John R. Kasich, Governor Mary Taylor, Lt. Governor/Directorinsurance.ohio.gov/Company/Documents/ACA Filing... · John R. Kasich, Governor Mary Taylor, Lt. Governor/Director 2017 Plan
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John R. Kasich, GovernorMary Taylor, Lt. Governor/Director
2017 Plan Year Major Medical Form and Rate Industry Training.
Please call 1-877-820-7831, meeting number: 805189# for the audio
portion of the training. All lines will be muted for the duration of the
webinar.
If you are experiencing technical difficulties or have any questions,
please email planmanagementquestions@insurance.ohio.gov.
Thank you for your participation.
Agenda
• Overview and Introductions• Applicable Timeframes
• Plan Management Toolkit
• 2017 Benchmark Plan
• Form Filing Guidance
• Rate Filing Guidance
• Q & A
OverviewPlease submit questions during this webinar to:
planmanagementquestions@insurance.ohio.gov
IntroductionsPresenters
• Laura Miller, Assistant Director of Product Regulation and Actuarial Services
• Marjorie B. Ellis, Life & Health Chief
• Theresa Schaefer, Life & Health Chief
Agenda• Overview and Introductions
• Applicable Timeframes• Plan Management Toolkit
• 2017 Benchmark Plan
• Form Filing Guidance
• Rate Filing Guidance
• Q & A
2017 ODI Filing DeadlinesFiling Submission Deadlines• March 15, 2016 – All Student Health Plan Form Filings for the 2016/2017 school year.
• April 15, 2016 – All Individual and Small Group, Major Medical and Dental, On and Off Exchange Form Filings. This includes all amendments, endorsements, riders and new forms that will be used in 2017.
• April 27, 2016 – Individual and Small Group, Dental, On and Off Exchange RateFilings; all Student Health Plan Rate Filings; and, all Binder submissions for on-exchange major medical plans and SADPs that are on-exchange and off-exchange certified.
• May 13, 2016 – Individual and Small Group, Major Medical, On and Off Exchange Rate Filings.
• September 2, 2016 – Large Group Form and Rate Filings
Agenda• Overview and Introductions
• Applicable Timeframes
• Plan Management Toolkit• 2017 Benchmark Plan
• Form Filing Guidance
• Rate Filing Guidance
• Q & A
Plan Management Toolkit• Register for Email Notifications at the bottom of the Plan
Management Home page.
SCROLL TO BOTTOM OF PAGE …
Agenda• Overview and Introductions
• Applicable Timeframes
• Plan Management Toolkit
• 2017 Benchmark Plan• Form Filing Guidance
• Rate Filing Guidance
• Q & A
2017 Benchmark PlanAVAILABLE GUIDANCE • Ohio Essential Health Benefits Resource
Document for 2017 Plan Year• Essential Health Benefit Certificate of Coverage
(Blue Access PPO – Standard Opt D55)• Governor’s Habilitative Services Letter• Prescription Drug EHB – Benchmark Plan RX
Listing by Category and Class• MetLife 2014 Federal Dental Plan – High Option• FEP 2014 Blue Vision – High Option
2017 Benchmark PlanMedical Plan Updates
• Plan now includes many of the benefits added and excludes many of the restrictions deleted manually in the past
• Some benefits still need to be adjusted to comply with federal/EHB requirements
2017 Benchmark PlanMedical Plan Updates
• Reconstructive Services coverage expanded
• No other substantive changes from previous version
2017 Benchmark PlanDental Plan Updates
• Orthodontia waiting period eliminated
• New dental procedure codes in Class A, B and C services
• New dental procedure codes in Services Not Covered sections
2017 Benchmark PlanVision Plan Updates
• Ultraviolet Protective Coating now a standard lense option
• Evaluation, fitting and follow up care now included for regular contact lenses
Agenda• Overview and Introductions
• Applicable Timeframes
• Plan Management Toolkit
• 2017 Benchmark Plan
• Form Filing Guidance• Rate Filing Guidance
• Q & A
Form Filing Guidance
• Changes in Ohio Laws and Regulations• Changes in Federal Laws and Regulations• 2017 Filing Requirements
o Revised Guidanceo Redline Requirementso 2017 Cost Sharingo Supporting Documentation
Changes in Ohio Laws and Regulations
• Ohio HB 64/SB 223 – Changes to Subrogee Rights o HB 64 created ORC 2323.44 that provided
proportional recovery and expenses shared on a pro rata basis
o SB 223 revised the effective date of ORC 2323.44 to be forms delivered, issued for delivery or renewed on or after January 1, 2017
o Filed forms may not require updates
Changes in Ohio Laws and Regulations
• Ohio SB 223 – Expanded coverage limits for OLHIGA o Increases OLHIGA liability to: $500,000 for basic hospital, medical and surgical
insurance or major medical insurance
o Filed forms may not require updates
Changes in Ohio Laws and Regulations
