exchange enrollment and policy administration system.
At HealthCare.gov, in 2017, CMS “will not use formal enforcement remedies for non-compliance” with federal exchange customer service standards when issuers facing a flood of new enrollees “make reasonable efforts to address concerns in an appropriate time frame,” CCIIO officials write in a new answer to a frequently asked question.
CMS will be especially flexible if an exchange plan issuer cooperates with CMS, resolves problems in a reasonable amount of time, and reports on its progress with fixing the problem, officials say.
Drafters of the ACA set up the public health insurance exchange system in an effort to give consumers an efficient way to shop for health coverage.
Many of the insurers now selling coverage through the exchange system are reducing the extent of their participation in 2017, and that could lead to a spike in enrollment at the remaining carriers.
Regulators see rapid growth at an insurer more as a risk factor than as something to welcome.
Rapid growth may increase the remaining exchange plan issuers’ revenue, but it could also increase the percentage of enrollees with high medical claim costs.
Another major risk is an increase in strain on key personnel, such as claim processors, customer service representatives, fraud analysts, and financial analysts.
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