Specialty Insurers Seeking to Market in Exchanges

Specialty Health Insurers Want Access to Health Exchanges

Copyright: (c) 2011 A.M. Best Company, Inc.
Source: A.M. Best Company, Inc.

The National Association of Specialty Health Organizations is calling on state and federal officials to consider insurance for vision care, dental, physical therapy and other services when drafting rules for health insurance exchanges for small businesses and individuals.

The Affordable Care Act did not specifically address these services, with some exceptions for dentistry and eye care for children, so specialty providers want to ensure they have a role in the exchanges now being formed. The association sought to bring attention to its members’ services, including hearing, pharmacy benefit management, behavioral health, chiropractic and radiology management, in a letter to members of the National Association of Insurance Commissioners’ Health Insurance and Managed Care Exchanges Subgroup.

"First and foremost, we want to be a part of the exchange," said NASHO Executive Director Julian Roberts. "This was completely left out of consideration when they wrote the health care act."

Plans offered by NASHO members are sometimes purchased as stand-alone products and sometimes through partnerships with comprehensive insurance plans, Roberts said. What NASHO proposed in a white paper provided to the NAIC is a means for specialty plans to be offered to individuals and small groups purchasing through the exchanges as a seamless option.

"It’s about choice and access," Roberts said. "We don’t want to be forced on anyone."

The U.S. Department of Health and Human Services is working to determine what services will be considered "essential health benefits" that must be included in insurance plans participating in state insurance exchanges. Some HHS officials have estimated that preliminary proposals may be coming soon, but members of the NAIC, who have been advising HHS on regulatory language, are not expecting formal regulations until late this year or early 2012 (BestWire, April 4, 2011).

The Affordable Care Act defines essential benefits as including some level of care and services in the following categories: "ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and rehabilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care."

NASHO has reached out to federal officials, as well, in part with a goal to make sure specialty insurance products are accessible to more consumers. Provisions for vision care, for example, will be deemed "essential" for children, but not for adults.

"It’s our preference that our members can get benefit coverage for the entire family," Roberts said.

The exchanges for small groups and individuals are not scheduled to launch until 2014, but HHS will determine state plans’ fitness for compliance with the ACA in early 2013. State governments, particularly legislatures that meet infrequently, are currently making decisions on this issue. The NAIC has eight groups working to develop guidance and supporting documents for states, which are expected to take a variety of approaches (BestWire, April 4, 2011).

(By Sean P. Carr, Washington Bureau Manager: sean.carr)

Kevin Wrege, Esq.

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016


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