2020 Individual Insurance Market – Hot Topics HC4ME October 3, 2019
Consumer Health Care Division/BOI Health, life, disability, LTC, Medicare supplement, annuities Ensures that forms from insurers to consumers comply with statutes and regulations Assists Mainers having problems with their fully-insured plans Provides information/answers questions about insurance, rights, and responsibilities
Maine’s Health Insurance Market Looking at trends Looking at 2020
Maine’s Health Insurance Enrollment Enrollment reported as of 3/31 except for 2013 & 2014 is year end.
Maine Guaranteed Access Reinsurance Association (MGARA) • Purpose: stabilize and reduce premiums in individual market; encourage participation (or continued participation) of carriers • ACA Section 1332 “State Innovation Waiver” application • Restart: 1/1/2019 • “Invisible high risk pool”
MGARA 2019 YTD 1332 grant transfer to MGARA completed 6/26/19 $23,910,080 drawn from MGARA's account with the Feds as of 8/15/2019. As of 6/30/2019: Ceded lives: 3227 Ceded premium: $15,963,061 Assessment revenue: $5,452,869 Claims incurred: $34,542,973
2020 Individual and Small Group Approved Health Insurance Rate Filings Individual HealthcarePlans Small Group HealthcarePlans
Catastrophic Plans • High deductibles, plus 3 PCP visits & preventive care • Eligibles: • People under age 30 • Hardship/affordability exemption (for households whose premiums are more than 8.24% of their income) • No premium subsidies • Cannot combine with an HSA • Won’t necessarily show up on lists of plan options for people aged 30+ • Exemption process goes through healthcare.gov - can be lengthy
Hot Topics Maine’s Legislative Session Washington, DC
Health Benefits For health plans issued or renewed on/after 1/1/2020 Hearing aids: all individual & group plans must cover up to $3,000 for those over 18 with documented hearing loss. Colorectal cancer screenings: removes age. Now, most recent cancer guidelines (age 45). Abortion: a carrier covering maternity services also provides coverage for abortion. Telehealth/telemonitoring: coverage for any medically necessary service delivered through telehealth, including telemonitoring.
Pharmacy Benefit Manager (PBM) Licensure Effective 1/1/20, but PBMs with current registration – 4/1/20 • Licensure: application and checklist went live 10/1/19 • Carrier responsible for activities of PBM; PBM has fiduciary duty to carrier • Allows payment of cash price for meds and not filing a claim if cash price is less than cost-share • Prohibits spread pricing • Requires that all rebates must be remitted by PBM to carrier and used to lower premiums • Rulemaking starts soon
Short-Term Limited-Duration Policies Bulletin in the works: • Nonrenewable • Issued for period ending 12/31 of issue year • All prior policies can’t exceed 24 months (combined, regardless of same or different carriers) • 12 months between policies • Subject to State mandated benefits, preventive coverage • Forms & rates are pre-approved • MLR minimum: 50% • In-person broker sales only • No marketing of 1/1 policies during open enrollment • Written disclosure required by carrier or producer
Association Health Plans Maine’s position has not changed: • Non-fully insured AHPs: MEWA licensing law, solvency requirements, actuarial review of rates (and community rated small groups), network adequacy requirements, mandates for small groups, joint & several liability • Fully-insured AHPs: 24-A M.R.S. § 2805-A (association groups); § 2806 (trustee groups); § 2808 (other groups) • Rate review if they include small groups • Form filing • Bona fide sponsoring organization approved by the Bureau as meeting the requirements of Maine law for either an association, trust, or “other” group
Maine Bureau of Insurance Maine.gov/pfr/insurance 1-800-300-5000 (TTY: Relay 711) Insurance.email@example.com