Proposed New Insurance Standards for 2015 Enrollment
- By BSTQ Staff
According to a new proposal from the Centers for Medicare & Medicaid Services (CMS), insurers that want to sell plans through the federal exchanges for 2015 would have to do more to ensure members have access to an adequate network of providers. Under the proposal, participating health plans would be required to submit a list to CMS of all in-network providers and medical facilities covered under a plan, which would then be reviewed by CMS, in conjunction with state regulators, to ensure that there is “reasonable access” to all types of providers. Health insurance plans sold through the 2015 exchange would be required to include at least 30 percent of such providers in the territory covered, compared with the 20 percent that was required in 2014. If insurers fail to offer this level of access to essential community providers, they would need to provide an explanation to CMS as to why their health plan should still be sold on the exchange. CMS will then review their explanation to see if it is adequate.
CMS is also considering requiring all exchange plans, or at least one plan at each level of coverage per insurer, to cover at least three primary care office visits per year prior to incurring any deductible. Timothy Jost, a healthcare expert at Washington and Lee University School of Law, suggests that “such a requirement may be a means of enticing younger, healthier individuals into the exchange by guaranteeing access to a certain level of free care even for high-deductible plans.”
Participating insurers will need to submit plan details to CMS by June 27 for products they want to sell during the 2015 enrollment period. There will be two review periods over the summer, during which time federal officials will notify insurers about any deficiencies in their applications and allow them to submit changes. Signed agreements for products to be sold through HealthCare.gov must be finalized by Oct. 17. Open enrollment begins Nov. 15.
