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The New Health Insurance Marketplace Impact of the ACA on the S.C. Health Insurance Marketplace.

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Presentation on theme: "The New Health Insurance Marketplace Impact of the ACA on the S.C. Health Insurance Marketplace."— Presentation transcript:

1 The New Health Insurance Marketplace Impact of the ACA on the S.C. Health Insurance Marketplace

2 Presentation Overview This presentation: This presentation: is designed to provide a basic overview of the ACA and its implementation in SC. is designed to provide a basic overview of the ACA and its implementation in SC. is not a comprehensive overview of the law or the states implementation activities. is not a comprehensive overview of the law or the states implementation activities. provides a highlight of the more significant provisions of the law and their impact on insurance regulation and South Carolina insurance markets. provides a highlight of the more significant provisions of the law and their impact on insurance regulation and South Carolina insurance markets.

3 What is the ACA? The Patient Protection and Affordable Care Act ("PPACA"; P.L. 111–148, 124 Stat. 119), and its companion amendment, the Health Care and Education Reconciliation Act of 2010 ("HCERA"; P.L , 124 Stat. 1029), are collectively, the "Affordable Care Act" or "ACA. The Patient Protection and Affordable Care Act ("PPACA"; P.L. 111–148, 124 Stat. 119), and its companion amendment, the Health Care and Education Reconciliation Act of 2010 ("HCERA"; P.L , 124 Stat. 1029), are collectively, the "Affordable Care Act" or "ACA. The ACA makes a number of changes to the U.S. health care system, many of which directly affect insurers and employers in their role as sponsors of group health plans offered to current and former employees, and their dependents. The ACA makes a number of changes to the U.S. health care system, many of which directly affect insurers and employers in their role as sponsors of group health plans offered to current and former employees, and their dependents. The ACA also altered many other facets of the U.S. health care delivery and payment system, such as Medicare, Medicaid, and community health services. The ACA also altered many other facets of the U.S. health care delivery and payment system, such as Medicare, Medicaid, and community health services.

4 What is the legislative purpose of the ACA? Increase the number of Americans with health insurance Increase the number of Americans with health insurance Ensure that coverage meets certain minimum thresholds Ensure that coverage meets certain minimum thresholds

5 How does the ACA accomplish its legislative How does the ACA accomplish its legislative purpose? Require most Americans to purchase health insurance coverage or pay what the ACA calls a "penalty," which the Supreme Court deemed to be a tax (the "Individual Mandate"), Require most Americans to purchase health insurance coverage or pay what the ACA calls a "penalty," which the Supreme Court deemed to be a tax (the "Individual Mandate"), Prohibit insurance companies from denying coverage to those with preexisting conditions or health issues (i.e., guaranteed issue), Prohibit insurance companies from denying coverage to those with preexisting conditions or health issues (i.e., guaranteed issue), Prohibit insurance companies from charging unhealthy individuals higher premiums than healthy individuals (i.e., adjusted community rating), and Prohibit insurance companies from charging unhealthy individuals higher premiums than healthy individuals (i.e., adjusted community rating), and Provide avenues for Americans to acquire health insurance that provides a minimum basic level of coverage. Provide avenues for Americans to acquire health insurance that provides a minimum basic level of coverage.

6 Where do you go to find coverage in the new marketplace? The current avenues for acquiring coverage are: The current avenues for acquiring coverage are: For individuals under 65 and small businesses, from the individual health insurance market inside and outside the "American Health Benefit Exchanges" ("Exchanges"), For individuals under 65 and small businesses, from the individual health insurance market inside and outside the "American Health Benefit Exchanges" ("Exchanges"), for persons age 65 or over or disabled, through Medicare, for persons age 65 or over or disabled, through Medicare, through Medicaid or CHIP for persons who meet state eligibility requirements, through Medicaid or CHIP for persons who meet state eligibility requirements, for "full-time" employees of "Large Employers" (i.e., generally employers with 50 or more employees) through their employer, to the extent their employer elects to "play" under the Large Employer mandates, for "full-time" employees of "Large Employers" (i.e., generally employers with 50 or more employees) through their employer, to the extent their employer elects to "play" under the Large Employer mandates, TRICARE TRICARE Veterans Health Insurance Program Veterans Health Insurance Program Grandfathered Plans Grandfathered Plans Other government programs Other government programs State high risk pools State high risk pools Many individuals will be eligible for coverage under more than one of these avenues and will be able to choose what is the best value for them. Many individuals will be eligible for coverage under more than one of these avenues and will be able to choose what is the best value for them.

