SPECIAL SECTION: Patient Protection and Affordable Care Act & State Insurance Regulation
CONSUMERS: FREQUENTLY ASKED QUESTIONS  |  INSURE U - GET SMART ABOUT INSURANCE
LATEST NEWS:
NAIC Addresses Questions about Health Care Reform To enhance its ongoing effort to provide clarity on the Patient Protection and Affordable Care Act (PPACA), the NAIC has developed a brief, educational video to address frequently asked questions from consumers. (6/15/11) Read More
Conference calls & meetings:
Media Inquiries:
Communications Division (816) 783-8909 news@naic.org
Visit HealthCare.gov for information from U.S. Dept. of Health & Human Services (HHS)

Essential Health Benefits (EHB) Data from The Center of Consumer Information and Insurance Oversight (CCIIO):

In the Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation Final Rule ("EHB Rule"), HHS defines EHB based on state-specific benchmark plans. CCIIO has posted a summary of each state's EHB-benchmark plan on the CCIIO website (http://cciio.cms.gov/resources/data/ehb.html). The EHB-benchmark plan begins as the selected or default plan ("base benchmark") and is amended and/or supplemented to meet the requirements for coverage of benefits and limits described in 45 CFR 156.110.  

The following policy documents contain additional details about the base benchmark plans. Although they may not reflect all EHB and Affordable Care Act requirements including all the limitations and benefits covered by the EHB-benchmark, these documents are available to assist issuers when designing EHB plan benefits that are substantially equal to the EHB-benchmark plan. Scroll through the drop-down menu to find more information on that state's benchmark plan, then click "Open File" to download.

NAIC Letter to Congress on ACA Implementation Issues

NAIC Comment Letter to Centers for Medicare & Medicaid Services, Department of Health and Human Services Regarding Benefit and Payment Parameters for 2014 1/16/13

NAIC Comment Letter to U.S. Department of Labor, U.S. Department of Health and Human Services and U.S. Department of Treasury on Fixed Indemnity Letter 8/27/2013

NAIC Comments on Proposed EHB/AV/Accreditation Rule 12/19/12

NAIC Comments on Proposed Market Reform Rule 12/19/12

NAIC Comments on Proposed Rate Review Template 12/19/12

NAIC Comments on Proposed Multi-State Plan Rule 12/19/12

NAIC Comment Letter on OPM's Multi-State Plan Application

NAIC Statement Regarding the Supreme Court Ruling on the Affordable Care Act (ACA)
6/28/12

Supreme Court decision on the ACA [PDF] 6/28/12

NOW IN SPANISH!
Kaiser Family Foundation video (9 mins) explaining challenges with the current health care system, the changes taking place now, and the changes coming in 2014 (posted with permission from Kaiser Family Foundation)

Presentation: Health Insurance Exchange Plan Management, the NAIC and SERFF: Learning How the Pieces Fit [PDF] 11/29/11

Resolution Urging the U.S. Department of Health and Human Services to Take Action to Ensure Continued Consumer Access to Professional Health Insurance 11/22/11

NAIC letter to Secretary Sebelius regarding Exchange partnership guidelines 11/7/11

NAIC letter to the Centers for Medicare and Medicaid Services regarding Standards Related to Reinsurance, Risk Corridors and Risk Adjustment 10/5/11

NAIC letter to the Centers for Medicare and Medicaid Services regarding the Establishment of Exchanges and Qualified Health Plans 10/5/11

NAIC letter to the Joint Select Committee on Deficit Reduction Regarding Supplemental Health Insurance for Medicare Beneficiaries 9/21/11

NAIC Comments on Multi-State Plans, submitted to Office of Personnel Management on August 10, 2011

Rate Review Regulation - Associations

HHS Published Regulation: Rate Increase Disclosure and Review (45 CFR Part 154, CMS-9999-FC, RIN 0938-AQ68) and related Fact Sheet. NAIC comments on Notice of Proposed Rulemaking (NPRM) to HHS (2/28/11).