• OAC 3901-8-16 – Required Network Disclosures for Consumers o Provider Directory requirements o Out of Network coverage disclosures Process and method to determine reimbursement Any balance billing that may occur
o Requires ID cards to denote name of the network(s) and if coverage is provided through the exchange
o Filed ID cards and forms may require updates
Changes in Federal Laws and Regulations
• Standardized ACA Plans
• Network Adequacy – Continuity of Care
• Habilitative Services
Changes in Federal Laws and Regulations
• Standardized ACA Planso Carriers may choose to participate in this programo Option to offer Bronze, Gold, and/or Silver planso If offer Silver plan, must offer all Silver cost
sharing reduction variation plans o Benefit design in Table 9, 2017 Payment Notice
Final Ruleo Include in your SERFF Filing Description the Form
Number and Metal Level of any Standardized ACA Forms included in the filing
Changes in Federal Laws and Regulations
• Network Adequacy – Continuity of Careo Provider Transitions Standards for QHPso 45 CFR §156.230o Written notice is required for certain patients
of a discontinued providero Allow patients in active treatment to continue
care when a provider is terminated without cause
o The benefit should be included in the Policy, EOC and Certificate
Changes in Federal Laws and Regulations
• Habilitative Services
o Must include coverage required through the Governor’s letter dated December 26, 2012
o Habilitative and Rehabilitative services must have separate visit limits
2017 Filing Guidance• Revised Form Filing Guidance
o Updated for the 2017 Plan Yearo New Form Filing Guidance for Student Health
Planso Specific Issues for HICs (HMOs) Onlyo CMS Summary clarifications
2017 Filing Guidance• Redline Requirements
o Compare the newest version to the last version of the form
o Use contrasting colors, gray or black are difficult to distinguish
o Redline must match the newest version of the form
o Attach the redline version to the Supporting Documentation tab
Cost Sharing Values - Medical
Maximum Out Of Pocket 2016 Benefit Year 2017 Benefit Year
Federal Poverty Level (FPL) above 250%
Individual $6,850 $7,150
Family $13,700 $14,300
FPL 200% - 250% (Silver)
Individual $5,450 $5,700
Family $10,900 $11,400
FPL below 200% (Silver)
Individual $2,250 $2,350
Family $4,500 $4,700
Cost Sharing Values - Dental• Stand Alone Pediatric Dental Out-of-Pocket
Maximums
o 2016 values • $350 One child• $700 Two or more children
o 2017 values • $350 One child • $700 Two or more children
Major Medical – Supporting Documentation
Scenario Form Filing Checklists
EHB Locator Are Rates Required?
I plan NO changes to my existing ACA compliant forms (no form filing required) N/A
Yes, withRate Filing YES
I want to use an Amendment, Endorsement or Standard Plan Rider to make changes to my existing Standard Benchmark Plan or Standard Plan Variation
NO YES YES
I want to make changes by creating a new Standard Benchmark Plan or Standard Plan Variation
YES YES YES
Dental – Supporting Documentation
Scenario Form Filing Checklist
Are Rates Required?
I plan NO changes to my existing ACA compliant forms (no form filing required) N/A YES*
I want to use an Amendment, Endorsement or Standard Plan Rider to make changes to my existing ACA compliant forms
NO YES
I want to create a new ACA compliant form YES YES
*A rate filing must be submitted only if rates will change or if trend was used when developing the currently approved rates.
Agenda• Overview and Introductions
• Applicable Timeframes
• Plan Management Toolkit
• 2017 Benchmark Plan
• Form Filing Guidance
• Rate Filing Guidance• Q & A
2017 Rate Filing Guidance
• Rate Filing Guidance Checklist – Updated for 2017o Plan Management Toolkit
Rate Filing Guidance tab
o Changes Layout of the document Added a column for Student Health Plans Risk Adjustment assumption Reinsurance assumption deleted
2017 Rate Filing Guidance• Changes in Rating Factors
o Must be justified
o Must be actuarially sound
o No confidential information/trade secret
• Unified Rate Review Template (URRT)
o Worksheet 2 is now on a Plan level
o As rate review is completed, changes to the URRT must be uploaded into the rate filing via SERFF and to CMS via HIOS
o ODI: Excel and PDF formats are needed
2017 Rate Filing Guidance• Timing of Rate Filings vs the Binder Filings
o Binder Filings – April 27th
o Rate Filings (Major Med) – May 13th
• Binder requirements for Rates
o Associate the Rate SERFF number in the Binder
URRT not needed in the Binder
Actuarial Memo not needed in the Binder
o Rate Data Template should contain best estimates
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