Student Health Plan Form and Rate Filing Instructions for the 2019-2020 School Year

BULLETIN 18-26 Date: December 19, 2018 To: Insurers, Nonprofit Health Service Plans, and Health Maintenance Organizations (“Carriers”) Re: Student Health Plan Form and Rate Filing Instructions for the 2019-2020 School Year The purpose of this Bulletin is to provide guidance to carriers regarding form and rate filing requirements for student health benefit plans that will be issued for the 2019-2020 school year. Background Since 2015, the Maryland Insurance Administration (“MIA”) has required carriers to submit new form and rate filings for student health benefit plans each school year. Initially, the annual filings were required to include school-specific rates and plan-specific schedules of benefits. However, in recent years, there were changes to the federal requirements for student health plans, which prompted the MIA to begin permitting carriers to file variable schedules of benefits and no longer require school-specific rates. As a result, the need for annual filings has diminished. When is an annual filing required? For the 2019-2020 school year, a separate filing to sell or renew a student health benefit plan is required if a carrier intends to use new forms, amend previously approved forms, or revise the previously filed rates. A separate filing for the 2019-2020 school year is not required if a carrier: a) Is not making any changes to the previously approved forms, other than changes that are expressly within the scope of the previously filed statement of variability for the approved forms; and b) Is not proposing any changes to the previously filed rating methodology or the previously approved manual rates. AL REDMER, JR. Commissioner NANCY GRODIN Deputy Commissioner LARRY HOGAN Governor BOYD K. RUTHERFORD Lt. Governor 200 St. Paul Place, Suite 2700, Baltimore, Maryland 21202 1-800-492-6116 TTY: 1-800-735-2258 www.insurance maryland.gov A carrier that determines a filing is not required for the 2019-2020 school year is expected to monitor changes in federal and state requirements regarding student health benefit plans to ensure that the previously approved forms and rates remain compliant with all applicable requirements. If a new filing is required based on the guidelines outlined above, the deadline for submitting student health plan form and rate filings for the 2019-2020 school year is February 1, 2019. Filing Procedures and Requirements The following requirements apply to the student health plan form and rate filings: 1. Student health benefit plan filings are required to be submitted under separate SERFF tracking numbers from other filings, using the Type of Insurance (“TOI”): H22 Student Health Insurance. If forms and rates will be submitted for the 2019-2020 school year, both components must be submitted in the same filing prior to the February 1, 2019 deadline using the SERFF Filing Type: Form/Rate. 2. Each filing for a student health benefit plan is required to include: a. Identification of all forms that will comprise the entire contract of insurance, provided in the following manner: a complete listing of previously approved forms that will be used with approval dates and SERFF tracking numbers, and submission for approval of any new or amended forms; b. The rating methodology and manual rates for the student health benefit plan product, or, if applicable, the approval date and SERFF tracking number for the previously approved rate filing that remains effective. School-specific rates are not required to be filed; and c. Certification that the health benefit plan’s prescription drug benefit complies with 45 CFR § 156.122 based on the information provided in the CMS Essential Health Benefits Rx Crosswalk Methodology for Plan Year 2019 and the 2017 EHB Benchmark Plan Information summary document provided by CMS. 3. Student health benefit plans are required to provide the same essential health benefits that are applicable to the individual market.1 The essential health benefits for the 2019-2020 school year are based on the 2017 benchmark plan selected by the MIA in consultation with the Maryland Health Benefit Exchange. Therefore, the instructions for required benefits and exclusions for individual health benefit plans described in Bulletin 15-33, dated December 10, 2015, will apply to the student health plans designed for the 2019-2020 school year. The 2017 benchmark plan may be viewed on the Maryland Insurance Administration’s website in its entirety at: http://insurance.maryland.gov/Documents/newscenter/legislativeinformation/2017- BenchMark-Plan.pdf. 1 45 CFR § 147.145. 4. For 2019-2020 school year, the MIA will continue to permit variability in cost-sharing, such as copayment amounts, coinsurance percentages, and deductible amounts. Carriers are not required to file a separate schedule of benefits form for each benefit design. However, federal regulations require that student health insurance coverage must provide an actuarial value of at least 60%, and carriers must specify in any plan materials summarizing the terms of coverage the actuarial value and the level of coverage (or next lowest level of coverage) that the coverage would otherwise satisfy.2 Therefore, if a variable schedule of benefits form is submitted, the form must include a variable section where the appropriate actuarial value and level of coverage will be specified, unless the carrier has established an alternative method to provide the required disclosure for each benefit design that is issued. If a carrier chooses to file a separate schedule of benefits form for each benefit design, then each schedule must disclose the appropriate actuarial value and level of coverage, unless an alternative method is used to provide the required disclosure. 5. If new or revised schedule of benefits forms are submitted for approval, the filing must include documentation of compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) regulations as found in 45 CFR § 146.136. If separate schedule of benefits forms are submitted for each benefit design, the documentation is required to include an actuarial demonstration of how each financial requirement applicable to a mental health or substance abuse benefit in the benefit design is no more restrictive than the predominant financial requirement of that type that applies to substantially all of the medical/surgical benefits in the same classification. If variable schedule of benefits forms are submitted, an explanation of variability must be included that clearly demonstrates how the carrier will ensure, for each variable plan design, that each financial requirement applicable to a mental health or substance abuse benefit in the plan design will be no more restrictive than the predominant financial requirement of that type that will apply to substantially all of the medical/surgical benefits in the same classification. The documentation should include a clear description of the methodology used by the carrier to determine the dollar amount of all plan payments for the substantially all/predominant analysis. For additional information, carriers should review the guidance provided by the Departments of Labor, Health and Human Services, and the Treasury in FAQs about Affordable Care Act Implementation Part 31, Mental Health Parity Implementation, and Women’s Health and Cancer Rights Act Implementation, Q8, published April 20, 2016, and FAQs about Affordable Care Act Implementation Part 34 and Mental Health and Substance Use Disorder Parity Implementation, Q3, published October 27, 2016. 6. If new or revised rates are submitted for approval, the filing must include: a. All rating factors and a demonstration that there are no factors not allowed by PPACA and that family tier factors are reasonable and not a surrogate for rating by health status; b. Demonstration of the medical loss ratio calculation to show that the medical loss ratio is at least 80%; 2 45 CFR § 147.145 c. Demonstration that the actuarial value of the coverage is at least 60%, as determined in accordance with 45 CFR § 156.135 using the AV calculator developed and made available by HHS (only required if specific benefit designs are filed);3 and d. The screen prints of each plan’s AV calculator (only required if specific benefit designs are filed). Questions about this Bulletin may be directed to the Life/Health Section of the Maryland Insurance Administration at 410-468-2170. _____ Robert D. Morrow Jr. Associate Commissioner Life and Health 3 If a health benefit plan’s design is not compatible with the AV calculator, the carrier must submit actuarial certification using the chosen methodology in the rule. 45 CFR § 156.135(b). signature on original