7 What will SCs health insurance market consist of? Private health insurance market Individual market Exchange Outside the exchange Group Large Group Small Group Exchange Outside Exchange Medicare Medicaid TRICARE

8 When will the ACA take effect? Some provisions took effect immediately upon enactment March 23, Some provisions took effect immediately upon enactment March 23, Others took effect within 90 days of enactment. Others took effect within 90 days of enactment. Other provisions such as the immediate market reforms took effect on September 23, Other provisions such as the immediate market reforms took effect on September 23, Other provisions took effect in 2012 and They include womens preventive health mandates, reductions to flexible spending accounts, annual limits restrictions, etc. Other provisions took effect in 2012 and They include womens preventive health mandates, reductions to flexible spending accounts, annual limits restrictions, etc. Provisions such as guaranteed issue/renewal and pre- existing exclusion prohibition, adjusted community rating, essential health benefits will take effect in The next slide shows the implementation schedule. Provisions such as guaranteed issue/renewal and pre- existing exclusion prohibition, adjusted community rating, essential health benefits will take effect in The next slide shows the implementation schedule.

9 Implementation Timeline Temporary High Risk Pool Program Immediate Reforms: No Lifetime Limits Restricted Annual Limits Restrictions on Rescission First Dollar Coverage of Preventive Services Medical Loss Ratios with Rebates Exchanges Subsidies Individual/Employer Mandates Market Reforms Guaranteed Issue No Pre-Existing Condition Exclusions for Adults Rating Rules Essential Health Benefits Plans No Annual Limits for Essential Benefits Risk Adjustment Extended Dependent Coverage Internal/External Review No Pre-Existing Conditions for Children Disclosure of Justifications for Premium Increases Individual Market Reinsurance Program & Risk Corridors Temporary Reinsurance Program For Early Retirees Co-Op Plans & Multistate Plans

10 What changes are already in place? Several changes are already in place: Lifetime dollar limits on essential health benefits arent allowed. Annual dollar limits on essential health benefits are being phased out by January 1, Lifetime dollar limits on essential health benefits arent allowed. Annual dollar limits on essential health benefits are being phased out by January 1, The appeal procedures available to consumers are different. The appeal procedures available to consumers are different. Insurers cant deny coverage to children younger than 19 years old because of a pre-existing condition. Insurers cant deny coverage to children younger than 19 years old because of a pre-existing condition. Nearly all adult children up to age 26 are eligible to remain on a parents health insurance policy, regardless of the childs marital status, financial dependency, enrollment in school, or place of residence. Nearly all adult children up to age 26 are eligible to remain on a parents health insurance policy, regardless of the childs marital status, financial dependency, enrollment in school, or place of residence. Insurers must cover preventive services. There can be no cost-sharing for preventative services if delivered by an in-network provider. Insurers must cover preventive services. There can be no cost-sharing for preventative services if delivered by an in-network provider.

11 What changes are already in place, contd? Consumers have more access to information about proposed rate changes. Consumers have more access to information about proposed rate changes. Medical loss ratio standards limit how much of premium dollars insurers can spend on administrative expenses. Medical loss ratio standards limit how much of premium dollars insurers can spend on administrative expenses. All insurers must use a standardized Summary of Benefits and Coverage (SBC), which should make it easier to understand what a plan does and does not cover. Consumers get the SBC after purchase of the coverage. All insurers must use a standardized Summary of Benefits and Coverage (SBC), which should make it easier to understand what a plan does and does not cover. Consumers get the SBC after purchase of the coverage. Small businesses that provide health care for employees can apply for a tax credit. Small businesses that provide health care for employees can apply for a tax credit. Persons with Medicare prescription drug coverage receive a rebate to help cover the cost of the donut hole. This donut hole should be totally phased out by Persons with Medicare prescription drug coverage receive a rebate to help cover the cost of the donut hole. This donut hole should be totally phased out by ACA made subsidized coverage available in every state for people with pre- existing conditions who cant find coverage in the private market. However, because theres not enough money, no new enrollments in this PCIP program are being accepted. ACA made subsidized coverage available in every state for people with pre- existing conditions who cant find coverage in the private market. However, because theres not enough money, no new enrollments in this PCIP program are being accepted.

