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

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 [email protected].

Thank you for your participation.

mailto:[email protected]

John R. Kasich, GovernorMary Taylor, Lt. Governor/Director

Industry Training WebinarMarch 24, 2016

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:

[email protected]

mailto:[email protected]

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




• 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


• Applicable Timeframes

• Plan Management Toolkit• 2017 Benchmark Plan



• Q & A

Plan Management Toolkit

• New Student Health Plans tab

• Register for Email Notifications

Plan Management Toolkit• Access through the ODI Home Page under Featured Links

Plan Management Toolkit• All Student Health Plan materials can be accessed through this tab.

Plan Management Toolkit• Register for Email Notifications at the bottom of the Plan

Management Home page.

SCROLL TO BOTTOM OF PAGE …




• 2017 Benchmark Plan• Form 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

Plan Management Toolkit• All Resource Documents can be quickly accessed through one tab

selection.

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





• 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


• 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


• 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


• 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


• 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


• 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)


Family $10,900 $11,400

FPL below 200% (Silver)


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.






• 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







• Q & A