Frequently Asked Questions

Yes, please review the filing requirements listed in Bulletin 2010-04. The Uniform Compliance Summary provides for each category, including a description and page number. This, along with the certification will confirm compliance.

Plans that were in effect as of March 23, 2010, and have maintained their grandfathered status per regulation are considered grandfathered.

Individual

• Dependent coverage for children until age 26
• Individual lifetime dollar limits on essential benefits
• Prohibition of rescission

Small / Large Group

• Dependent coverage for children until age 26
• Eliminate annual dollar limits on essential benefits
• Eliminate lifetime dollar limits on essential benefits
• Eliminate pre-existing condition exclusions for enrollees under age 19
• Prohibition of rescission

The changes should be made as amendments to the original product as specified in Bulletin 2010-04.

Non-grandfathered

All immediate market reforms as specified in Bulletin 2010-04 that are required of all non-grandfathered plans apply to these.

A new product must be filed because a single product number cannot offer different coverages. A ‘me-too’ filing may be made with a new form number and the appropriate amendments.

The same filing requirements as the other reforms must be adhered to. The category can be manually filled in. It applies to non-grandfathered group health plans.

Internal claims appeal process:

• Grandfathered plans have no filing requirements.
• Non-grandfathered plans – all plans – new product must incorporate Department of Labor’s claims and appeals procedures.

External review:

• Non-grandfathered plans - all plans - must meet current state law requirements.

The department has until July 1, 2011, to adopt most recent model act at which time plans must comply with the new model act.

The current rating statutes apply. However, it is important to note that the new Medical Loss Ratio standards become effective Jan. 1, 2011. These new standards must be reflected in new rate filings. Also, the Department of Health and Human Services is establishing guidelines to define ‘unreasonable’ rate increases. Additional filing requirements may be required when the new regulations are developed.