DAILY
STATE HEALTH EXCHANGES:
FALL NATIONAL MEETING
TUESDAY 11.18.2014
NEWS
WHAT YOU NEED TO
KNOW TO (RE)ENROLL
Information to help you make the best decision during open
enrollment.
Most Americans get health insurance through their employer or a
family member’s company. However, nearly eight million people
are now buying health coverage through an insurance marketplace. If you bought insurance through the exchange last year, or
are considering buying from the exchange this year, the National
Association of Insurance Commissioners (NAIC) has some information to make the process a little easier.
The Basics: Health insurance marketplaces, or exchanges, operate in
every state. These online portals ask a series of questions to determine
which plans meet your needs. They also determine if you are eligible for any subsidies or alternative coverage through Medicaid or the
Children’s Health Insurance Program (CHIP). You can apply online,
by mail or in person. If you get coverage through Medicare or an
employer, you don’t need to apply for coverage through the exchange.
the marketplace last year, you will be auto-enrolled in the same
or similar plan unless you select a different plan by December 15th.
However, you should still verify your information and look at the
available policies. There may be a new option that is less expensive or
better suits your needs. Even if you are auto-enrolled in a plan, you are
able to choose a different plan at any time during the open enrollment
period, which goes through February 15, 2015.
In addition, your eligibility for subsidies depends on your income and
Open Enrollment is the period in which you can shop and sign up for available policies in your area. Either of these may have changed from
insurance coverage in the exchange. Open enrollment for 2015 cover- last year. Even if your income and chosen plan have not changed, if
age starts November 15, 2014 and ends February 15, 2015.
there is a less-expensive option it could affect the amount of subsidy you
If You Enrolled Last Year: If you purchased health insurance through are entitled to. If you do not complete a new eligibility determination,
Continued on Page 2
NAIC FOCUS ON FSOC CONTINUES
Missouri Department of Insurance, Financial
Institutions and Professional Registrations
Director John Huff was honored for his service as the NAIC first state insurance commissioner representative to the Financial Stability
Oversight Council (FSOC). For four years,
Director Huff was the state regulator’s voice
on the Council.
NAIC COMMUNICATIONS DIVISION:
Scott Holeman, Miun Gleeson,
Katherine Jones, Laura Peterson,
Erin Yang, Jeremy Wilkinson
DAILY NEWS PICKUP SITES:
Registration Desk, Commissioner Services,
Regulators’ Lounge, Coffee Stations
& Meeting Rooms
“John has done an outstanding job representing us and we have benefitted greatly from his
technical expertise and policy guidance, but
most of all for his diligence and devotion to
state insurance regulation,” said Adam Hamm,
NAIC President and North Dakota Insurance
Commissioner. During his term, Huff made
dozens of trips to Washington D.C. and spent
countless hours working on the NAIC’s behalf
making sure FSOC understood not only the
Continued on Page 4
2
TODAY’S AGENDA
Market Conduct Accreditation (D) Working Group
8 – 9 AM - Thurgood Marshall NE—Mezzanine Level
Speed to Market (EX) Task Force
8 – 9 AM - Virginia—Lobby Level
PHOTO FILE
Surplus Lines (C) Task Force
8 – 9 AM - Lincoln 5-6—Exhibition Level
*Financial Analysis (E) Working Group
8 – 10:30 AM - Maryland—Lobby Level
Market Regulation and Consumer Affairs (D) Committee
9 – 10:30 AM - Thurgood Marshall Northeast—Mezzanine Level
*Antifraud (D) Task Force
10:30 – 11:30 AM - Lincoln 2—Exhibition Level
Governance Review (EX) Task Force
10:30 – 11:30 AM - Thurgood Marshall Southwest—Mezzanine Level
*Chief Financial Regulator Forum
10:30 AM – 12 PM - Thurgood Marshall Northeast—Mezzanine Level
*Investigation of Life Insurance and Annuity Claims Settlement
Practices (D) Task Force
11 AM – 12 PM - Lincoln 3—Exhibition Level
Catastrophe Response (C) Working Group
11 AM – 12:30 PM - Lincoln 5-6—Exhibition Level
Mortgage Guaranty Insurance (E) Working Group
11 AM – 1 PM - Maryland—Lobby Level
Workers’ Compensation (C) Task Force
12 – 1 PM - Thurgood Marshall NE—Mezzanine Level
Financial Condition (E) Committee
1 – 2 PM - Thurgood Marshall NE—Mezzanine Level
NAIC/Consumer Liaison Committee NAIC/American Indian and
Alaska Native Liaison Committee
1 – 2 PM - Virginia—Lobby Level
*Market Actions (D) Working Group
1 – 4 PM - Lincoln 3—Exhibition Level
Property and Casualty Insurance (C) Committee
2 – 4 PM - Thurgood Marshall SW—Mezzanine Level
NAIC/Industry Liaison Committee
4 – 5 PM - Thurgood Marshall NE—Mezzanine Level
* Regulator only - see agenda, or visit meetings.naic.org for policy
statement on open meetings.
STATE EXCHANGES from Page 1
you may be responsible for repaying the
difference between what you are currently
receiving and what you should receive when
you file your 2015 taxes.
