Health Insurance and Managed Care (B) Committee
Health Insurance and Managed Care (B) Committee Page
Joint Executive (EX) / Plenary Committee Summary Report
Summer 2009 Meeting Summaries Index

The Health Insurance and Managed Care (B) Committee met June 15, 2009.

During this meeting, the Committee:

• Heard a presentation from Jennifer Libster from the Georgetown University Health Policy Institute. She discussed the findings from the report “Coverage When It Counts: What Does Health Insurance Cover and How Can Consumers Know?” in the California and Massachusetts markets.

• Discussed pandemic influenza preparedness.

• Heard a legislative update on federal issues, which included a discussion of recent health care insurance reform proposals, including the bill recently introduced by the Senate Health, Education, Labor and Pensions Committee.

• Adopted the Regulatory Framework Task Force report. The Task Force heard a discussion from representatives of the Centers for Medicare and Medicaid Services (CMS) and the Department of Labor (DOL) on implementation issues with respect to the COBRA provisions under the American Recovery and Reinvestment Act. The Task Force also heard updates from these representatives on the status of regulations and other implementation activities related to the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addition Equity Act of 2008 and the Genetic Information Nondiscrimination Act of 2008 (GINA). The Task Force released for comment drafts of revisions to three NAIC models impacted by GINA and the special enrollment provisions in SCHIP. The Task Force reviewed revised drafts of external review model notices and forms. The recently adopted Uniform Health Carrier External Review Model Act includes several model notices and other forms to be developed by the Task Force. After review and discussion of the comments, the Task Force requested NAIC staff to develop new drafts for comment that incorporate the suggested revisions. The Task Force continued its discussion of the draft survey to companies concerning the issue of policy rescissions and preexisting condition exclusion decisions and made several revisions to the draft survey. The Task Force intends to send the survey out in July with the hope of receiving responses from the companies prior to the Fall National Meeting. The Task Force continued its discussion of the Task Force’s charge to review issues concerning the standardization of forms practices and procedures in health insurance underwriting with respect to regulatory modernization. Believing that any work on this charge could be impacted by potential federal health care reform legislation, the Task Force decided to table discussion of the charge until the Fall National Meeting. The Task Force received the report of the ERISA Subgroup.

• Adopted the Senior Issues Task Force report. The Task Force adopted revisions to the Long-Term Care Insurance Model Act and Regulation to include an independent review process for benefit trigger decisions and prompt payment of claims. The Task Force appointed a small subgroup to revise Appendix E of the Long-Term Care Insurance Model Regulation to standardize claims reporting definitions. Related to the work of this subgroup, the Task Force agreed to seek approval from the Committee to revise the initial model law development request for the Long-Term Care Insurance Model Regulation to include the work to revise Appendix E. The Task Force received an update on the implementation of the long-term care partnership program. The Task Force reported on its implementation activities with respect to the recent changes made to the Model Regulation to Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act. States must comply with the Genetic Information Nondiscrimination Act of 2008 (GINA) by July 1. States must also implement changes to the model regulation pursuant to the Medicare Improvements for Patients and Providers Act (MIPPA) by Sept. 24. Based on responses to a survey sent out to the states regarding implementation states, most states will meet the deadlines. The Task Force received a report from the Accident and Health Working Group on their work on Medicare supplement and long-term care issues. As part of that report, the Task Force voted to accept and forward the revisions to the NAIC Medicare Supplement Insurance Model Regulation Compliance Manual with a recommendation that the Committee adopt the revisions. The Task Force discussed a concern that SERFF is not currently prepared to accept filings for new 2010 Medicare supplement plans. It was reported that new codes have been created for the 2010 plans, but that SERFF was not on track to accept filings until mid-2010. This is a concern, as states will need to accept numerous filings for 2010 Medicare supplement plans as early as possible. The Task Force received a federal update on issues of importance to the Task Force, including new changes to Medicare supplement plans being considered by the Senate, potential Medicare reforms, and new long-term care legislation. 

• Adopted the Accident and Health Working Group report. The Working Group discussed the project to update the refund calculation in Appendix A of the Model Regulation to Implement the NAIC Medicare Supplement Minimum Standards Model Act and requested an extension to work on the project. The Working Group adopted an updated version of the NAIC Medicare Supplement Insurance Model Regulation Compliance Manual with a new section on innovative benefits and included information on the new Medicare supplement plans to be issued in 2010. The Working Group discussed an update to the Health Financial Analysis Handbook to reflect the changes to the Actuarial Opinion section of the annual statement instruction for the Health Insurance blank. The Working Group discussed the survey of state experience to address the question of closed blocks of long-term care insurance. It appointed a subgroup to review the Actuarial Opinion section of the health annual statement instructions for 2010. The Working Group discussed prospective principles-based reserve issues for health insurance. The Working Group received a status report from the American Academy of Actuaries Long-Term Care Principle-Based Reserve Work Group. The Working Group formed a subgroup to discuss long-term provisions under the Pension Protection Act.

Action Items:

1. Adopted the Regulatory Framework Task Force report.
2. Adopted the Senior Issues Task Force report, which included adopting the revisions to the Long-Term Care Insurance Model Act and Regulation and the request of the Task Force for the Committee to seek Executive (EX) Committee approval to revise the Model Law Development request for the Long-Term Care Insurance Model Regulation to reflect the work to revise Appendix E. 
3. Adopted the Accident and Health Working Group report, which included adopting the revisions to the NAIC Medicare Supplement Insurance Model Regulation Compliance Manual and the request for a one-year extension to complete its project to update the refund calculation in Appendix A of the Model Regulation to Implement the NAIC Medicare Supplement Minimum Standards Model Act.