NAIC's statement regarding Government Accounting Office (GAO) report requested by Sen. Ben Nelson: Private Health Insurance Coverage: Expert Views on Approaches to Encourage Voluntary Enrollment (PDF).

Summary of the HHS NPRM on Establishment of Exchanges and Qualified Health Plans

PPACA Section-by-Section Chart
(updated 5/12/2011) - Now includes information on changes to the law pursuant to the Full-Year Continuing Appropriations Act, 2011 (P.L. 112-10).

For more recent updates to individual issues see the Advance Call and Meeting Material section of the Health Insurance and Managed Care (B) Committee. This Committee will consider the draft before advancing it to the NAIC Plenary.

This page provides information regarding NAIC implementation efforts regarding The Patient Protection and Affordable Care Act (PPACA; P.L. 111-148) and Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) and the vital role of state insurance departments in protecting insurance consumers.

NAIC COMMITTEES & IMPLEMENTATION ACTIVITIES
Health Insurance and Managed Care (B) Committee
  • Data Collection by Secretary and State (Joint B & D Committee)
  • Exchanges
  • Uniform Explanation of Coverage, Standardized Definitions and Uniform Enrollment
Jolie H. Matthews: 202-471-3982

Jennifer Cook: 202-471-3986

Brian R. Webb: 202-471-3978

Consumer Information (B) Subgroup

Jennifer Cook: 202-471-3986

Jane Sung: 202-471-3979
Julie Fritz: 816-783-8709

Exchanges (B) Subgroup

Jolie H. Matthews: 202-471-3982
Brian R. Webb: 202-471-3978

Regulatory Framework Task Force (B)
  • Rescission Procedures
  • Individual Market Reform
  • Group Market Reform
Jolie H. Matthews: 202-471-3982

Jennifer Cook: 202-471-3986


ERISA Subgroup (B)
  • Uniform Fraud Reporting Form
  • MEWA Fraud Provisions

Jennifer Cook: 202-471-3986


Senior Issues (B) Task Force

  • Medigap Changes
Jane Sung: 202-471-3979

Brian Webb: 202-471-3978


Market Regulation and Consumer Affairs (D) Committee
  • Data Collection by Secretary and State (Joint B & D Committee)
Tim Mullen: 816-783-8260
Craig L. Leonard: 816-783-8268

Antifraud Task Force (D)
Tim Mullen: 816-783-8260

Speed to Market Task Force (EX)
  • Rate Review
Julienne L. Fritz: 816-783-8709

Health Actuarial Task Force
  • Medical Loss Ratio
  • Interim Reinsurance Program and Risk Adjustment Mechanism
  • Rate Review
Eric King: 816-783-8234

Health Reform Solvency Impact Subgroup (E)
  • Rate Review
  • Medical Loss Ratio
Todd Sells: 816-783-8403

Reinsurance Task Force (E)
  • Interim Reinsurance Program and Risk Adjustment Mechanism

Dan Schelp: 816.783.8027

Ryan Couch: 816.783.8421
Health Insurance Exchanges
Julienne L. Fritz: 816-783-8709

Joy Morrison: 816-783-8471


Medical Loss Ratio Quality Improvement Activities Subgroup
Jolie H. Matthews: 202-471-3982
Brian R. Webb: 202-471-3978

RELATED DOCUMENTS AND RESOURCES:

General

Chart of All Federal ACA FAQs
U.S. Territories Discussion Paper (Adopted by the Health Insurance and Managed Care (B) Committee, Oct. 7, 2013)

Guidance White Papers

  1. Accreditation & Quality Guidance White Paper
  2. Form Review Guidance White Paper
  3. Marketing & Consumer Information Guidance White Paper
  4. Network Adequacy Guidance White Paper
  5. Rate Review Guidance White Paper

Uniform Health Carrier External Review Model Act

Implementing the Affordable Care Act's Insurance Reforms: Consumer Recommendations for Regulators and Lawmakers

Resolution Urging the U.S. Department of Health and Human Services to Take Action to Ensure Continued Consumer Access to Professional Health Insurance 11/22/11

Implementation measures passed by The Joint Executive Committee & Plenary Committee Dec. 16, 2010...

