Health Insurance and Managed Care (B) Committee
Conference Call
June 28, 2018
3:30 PM ET/2:30 PM CT

Health Insurance and Managed Care (B) Committee
Conference Call
April 19, 2018
3:00 PM ET/2:00 PM CT

Related NAIC Publications


Health Insurance and Managed Care (B) Committee



    The mission of the Health Insurance and Managed Care (B) Committee is to consider issues relating to all aspects of health insurance.

    Ongoing Support of NAIC Programs, Products or Services

  1. The Health Insurance and Managed Care (B) Committee will:
    1. Respond to inquiries from the U.S. Congress, the White House and federal agencies; analyze policy implications and effect on states of proposed and enacted federal legislation and regulations; and communicate the NAIC’s position through letters and testimony when requested.

    2. Monitor the activities of the Health Actuarial (B) Task Force.

    3. Monitor the activities of the Regulatory Framework (B) Task Force.

    4. Monitor the activities of the Senior Issues (B) Task Force.

    5. Serve as the official liaison between the NAIC and the Joint Commission on Accreditation of Healthcare Organizations, the National Committee on Quality Assurance (NCQA) and URAC.

    6. Examine factors that contribute to rising health care costs and insurance premiums; review state initiatives to address cost drivers.

    7. Utilize the Regulatory Framework (B) Task Force to review and, if necessary, consider revisions to the Health Carrier Prescription Drug Benefit Management Model Act (#22) to address issues related to:
      1) transparency, accuracy and disclosure regarding prescription drug formularies and formulary changes during a policy year;
      2) accessibility of prescription drug benefits using a variety of pharmacy options; and 3) tiered prescription drug formularies and discriminatory benefit design.

    8. Coordinate with the Market Regulation and Consumer Affairs (D) Committee, as necessary, to provide policy recommendations regarding uniform state enforcement of the federal Affordable Care Act (ACA).

    9. Coordinate with the Producer Licensing (D) Task Force, as necessary, regarding the regulation and activities of navigators and non-navigator assistance personnel as provided under the ACA and regulations implementing the ACA.

    10. Coordinate with the Antifraud (D) Task Force, as necessary, regarding state and federal antifraud activities related to the implementation of the ACA.

  2. The Consumer Information (B) Subgroup will:
    1. Develop information or resources, as needed, that would be helpful to state insurance regulators and others in assisting consumers to better understand health insurance.

    2. Review NAIC publications that touch on health insurance to determine if they need updating. If updates are needed, suggest specific revisions to the appropriate NAIC group or NAIC division to make the changes.
  3. The CO-OP Solvency and Receivership (B) Subgroup will:

    1. Provide a forum for state insurance regulators to discuss and share information through conference calls and meetings on the status of the Consumer Operated and Oriented Plans (CO-OPs) created under the ACA.
  4. The Health Care Reform Regulatory Alternatives (B) Working Group will:

    1. Provide a forum for the discussion of, and guidance on, the alternatives to implementing an ACA-compliant state-based exchange and the implications of such alternatives on NAIC-member regulatory authority.

    2. Identify and assist NAIC members in resolving open issues that need to be addressed with regard to non-state exchange ACA alternatives.

    3. Analyze the impact of the ACA on existing NAIC-member regulatory authority, both inside and outside of a federal exchange.

    4. Identify opportunities for NAIC members to continue to innovate and regulate outside of a federal exchange.
  5. The Medical Loss Ratio Quality Improvement Activities (B) Subgroup will:
    1. Review new quality improvement (QI) initiatives, as reported annually on the Supplemental Health Care Exhibit (SHCE) Allocation Report, and make recommendations to the secretary of the U.S. Department of Health and Human Services (HHS) on certifying for inclusion or exclusion in the QI expense category of the SHCE.

NAIC Support Staff: Jolie H. Matthews/Brian R. Webb/Jennifer R. Cook