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Health Insurance Exchange Plan Management

Health Insurance Exchange Plan Management

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Health Insurance Exchange Plan Management

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  1. Health Insurance ExchangePlan Management Exchange Plan Management, the NAIC and SERFF: Learning How the Pieces FitKelly McCumber, Product Specialist II Jon Sink, Business Analyst II

  2. The NAIC, SERFF and Health Insurance Exchange Plan Management • Today’s Demonstration • Targeted towards Health Insurance Exchange planners (non-insurance regulator) • NAIC background and support role for state insurance regulators • SERFF’s role in Health Insurance Exchange Plan Management

  3. The NAIC, SERFF and Health Insurance Exchange Plan Management • Goals for today: • Explain to you how SERFF currently functions • Explain to you our ideas regarding how current functionality can be used in Exchange Plan Management • Review our high-level anticipated enhancements to accommodate Exchange Plan Management functionality

  4. NAIC History • The NAIC was established in 1871 • The U.S. standard-setting and regulatory support organization • Governed by chief insurance regulators from 50 states, D.C. and five U.S. territories

  5. NAIC & State Regulators • Establish standards and best practices • Conduct peer review • Coordinate regulatory oversight

  6. NAIC Offices • New York (Securities Valuation Office) • District of Columbia (Executive Headquarters) • Kansas City (Central Office) ----------------------------------------------- • All locations support the efforts of state insurance regulators • Represent the collective views of state regulators • Form the national system of state-based insurance regulation in the US

  7. NAIC Members • Elected or appointed state government officials • Regulate the conduct of insurance companies and agents

  8. NAIC Mission • Assist state insurance regulators, individually and collectively in: • Serving the public interest • Promoting competitive markets • Consumer protection • Financial solvency of insurance institutions

  9. NAIC Support • Work with the insurance commissioners and insurance department staff as they develop regulatory policy • Provide numerous technology solutions to automate and streamline the regulatory process

  10. Key Premises in Exchange Development • States will continue to regulate health insurance or play a key role in product review/approval and/or consumer assistance • Exchange solutions should minimize the regulatory burden • State insurance regulators wish to use existing information technology investments vs. building new ones

  11. NAIC’s Electronic Support • 30 years of software development • Data repositories across all jurisdictions • The NAIC provides many tools to allow states to make the most of their resources • Electronic processing for uniformity and efficiency standards

  12. SERFF History • A product of the NAIC • Developed in 1998 • Key component in establishing uniformity and speed-to-market in the insurance industry • Used by 51 state jurisdictions to review and approve industry rate and form filings

  13. NAIC andInsurance Regulation • The NAIC has collective membership expertise in the individual and small group markets • Uniquely positioned to have a key role in the major health care overhaul • The NAIC has been a constant for over 140 years • The NAIC support offices are a major contributor in the forum of health care reform

  14. NAIC andHealth Care Reform • More than two dozen mentions in the federal law • 10 provisions give the NAIC responsibility or asks for assistance • The NAIC’s efforts are recognized by the law and intended to be leveraged in order to bring about health care reform

  15. Health Insurance Exchanges • Key component in health care reform • Expected to provide consumers better access to health care choices • Requires the coordination of multiple state and federal agencies The reason we’re talking to YOU today!

  16. SERFF & Insurance Regulation • Used by insurance carriers and states since 1998 • Provides a single tool used by 49 states, DC and 1 territory • Used by over 3,400 companies

  17. SERFF & Insurance Regulation • Streamlines the filing and review process • Promotes speed-to-market and uniformity throughout the industry • 27 jurisdictions mandate the use of SERFF for all rate and form filings • Two million filings in the past 4 years

  18. SERFF & Health Insurance Exchange Plan Management We want to collect the correct contact information for individuals responsible for Exchange development. If you received notice of this demo from someone else, please send your contact information to You’ll be put on a list for future correspondence. Thank you for attending!