On Thursday, NAHU sent a letter to the Department of Health and Human Services (HHS) on the proposed Notice of Benefit and Payment Parameters for 2018 regulation. The 294-page proposed regulation, a version of which is released towards the end of each year, serves as an omnibus policy document covering a wide-range of health insurance market topics. Among other concerns, our comments specifically addressed the ongoing issues of insurers reducing or eliminating broker commissions during the plan year. We requested that the Center for Medicare and Medicaid Services (CMS) require issuers who file premium rates with the state that include broker compensation that as a condition of approval the issuer may not alter the general compensation rate for brokers proposed and approved for the duration of that plan year. We noted our concerns about insurers who are implementing mid-year compensation changes and the impact that this can have on consumers and market stability and advocated that CMS has the authority to enforce commission rates that were included in plans certified on the marketplace.
Our comments included:
- Concern about the proposal to create multiple age bands for children covered through either individual or small-group market fully insured coverage and recommend no change to the existing age-rating structure for children.
- Not recommending any changes regarding guaranteed availability of coverage that would prohibit plans limiting coverage through shared networks of affiliated issuers.
- Seeking clarification that the carriers may only impose renewal-participation requirements on employer groups subject to IRC §4980H if state law requires a minimum participation standard for such employers.
- Recommending that HHS exempt any employer that can document that it is subject to IRC §4980H, regardless of employee count, from having to meet small-group participation requirements at any time during the year.
- Requesting that all issuers, including stop-loss plans providing coverage to employer-sponsored health benefit plans, treat all individuals offered coverage based on their hours worked/full-time status in the employer’s measurement period as full-time for coverage-participation requirements in the subsequent stability period, regardless of their actual hours worked in the stability period.
- Supporting the proposed changes to modify the five-year reentry rule to make it easier for carriers undergoing mergers or transitions to not inadvertently violate the rule, but believe that Administration policy should encourage such issuer course corrections rather than punishing them for responding to market trends and solvency risks.
- Supporting disallowing passive reenrollment for individuals whose birth-date indicates that they are likely Medicare-eligible.
- Requesting that the language requirement permitting the aggregation of the top 15 languages spoken across multiple states for multistate issuers and web brokers be scaled for employers that must develop SBCs for self-funded employee benefit coverage options.
- Seeking clarification on the requirement for year-round consumer support.
- Supporting extending the accessibility of enhanced enrollment to state-based exchanges, both for direct issuer enrollment and web brokers.
- Recommending that issuers be required to obtain written authorization from a consumer in order to change or increase the designated monthly EFT amount for the consumer, particularly when consumers lose their tax credit eligibility.
- Concern about the proposed change to not require binder payments if an individual is passively reenrolled in the same product.
- Supporting the clear codification of special enrollment period (SEP) qualifications and would support verification of an individual and/or dependents qualification for these SEPs.
- Supporting starting the 30-day clock for new employees to make plan determinations on the day the employer tells the SHOP about the new employee, as well as allowing the consumer’s start date be the first day of the month post-plan selection or the end of the legal waiting period.
- Concern with the proposal to limit variable-hour measurement periods for SHOP-participating employers to 10 months rather than the maximum of 12 allowable for all other employers as it would be a substantial barrier to entry and a compliance issue for any large employer considering purchasing coverage through a SHOP exchange.
- Supporting the provision of increased flexibility for Bronze plans, but we are concerned about the lack of specificity in the “major service” coverage requirements and request much more detail about the application of this requirement.
- Concern about the requirement for individual-market QHP issuers to also offer Silver and Gold small-group products through the state SHOP exchanges.
- Concern about the expansion of standardized federal marketplace options, including the creation of a new standardized, HSA-qualified, Bronze High-Deductible Health Plan (HDHP) option and request that the Administration wait until there is evidence of consumer response and data on how well the standardized plan options work in 2017.
- Requesting that CMS require certified issuers who file premium rates with the state that include broker compensation and the QHP and that plan and premium are ultimately certified, that as a condition of approval the issuer may not alter the general compensation rate for brokers proposed and approved for the duration of that plan year.
- Supporting greater rule flexibility for new market entrants and smaller plans by allowing them to exclude new 12-month policies from the calculation until they have more than one year of claims experience.