12 What changes will take effect on January 1, 2014? For Small Group and Non-Group Coverage Sold or Renewed on or after 1/1/2014: Guaranteed Issue Guaranteed Issue No Pre-Existing Condition Exclusions No Pre-Existing Condition Exclusions Adjusted Community Rating & Single Risk Pool for Each Market Adjusted Community Rating & Single Risk Pool for Each Market Essential Health Benefits & Cost-Sharing Must Meet Actuarial Value Levels Essential Health Benefits & Cost-Sharing Must Meet Actuarial Value Levels These apply inside and outside of an Exchange Note: Different rules apply to grandfathered plans

13 How will my coverage be impacted by the ACA? Every plan sold or renewed in the individual and small group market after January 1, 2014, must include all the benefits in a benchmark plan – a plan chosen for the state based on coverage currently available in the state – and will cover services in the following categories: Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance abuse disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care These are known as the essential health benefits. Different rules apply to grandfathered plans.

14 Where can consumers get information about health insurance coverage in South Carolina? Consumers may continue to shop for insurance in the South Carolina insurance marketplace (private market outside the exchange). Consumers may continue to shop for insurance in the South Carolina insurance marketplace (private market outside the exchange). Health insurance will also be available to consumers through the federally-facilitated health insurance exchange. (Call Center: ) Health insurance will also be available to consumers through the federally-facilitated health insurance exchange. (Call Center: ) Consumers may also contact their agent for assistance in finding coverage. Consumers may also contact their agent for assistance in finding coverage. Consumers may also contact the South Carolina Department of Insurance for general information on insurance coverage issues (DOI: ). Consumers may also contact the South Carolina Department of Insurance for general information on insurance coverage issues (DOI: ). Consumers may also contact their insurance company. Consumers may also contact their insurance company.

15 What are exchanges? Can I still purchase coverage through my agent? Exchanges are the central mechanisms created by the health reform bill to help individuals and small businesses purchase health insurance coverage. On October 1, 2013, an Exchange in every state will begin enrolling individuals and small businesses into qualified health plans. The Exchange, operated by the federal government, will provide information to consumers about their coverage options and what assistance is available to them. The Exchanges will also administer the new health insurance subsidies and facilitate enrollment in private health insurance, Medicaid, and the Children's Health Insurance Program (CHIP). The federal law does not require anyone to purchase health insurance through the Exchange, though subsidies will only be available for plans sold through the Exchange. You will be able to purchase this coverage right on the Exchanges website or through your agent if he or she is approved to sell Exchange plans. If you would rather buy other health insurance through an insurance agent or broker, you will be free to do so. Coverage will also be available in the market outside the Exchange.

16 What role will the FFE have in the South Carolina health insurance market? The FFE is one segment of the South Carolina health insurance market. The FFE is one segment of the South Carolina health insurance market. It is a marketplace where insurers can shop and compare insurance products but is not the sole market for health insurance products. It is a marketplace where insurers can shop and compare insurance products but is not the sole market for health insurance products. The FFE will be responsible for issues related to its operation. It will not have any general oversight of the South Carolina health insurance market. The FFE will be responsible for issues related to its operation. It will not have any general oversight of the South Carolina health insurance market.

17 Does the South Carolina Department of Insurance regulate the FFE? No, but the South Carolina Department of Insurance regulates the insurers and other entities that may offer products through the FFE. The Department approves the forms and rates and regulates the solvency of these insurers. No, but the South Carolina Department of Insurance regulates the insurers and other entities that may offer products through the FFE. The Department approves the forms and rates and regulates the solvency of these insurers. An insurer cannot offer products through the FFE unless it is licensed by the South Carolina Department of Insurance. An insurer cannot offer products through the FFE unless it is licensed by the South Carolina Department of Insurance. The multi-state plan is the exception. The Office of Personnel Management has primary regulatory oversight over the MSPs. MSPs must be licensed. in each of the states in which it operates. The multi-state plan is the exception. The Office of Personnel Management has primary regulatory oversight over the MSPs. MSPs must be licensed. in each of the states in which it operates.

18 Can an insurer offer a health insurance product at a cheaper rate outside the FFE? Generally, no. If an insurer is selling products inside and outside the FFE, the rates and coverage must be the same. Generally, no. If an insurer is selling products inside and outside the FFE, the rates and coverage must be the same. This does not affect plans sold outside the Exchange or grandfathered plans. This does not affect plans sold outside the Exchange or grandfathered plans. Grandfathered plans are not subject to all of the ACA mandates, but grandfathered plans cannot be sold or marketed through the Exchange. Grandfathered plans are not subject to all of the ACA mandates, but grandfathered plans cannot be sold or marketed through the Exchange.

19 Where do I go for help if I have a problem with an insurer? Generally, you would file a complaint about the conduct of an insurance company or agent with the South Carolina Department of Insurance. You may submit that complaint online at or fax it to: (803) or or call Generally, you would file a complaint about the conduct of an insurance company or agent with the South Carolina Department of Insurance. You may submit that complaint online at or fax it to: (803) or or call Complaints about the operation of the FFE will go to the FFE. Complaints about the operation of the FFE will go to the FFE. Questions about Medicaid issues will go to SCDHHS. Questions about Medicaid issues will go to SCDHHS.

20 Do we know what products will be offered in the South Carolina Health Insurance Market? We have just completed the Departments review of products that will be offered through the FFE. The review of those products had a July 31 st deadline. CMS will make information about the products and rates available around October 1, We have just completed the Departments review of products that will be offered through the FFE. The review of those products had a July 31 st deadline. CMS will make information about the products and rates available around October 1, We are in the process of reviewing products that will be offered in the market outside the exchange. We are in the process of reviewing products that will be offered in the market outside the exchange. The Department has received a number of filings to market products outside the Exchange. These filings continue to come in. The Department has received a number of filings to market products outside the Exchange. These filings continue to come in.

21 What is the name the FFE? The official name of the FFE is The official name of the FFE is the Health Insurance Marketplace for individuals and families and the Health Insurance Marketplace for individuals and families and The Small Business Health Options Program (SHOP) for small businesses. The Small Business Health Options Program (SHOP) for small businesses. Both are federally operated. Both are federally operated. Contact Information: Contact Information:

22 What types of plans will be available through the FFE? Health plans sold through the FFE will be required to meet comprehensive standards for items and services that must be covered. To help consumers compare costs, plans available through the FFE will be organized in four tiers, or four levels of generosity of the cost-sharing that each plan includes: Bronze level –The plan must cover 60% of expected costs across a standard population. This is the lowest level of coverage. Bronze level –The plan must cover 60% of expected costs across a standard population. This is the lowest level of coverage. Silver level – The plan must cover 70% of expected costs across a standard population. Silver level – The plan must cover 70% of expected costs across a standard population. Gold level –The plan must cover 80% of expected costs across a standard population. Gold level –The plan must cover 80% of expected costs across a standard population. Platinum level – The plan must cover 90% of expected costs across a standard population. This is the highest level of coverage. Platinum level – The plan must cover 90% of expected costs across a standard population. This is the highest level of coverage. Also, a catastrophic plan will be offered, and will cover the same services. But, its coverage will be slightly less generous than the Bronze level plans. A catastrophic plan may be a less expensive option for those who are eligible: only young adults under 30 and individuals who have a hardship exemption from the individual mandate are allowed to purchase catastrophic plans. Premium tax credits and cost-sharing reductions are not available for catastrophic plans. Also, a catastrophic plan will be offered, and will cover the same services. But, its coverage will be slightly less generous than the Bronze level plans. A catastrophic plan may be a less expensive option for those who are eligible: only young adults under 30 and individuals who have a hardship exemption from the individual mandate are allowed to purchase catastrophic plans. Premium tax credits and cost-sharing reductions are not available for catastrophic plans. Stand-alone dental plans are available through the FFE. These plans can also be certified by the feds as providing the pediatric dental EHBs for sale outside the Exchange. Stand-alone dental plans are available through the FFE. These plans can also be certified by the feds as providing the pediatric dental EHBs for sale outside the Exchange. We anticipate having stand-alone dental products available in the market outside the Exchange. We anticipate having stand-alone dental products available in the market outside the Exchange.

