August 2015


NAIC Summer Meeting Wrap-up

NADP attended the National Association of Insurance Commissioners (NAIC) summer meeting, held in Chicago, Aug. 15-18. Multiple items impacting dental benefits were part of the ongoing meetings and discussions. Read more for highlights.

  • A network adequacy (NA) subgroup of the Health Committee has been meeting weekly since 2014 to update the current NAIC Network Adequacy Model to encompass requirements within the Affordable Care Act (ACA) and reflect recent state trends. NADP has been participating on these calls and has also formed a “Dental Network Subgroup” of the Government Relations Workgroup (GRW) to walk through the model from a dental perspective and provide timely comments to the NAIC. While NADP advocated for a separate dental section, the NAIC has agreed to specific dental and vision definitions, certain exemptions and drafting notes. The current draft is being updated and expected to be released next week. A three week window to allow for comments on technical changes will follow, which the GRW Dental Network Subgroup will review and provide. A final version will likely be voted on during the next NAIC meeting this November.

With the intense scrutiny on both medical and dental networks, and with only about a dozen of states currently rhaving dental network adequacy standards—an increase in regulationfrom adoption of its model is likely. NADP and carriers will need to be vigilant as states work to update statute or pass legislation; NADP’s subgroup will have language specific to dental ready for states to incorporate if it seems an exemption for dental networks will not succeed. An internal document pulls together the dental exemptions and drafting notes for easier reference.

  • Currently there are two Accident & Sickness models – one that outlines guidance (#170) and the second which implements that guidance (#171). These models were drafted to standardize terms and coverages of various accident and sickness policies, including fixed indemnity, accident only, and limited benefits, such as dental plans. They were broad in scope and are currently in place in many states and relatively non-problematic to carriers.

The models are now being discussed to reflect ACA changes, which carriers argue (minus a few technical changes) should not be changed as the Model oversees HIPAA-excepted benefits which are not part of the ACA. Consumer stakeholders are advocating the models should change and evolve to better reflect market reforms, such as Medical Loss Ratio (MLR) standards, especially as the ACA doesn’t address them. As one regulator stated “Dental is somewhat caught in the middle.” NADP and carriers will need to watch developments on these models closely. Calls related to these models are expected to startsoon.  

  • The Consumer Liaison Group of the NAIC is about ready to test an updated version of the Summary of Benefits Coverage, required for medical carriers by the ACA. The group has been working with stakeholders to include more valuable cost information and examples for consumers to better reflect medical policies.
  • On May 18, the NAIC forwarded a letter to Congressional leaders advocating a state’s right to make the decision on defining the number of employees within the small group. “NAIC health analyst Sean Dugan said at a session in Chicago today that the commissioners are working closely with House Speaker John Boehner’s office to bring the issue forward when Congress reconvenes next month. Under the legislation being pushed by NAIC, states would have the option of implementing the change or sticking with the current threshold. States already have the option of allowing companies to renew plans through September 2016 to the lower employee threshold, which provides some flexibility. The legislation has picked up significant bipartisan support in both chambers of Congress. The House bill has more than 200 sponsors. Similar legislation in the Senate has 28 sponsors, with roughly two thirds of them signing on just before the August recess. Among the Senate backers is New York Sen. Chuck Schumer, who is poised to become the Democratic leader following the 2016 elections.” Politico Pro (Whiteboard):
  • Potential discussions by the Health Committee for 2016 include: cost of care, balance billing, pharmacy formularies, ACA waivers and SIM (state innovation model) grants.




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