Patient Protection and Affordable Care Act of 2010

Arkansas Insurance Department Mike Beebe Jay Bradford Governor Commissioner 1200 West Third Street, Little Rock, AR 72201-1904 · (501) 371-2600 · (501) 371-2618 fax · www.insurance.arkansas.gov Information (800) 282-9134 · Consumer Services (800) 852-5494 · Seniors (800) 224-6330 · Criminal Inv. (866) 660-0888 BULLETIN NO. 6-2010 TO: ALL LICENSED INSURERS, HEALTH MAINTENANCE ORGANIZATIONS (HMOs), FRATERNAL BENEFIT SOCIETIES, FARMERS’ MUTUAL AID ASSOCIATIONS OR COMPANIES, HOSPITAL MEDICAL SERVICE CORPORATIONS, NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS, PRODUCER AND COMPANY TRADE ASSOCIATIONS, AND OTHER INTERESTED PARTIES FROM: ARKANSAS INSURANCE DEPARTMENT SUBJECT: PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010 DATE: August 3, 2010 On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). This new law will ultimately have a significant impact on the way healthcare is administered and paid for in Arkansas and across the country. The new law requires health care plans to issue policies compliant with certain relevant PPACA provisions, and HHS regulations pertaining thereto by September 23, 2010. As a result, numerous policy form changes will be required to ensure that Arkansas consumers will have access to compliant health coverage policies. The Arkansas Insurance Department (AID) will accept and review these filings, treating them as it does any other form filing. However, because of the anticipated volume of filings and the fact that policy amendments will reflect federal, rather than state law changes, we are providing filers with the attached PPACA Uniform Compliance Summary Form. This document will assist companies in ensuring they are meeting the immediate market reform requirements and will assist the AID in expediting the review of PPACA filings. This completed form must be submitted with all PPACA filings. We will accept grandfathered and non-grandfathered filings in one submission. Please note: These PPACA requirements only apply to policies for health insurance coverage referred to as “major medical” in the statute, which is comprehensive coverage that includes PPO and HMO coverage. For those companies submitting through SERFF, we are pleased to provide you with an overview of how NAIC SERFF staff plans to work with states to implement these changes. A new field is being implemented in SERFF to identify PPACA filings. Companies will be required to complete information on the General Information Tab of a SERFF filing if a filing has been marked PPACA eligible. A copy of the Arkansas PPACA Uniform Compliance Summary Form will be available in the SERFF Online Help section. We thank you for your cooperation and look forward to working with you to ensure this process works as smoothly as possible. If you have any questions or comments, please call the Life and Health Division at 501-371-2765, or email us at insurance.LnH@arkansas.gov August 3, 2010 JAY B' FORD, 1 i MMI S ONER DATE ARKANS S INS C DEPARTMENT PPACA Uniform Compliance Summary   ‐ 1 ‐  Please select the appropriate check box below to indicate which product is amended by this filing. INDIVIDUAL HEALTH BENEFIT PLANS (Complete SECTION A only) SMALL / LARGE GROUP HEALTH BENEFIT PLANS (Complete SECTION B only) This form filing compliance summary is to be submitted with your [endorsement][contract] to comply with the immediate market reform requirements of the Patient Protection and Affordable Care Act (PPACA). These PPACA requirements apply only to policies for health insurance coverage referred to as “major medical” in the statute, which is comprehensive health coverage that includes PPO and HMO coverage. This form includes the requirements for grandfathered (coverage in effect prior to March 23, 2010) and non-grandfathered plans, and relevant statutes. Refer to the relevant statute to ensure compliance. Complete each item to confirm that diligent consideration has been given to each. (If submitting your filings electronically, bookmark the provision(s) in the form(s) that satisfy the requirement and identify the page/paragraph on this form.) *For all filings, include the Type of Insurance (TOI) in the first column. Check box if this is a paper filing. COMPANY INFORMATION Company Name NAIC Number SERFF Tracking Number(s) *if applicable Form Number(s) of Policy being endorsed Rate Impact             Yes No    PPACA Uniform Compliance Summary SECTION A – Individual Health Benefit Plans TOI Category Statute Section Grandfathered Non- Grandfathered     2  Eliminate Pre-existing Condition Exclusions for Enrollees Under Age 19 [Sections 2704 and 1255 of the PHSA/Section 1201 of the PPACA] N/A Yes No If no, please explain. Explanation: Page Number: Eliminate Annual Dollar Limits on Essential Benefits Except allows for “restricted” annual dollar limits for essential benefits for plan years prior to January 1, 2014. [Section 2711 of the PHSA/Section 1001 of the PPACA] N/A Yes No If no, please explain. Explanation: Page Number: Eliminate Lifetime Dollar Limits on Essential Benefits [Section 2711 of the PHSA/Section 1001 of the PPACA] Yes No If no, please explain. Yes No If no, please explain. Explanation: Page Number: Prohibit Rescissions – Except for fraud or intentional misrepresentation of material fact. [Section 2712 of the PHSA/Section 1001 of PPACA] Yes No If no, please explain. Yes No If