23 What insurance companies will offer coverage through the FFE? The FFE website will include a list of the plans available for sale on or after October 1, The FFE website will include a list of the plans available for sale on or after October 1, Four companies applied to offer Qualified Health Plans (QHPs) in South Carolina. They have not yet been approved by HHS/CMS. Four companies applied to offer Qualified Health Plans (QHPs) in South Carolina. They have not yet been approved by HHS/CMS. HHS/CMS will let them know whether their applications to be a QHP has been approved during the first week of September. HHS/CMS will let them know whether their applications to be a QHP has been approved during the first week of September.

24 Can a person take benefits out of a plan? No, consumers cant take benefits out of a plan, but they may be able to add extra coverage. At a minimum, every health plan on and off the FFE must provide coverage for all of the essential health benefits the ACA requires. Even though a person may not need every benefit in a plan, plans must cover all of the essential benefits to share risk across a broad pool of consumers and be sure all benefits are available for everyone. This also helps to protect people from risks they cant always predict across their lifetimes. No, consumers cant take benefits out of a plan, but they may be able to add extra coverage. At a minimum, every health plan on and off the FFE must provide coverage for all of the essential health benefits the ACA requires. Even though a person may not need every benefit in a plan, plans must cover all of the essential benefits to share risk across a broad pool of consumers and be sure all benefits are available for everyone. This also helps to protect people from risks they cant always predict across their lifetimes.

25 What are the preventive benefits? Items or services recommended with an A or B rating by the U.S. Preventive Services Task Force Items or services recommended with an A or B rating by the U.S. Preventive Services Task Force Immunizations recommended by the Advisory Committee on Immunization Practices of the CDC Immunizations recommended by the Advisory Committee on Immunization Practices of the CDC Preventive care and screenings for infants, children and adolescents supported by the Health Resources and Services Administration Preventive care and screenings for infants, children and adolescents supported by the Health Resources and Services Administration Preventive care and screenings for women supported by the Health Resources and Services Administration per the August 1, 2011 guidance: Preventive care and screenings for women supported by the Health Resources and Services Administration per the August 1, 2011 guidance: well-woman visits well-woman visits screening for gestational diabetes screening for gestational diabetes HPV DNA testing HPV DNA testing counseling for sexually transmitted infections counseling for sexually transmitted infections counseling and screening for human immune-deficiency virus counseling and screening for human immune-deficiency virus contraceptive methods and counseling* contraceptive methods and counseling* breastfeeding support, supplies and counseling breastfeeding support, supplies and counseling screening and counseling for interpersonal and domestic violence screening and counseling for interpersonal and domestic violence A complete listing of recommendations and guidelines can be found at: A complete listing of recommendations and guidelines can be found at:

26 This all sounds so complicated… who will help consumers navigate the new system? Navigators Navigators State Assisters State Assisters Application Assisters (Counselors) Application Assisters (Counselors) Primarily in hospitals and clinics Primarily in hospitals and clinics Volunteers with training and certification Volunteers with training and certification Agents and Brokers Agents and Brokers Listed on the Exchange Listed on the Exchange Commissions Paid by Insurers Commissions Paid by Insurers Appointment Issues Appointment Issues

27 What is stand alone dental coverage and can it be sold in the Exchange? Stand-Alone Dental plans may be sold inside and outside the Exchanges Stand-Alone Dental plans may be sold inside and outside the Exchanges Not required to follow market rules; they are excepted benefits Not required to follow market rules; they are excepted benefits Stand alone dental benefits can be certified by the feds to provide the pediatric dental coverage required as a part of the EHB package Stand alone dental benefits can be certified by the feds to provide the pediatric dental coverage required as a part of the EHB package

28 What is a CO-Op Plan? Federal government will foster the creation of qualified nonprofit insurers Federal government will foster the creation of qualified nonprofit insurers Loans for start-up costs Loans for start-up costs Grants to help meet solvency requirements Grants to help meet solvency requirements Unobligated funds cut off in fiscal cliff deal Unobligated funds cut off in fiscal cliff deal CO-OP loans granted to plans in: IL, AZ, CO, CT, IA, NE, KY, LA, ME, MD, MA, MI, MT, NV, NJ, NM, NY, OH, OR, SC, TN, UT, VT, WI CO-OP loans granted to plans in: IL, AZ, CO, CT, IA, NE, KY, LA, ME, MD, MA, MI, MT, NV, NJ, NM, NY, OH, OR, SC, TN, UT, VT, WI Must be governed by majority vote of members Must be governed by majority vote of members Profits must be used to reduce premiums, increase benefits, or improve quality of care Profits must be used to reduce premiums, increase benefits, or improve quality of care Must be licensed by state and follow state insurance laws Must be licensed by state and follow state insurance laws Consumers Choice Health Plan is the name of the CO-OP in South Carolina. Consumers Choice Health Plan is the name of the CO-OP in South Carolina.

29 What is a multi-state plan? Does South Carolina have one? U.S. Office of Personnel Management (OPM) contracts with insurers to offer at least 2 plans in each state (at least one a non-profit) Contracting process similar to the Federal Employees Health Benefit Plan (FEHBP) Contracting process similar to the Federal Employees Health Benefit Plan (FEHBP) Insurers must be licensed in every state in which they operate Insurers must be licensed in every state in which they operate Must be in at least 60% of states in first year; 70% of states in second year; 85% of states in third year; and all states in fourth year Must be in at least 60% of states in first year; 70% of states in second year; 85% of states in third year; and all states in fourth year Not required to cover entire state unless required by state Not required to cover entire state unless required by state Plans must comply with state rules and regulations, if they exist. Plans must comply with state rules and regulations, if they exist. Multi-state Plans are not approved to sell on the FFE by the DOI, but it is anticipated that there may be a multi- state plan operating in SC. Multi-state Plans are not approved to sell on the FFE by the DOI, but it is anticipated that there may be a multi- state plan operating in SC.

30 How will the insurance market change? The ACA introduces new commercial standards such as The ACA introduces new commercial standards such as Elimination of lifetime limits Elimination of lifetime limits Prohibition on pre-existing condition exclusions Prohibition on pre-existing condition exclusions Removal of cost-sharing for preventive services Removal of cost-sharing for preventive services Health insurance plans must offer coverage on a guaranteed issue/renewal basis Health insurance plans must offer coverage on a guaranteed issue/renewal basis Plans must offer essential health benefits Plans must offer essential health benefits New rating standards New rating standards New benefit requirements New benefit requirements ACA introduces the Exchange as a new distribution channel ACA introduces the Exchange as a new distribution channel

31 Federal/State Regulatory System There is a dual regulatory system for health insurance States are still considered the primary regulators of the insurance market (exception MSPs) However, federal government has authority to enforce the ACA if states do not Effectively coordinating regulatory roles will be one of the challenges Effectively communicating with stakeholders so they understand how to navigate the system will be key

32 What does the ACA say about enforcement? Public Health Service Act Sec [42 U.S.C. 300gg–22.] ENFORCEMENT. (a) STATE ENFORCEMENT. (1) STATE AUTHORITY.Subject to section 2723{2724}, each State may require that health insurance issuers that issue, sell, renew, or offer health insurance coverage in the State in the small or large group markets individual or group market meet the requirements of this part with respect to such issuers. (1) FAILURE TO IMPLEMENT PROVISIONS.In the case of a determination by the Secretary that a State has failed to substantially enforce a provision (or provisions) in this part with respect to health insurance issuers in the State, the Secretary shall enforce such provision (or provisions) under subsection (b) insofar as they relate to the issuance, sale, renewal, and offering of health insurance coverage in connection with group health plans or individual health insurance coverage in such State.