Comment Letters:

MLR MODEL REGULATION (Adopted 10/21/10): Regulation for Uniform Definitions and Standardized Rebate Calculation Methodology for Plan Years 2011, 2012, 2013... (PDF)

Oct. 13, 2010 Letter to Sec. Sebelius, U.S. Dept. of HHS — MLR issues not mandated by PPACA to the NAIC (PDF).

Medical Loss Ratio (MLR) Blanks Proposal
(Adopted 8/17/10)

NAIC Resolution to Protect the Ability of Licensed Insurance Professionals to Continue to Serve the Public
(Adopted 8/17/10)

Letter to Kathleen Sebelius (8/5/10)

NAIC PPACA Health Reform Responsibilities April 2010
PPACA Uniform Compliance Summary
Health Care Reform Glossary
NAIC Health Reform Principles
Grandfathering of Health Insurance Coverage
PPACA Potential Funding Opportunities for States
FAQ Premium Review Grant
(updated 6/25/10)
Grant applications are due July 7, 2010
Preemption and State Flexibility
Health Insurance Reforms
Early Retiree Reinsurance
Text of Selected Insurance Provisions of PPACA
PPACA Section-by-Section Chart
(updated 5/12/2011) - Now includes information on rate review and medical loss ratio regulations.
High Risk Pools
State High Risk Pool Cover Letter
State High Risk Pool Solicitation-FINAL
HHS High Risk Pool Funding Letter 4/2/10
List of States
HHS Fact Sheet
Co-Op Board
Co-Op Board Members
Medical Loss Ratio (MLR)
PPACA Subgroup Preliminary Outline
HHS Federal Registrar Questions
FINAL ADOPTED Response to HHS Federal Register Questions (05/12/10)
NAIC June 1 Letter to Sec. Sebelius
Rate Review
HHS Published Regulation: Rate Increase Disclosure and Review (45 CFR Part 154, CMS-9999-FC, RIN 0938-AQ68) and related Fact Sheet.
NAIC comments on the Rate Increase Disclosure and Review Notice of Proposed Rulemaking (NPRM) to HHS (2/28/11)

Rate Filing Disclosure Form

Executive Summary for the Rate Filing Disclosure Form - Exhibit 1
HHS Federal Register Questions
FINAL ADOPTED Response to HHS Federal Register Questions (05/12/10)
Sec. Sebelius Letter (5-4-2010)
CA Review of Anthem Rate
National Web Portal
Pre-Existing Condition Insurance Program (PCIP)
Health Insurance Oversight System (HIOS) Excel Data Submission Tool - States
Data Submission for the Health Insurance Oversight System
HHS Interim Final Rule

HHS Fact Sheet

Tax Issues
Tax Treatment of Dependent Coverage
Small Business Tax Credit
Small Business Tax Credit -IRS
Links
Office of Consumer Information and Insurance Oversight at HHS
National Governors Association Health Reform Implementation Resource Center
NEWS RELEASES
Rate Oversight Important Step in Addressing Rising Health Care Costs
3/4/10
MP3 Audio: (38 min - 9.2 MB)
NAIC President and West Virginia Insurance Commissioner Jane Cline, NAIC Secretary-Treasurer and Oklahoma Insurance Commissioner Kim Holland, and NAIC Health Insurance and Managed Care Committee Chair and Kansas Insurance Commissioner Sandy Praeger discuss federal health reform proposals with the media.
2/26/10
NAIC Response to White House Health Reform Summit
2/25/10

State Insurance Regulators Participate in National Summit on Health Care Fraud
1/26/10

State Insurance Regulators Offer Insights to Ensure Success of Health Reform Effort
1/7/10