New to the Exchange? If you had a plan that
is no longer offered, you may have already
gotten a cancelation notice. That means that
the insurance company is either unable or has
chosen not to renew that policy. Some plans
were extended for one year and are no longer available. You should review all of your
insurance options, including purchasing on
the exchange. You can still purchase insurance “off” the exchange in the individual
market, but you will not be eligible for subsidies if you go this route.
Multi-State Plans: There was some confusion with multi-state plans sold on the
exchange. Carriers participating in the MultiState Plan Program offer policies in many
different states. Individuals who purchase
insurance in one state are NOT guaranteed
coverage of health care services provided in
another, even if the carrier sells the same plan
there. Be sure to understand which doctors
and hospitals are covered, and which services
and providers are “out of network.”
Coverage Options: Plans sold on the marketplace fall into one of four categories: bronze,
silver, gold or platinum. The different categories represent what an average enrollee would
pay out-of-pocket. All plans must cover 10
essential health benefits (EHBs). The levels
of payment are:
•Bronze: the plan pays, on average, 60%;
consumer pays 40%
•Silver: the carrier pays, on average, 70%;
consumer pays 30%
•Gold: the carrier pays, on average, 80%;
consumer pays 20%
•Platinum: the carrier pays, on average,
90%; consumer pays 10%
Consumers should note - if you purchase a
bronze plan, you would pay a higher portion
of the total cost of the care you receive than
you would if you had gold. While bronze
plans have lower premiums, they also have
higher deductibles, co-pays and coinsurance
levels. These all increase your costs if you
need medical care.
The marketplaces also offer catastrophic
plans. As the name suggests, they only
cover you if you require extensive care.
Catastrophic plans are available for individuals under 30 years old or for those with very
low incomes who cannot afford other options.
Consumers should be aware that catastrophic
plans will not be eligible for use with a health
savings account in 2015.
Finding Help: Each state has a program to
assist consumers with understanding their
options. While the actual names may vary
by state, each state has some form of assistance available. It may be an individual
or an organization, but trained navigators,
3
DAILY NEWS
FALL NATIONAL MEETING
TUESDAY 11.18.2014
The NAIC consumer representatives recognized Nebraska Insurance Director Bruce
R. Ramge with the Excellence in Consumer
Advocacy Award for his work on behalf of
insurance consumers.
application counselors and in-person assisters are able to
help you learn about the available choices and guide you
through the application process. These assisters may not be
licensed insurance agents and, if they aren’t, they cannot
recommend a specific insurance plan or sell you insurance.
A trained and licensed insurance agent or broker can help
you find the right policy. They can recommend a specific
plan, but they may be limited to selling for a particular
company.
Rates on the Exchange: Exact rates may depend on age,
family size, geographic location and tobacco use. In addition, some people may qualify for subsidies based on their
income. These subsidies come in the form of a tax credit,
applied to your monthly premiums, and cost-sharing
reductions, which increase the value of silver plans for
those who qualify.
More Information: If you have questions about the
health insurance marketplace in your state, contact your
state insurance department. For more information on the
NAIC’s activity on health care reform, visit the Healthcare
Reform Special Section. You can find more information on
the ACA on the HHS website.
Twenty-four legislators and state government officials from 22 jurisdictions
joined NAIC members at the 2014 Fall National Meeting.
4
HUFF, FSOC
from Page 1
insurance industry but the state based system of insurance regulation.
“It has been a great honor to serve on behalf of my fellow state insurance regulators on FSOC,” said Huff. “We have made great progress,
but we still have a ways to go before state insurance regulators are
fully integrated into this important work and the FSOC fully understands the insurance sector and its regulation. After four years, I am
still concerned that the non-banks designations remain the product of
something other than robust analytics.”
To replace Huff, the NAIC appointed Hamm to a two-year term as the
next state insurance commissioner representative on FSOC. Hamm’s
selection was ratified in an NAIC Plenary meeting.
“I look forward to serving my fellow regulators on FSOC to represent
our system of regulation,” said Hamm. “I assume this role with great
respect for the work of Director Huff and I look forward to working
with the other financial regulators as we take the next steps to promote a stable insurance marketplace and protect the broader financial
sector.”
FSOC is a fifteen member body comprised of the nation’s chief financial regulators. The council was created by the Dodd-Frank Wall Street
Protection and Consumer Protection Act in 2010 to monitor the safety
and stability of the nation’s financial system, identify risks to the system, and coordinate a response to any threats. The council also has the
authority to identify non-bank financial firms, financial market utilities and systemic payment, clearing, or settlement activities that could
potentially pose a threat to the financial stability of the United States.
NAIC’s NewsWire Email
GLOBAL COOPERATION The
is also a Mobile Web “App”
NAIC Vice President and Pennsylvania Insurance Commissioner
Michael F. Consedine (left) and International Association of Insurance
Supervisors (IAIS) Secretary General Yoshihiro Kawai (right) celebrate the IAIS Multilateral Memorandum of Understanding (or
MMoU) signing.
This week Pennsylvania became the 43rd signatory to the MMoU
globally, and the 6th U.S. state signatory.
The MMoU establishes a formal basis for cross-border cooperation
and information exchange amongst supervisors around the world. It
involves a rigorous application and accession process whereby an
independent evaluation assesses whether certain legal confidentiality
requirements of a jurisdiction are met as a precondition for effective
cooperation and coordination through the IAIS MMoU.
Get instructions for
iPhone & Android at
http://www.infoinc.com/naic/applanding.cfm