33 Federal Enforcement Actions Penalties Penalties The maximum amount of penalty imposed under this paragraph is $100 for each day for each individual with respect to which such a failure occurs The maximum amount of penalty imposed under this paragraph is $100 for each day for each individual with respect to which such a failure occurs No penalties if reasonable diligence found No penalties if reasonable diligence found Administrative review Administrative review Judicial review Judicial review Deny Exchange Participation Deny Exchange Participation

34 What should I do if my insurer wants to rescind my coverage? If your insurance company rescinds, or retroactively cancels, your health insurance coverage, it is now required to provide advance notice of its intention to do so, and may only do so if you committed fraud or made an intentional misrepresentation of an important fact. If your insurer notifies you that it wants to rescind your policy, and you have not done either of these things, request more information from the company. If you are not satisfied with their explanation, immediately contact the South Carolina Department of Insurance to file a complaint. If your insurance company rescinds, or retroactively cancels, your health insurance coverage, it is now required to provide advance notice of its intention to do so, and may only do so if you committed fraud or made an intentional misrepresentation of an important fact. If your insurer notifies you that it wants to rescind your policy, and you have not done either of these things, request more information from the company. If you are not satisfied with their explanation, immediately contact the South Carolina Department of Insurance to file a complaint.

35 What is the individual mandate and how does it affect me? Mandate: Beginning January 1, 2014, Americans must purchase health insurance or pay a tax if they do not Mandate: Beginning January 1, 2014, Americans must purchase health insurance or pay a tax if they do not You are exempt from the mandate if: You are exempt from the mandate if: You have insurance thru your job or purchase insurance on your own You have insurance thru your job or purchase insurance on your own You have coverage through Medicare, Medicaid, CHIP, VA, TRICARE, Indian Services, etc. You have coverage through Medicare, Medicaid, CHIP, VA, TRICARE, Indian Services, etc. You would have to spend more than 8% of income on the cheapest health insurance plan You would have to spend more than 8% of income on the cheapest health insurance plan Please consult your tax professional because new tax rules also may apply Please consult your tax professional because new tax rules also may apply

36 What is the current status of Exchange products? Most states have either approved or disapproved Exchange product submissions. Most states have either approved or disapproved Exchange product submissions. Plans are now going through the Plan Preview phase. Plan preview began on August 8 and will continue through August 16 th. Insurers have until August 16 th to request changes. Data submissions are due by August 23, Plans are now going through the Plan Preview phase. Plan preview began on August 8 and will continue through August 16 th. Insurers have until August 16 th to request changes. Data submissions are due by August 23, Plan Preview gives issuers the opportunity to review their products as they will appear on the Exchange website and make changes as approved by CMS. Plan Preview gives issuers the opportunity to review their products as they will appear on the Exchange website and make changes as approved by CMS.

37 What regulatory trends do we see? We see some evidence of We see some evidence of Market consolidations Market consolidations Insurer consolidations Insurer consolidations Provider mergers and other consolidations Provider mergers and other consolidations Some reliance on exclusive provider organizations/networks Some reliance on exclusive provider organizations/networks Focus on individual plans v. family plans Focus on individual plans v. family plans We anticipate that the individual market will grow We anticipate that the individual market will grow Differences between the individual and small group market will disappear. Differences between the individual and small group market will disappear.

38 What are the regulatory goals? To effectively perform our regulatory responsibilities To effectively perform our regulatory responsibilities To work with other regulators, so that we may assist consumers in understanding the new insurance marketplace. To work with other regulators, so that we may assist consumers in understanding the new insurance marketplace. The DOI, SCDHHS, other agencies are working together to make the transition to the new marketplace as smooth as possible for consumers. The DOI, SCDHHS, other agencies are working together to make the transition to the new marketplace as smooth as possible for consumers.

39 Thank You


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