no, please explain Explanation: Page Number: PPACA Uniform Compliance Summary SECTION A – Individual Health Benefit Plans TOI Category Statute Section Grandfathered Non- Grandfathered     3  Preventive Services – Requires coverage and prohibits the imposition of cost-sharing for specified preventative services. [Section 2713 of the PHSA/Section 1001 of the PPACA] N/A Yes No If no, please explain. Explanation: Page Number: Extends Dependent Coverage for Children Until age 26 – If a policy offers dependent coverage, it must include dependent coverage until age 26. [Section 2714 of the PHSA/Section 1001 of the PPACA] Yes No If no, please explain. Yes No If no, please explain. Explanation: Page Number: Appeals Process – Requires establishment of an internal claims appeal process and external review process. [Section 2719 of the PHSA/Section 1001 of the PPACA] N/A Yes No If no, please explain. Explanation: Page Number: Emergency Services – Requires plans that cover emergency services to provide such coverage without the need for prior authorization, regardless of the participating status of the provider, and at the in-network cost-sharing level. [Section 2719A of the PHSA/Section 10101 of the PPACA] N/A Yes No If no, please explain. Explanation: Page Number: PPACA Uniform Compliance Summary SECTION A – Individual Health Benefit Plans TOI Category Statute Section Grandfathered Non- Grandfathered     4  Access to Pediatricians – Mandates that if designation of a PCP for a child is required, the person be permitted to designate a physician who specialized in pediatrics as the child’s PCP if the provider is in-network. [Section 2719A of the PHSA/Section 10101 of the PPACA] N/A Yes No If no, please explain. Explanation: Page Number: Access to OB/GYNs – Prohibits authorization or referral requirements for obstetrical or gynecological care provided by in-network providers who specialize in obstetrics or gynecology. [Section 2719A of the PHSA/Section 10101 of the PPACA] N/A Yes No If no, please explain. Explanation: Page Number: PPACA Uniform Compliance Summary SECTION B – Group Health Benefit Plans (Small and Large) TOI Category Statute Section Grandfathered Non- Grandfathered     5  Eliminate Pre-existing Condition Exclusions for Enrollees Under Age 19 [Sections 2704 of the PHSA/Section 1201 of the PPACA] Yes No If no, please explain. Yes No If no, please explain. Explanation:   Page Number: Eliminate Annual Dollar Limits on Essential Benefits – Except allows for “restricted” annual dollar limits for essential benefits for plan years prior to January 1, 2014. [Section 2711 of the PHSA/Section 1001 of the PPACA] Yes No If no, please explain. Yes No If no, please explain. Explanation:   Page Number: Eliminate Lifetime Dollar Limits on Essential Benefits [Section 2711 of the PHSA/Section 1001 of the PPACA] Yes No If no, please explain. Yes No If no, please explain. Explanation:   Page Number: Prohibit Rescissions – Except for fraud or intentional misrepresentation of material fact. [Section 2712 of the PHSA/Section 1001 of PPACA] Yes No If no, please explain. Yes No If no, please explain. Explanation:   Page Number:     PPACA Uniform Compliance Summary SECTION B – Group Health Benefit Plans (Small and Large) TOI Category Statute Section Grandfathered Non- Grandfathered     6  ◊ For plan years beginning before January 1, 2010, grandfathered group plans are not required to extend coverage to a child until the age of 26 if such child is eligible to enroll in another employee-sponsored plan        Preventive Services – Requires coverage and prohibits the imposition of cost-sharing for specified preventative services [Section 2713 of the PHSA/Section 1001 of the PPACA] N/A Yes No If no, please explain. Explanation:   Page Number: Extends Dependent Coverage for Children Until age 26 – If a policy offers dependent coverage, it must include dependent coverage until age 26. ◊ [Section 2714 of the PHSA/Section 1001 of the PPACA] Yes◊ No If no, please explain. Yes No If no, please explain. Explanation:   Page Number: Appeals Process – Requires establishment of an internal claims appeal process and external review process. [Section 2719 of the PHSA/Section 1001 of the PPACA] N/A Yes No If no, please explain. Explanation:   Page Number: PPACA Uniform Compliance Summary SECTION B – Group Health Benefit Plans (Small and Large) TOI Category Statute Section Grandfathered Non- Grandfathered     7  Emergency Services – Requires plans that cover emergency services to provide such coverage without the need for prior authorization, regardless of the participating status of the provider, and at the in-network cost-sharing level. [Section 2719A of the PHSA/Section 10101 of the PPACA] N/A Yes No If no, please explain. Explanation:   Page Number: Access to Pediatricians – Mandates that if designation of a PCP for a child is required, the person be permitted to designate a physician who specialized in pediatrics as the child’s PCP if the provider is in-network. [Section 2719A of the PHSA/Section 10101 of the PPACA] N/A Yes No If no, please explain. Explanation:   Page Number: Access to OB/GYNs – Prohibits authorization or referral requirements for obstetrical or gynecological care provided by in-network providers who specialize in obstetrics or gynecology. [Section 2719A of the PHSA/Section 10101 of the PPACA] N/A Yes No If no, please explain. Explanation:   Page Number: