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This week, the National Association of Insurance Commissioners took a step forward to try and improve the situation for people with ACA-compliant plans who don’t get value for money.
The New Jersey-based group (NICA) said it will require plans to offer at least minimum essential coverage, or enough to “cover a minimum set of key health benefits, and would allow states to negotiate lower rates with insurers for lower-risk enrollees.” The commission said it has not determined any specific thresholds.
The ACA required insurers to offer customers coverage for essential health benefits. So far, 15 states have passed laws that allow health insurance plan customers to purchase such coverage, and several others in the coming months will do so.
Here’s what NICA’s interim policy would do:
Ensure that plans must cover one set of services — such as maternity care, mental health, or prescription meds — and exclude others.
Ensure that plans can’t charge customers premiums more than 15 percent of their income if they have pre-existing conditions.
Require plans to cover the cost of “essential health benefits.”
Allow customers to continue to change and enroll in plans before the year’s expiration date.
NICO’s proposal will be reviewed by the insurance commissioners after the fall federal Open Enrollment Period, which began Nov. 1. When that is over, the commissioners will likely have to determine which states can and can’t opt for the new mandates.
Some states may have to revise or eliminate their policies that exclude preventive care in order to comply with NICO’s requirement.
The ACA requires insurers to cover the cost of “essential health benefits,” such as hospitalization, prescription drugs, medical appliances, and dental care; “essential preventive services,” which include flu vaccinations, pregnancy tests, and maternity care; and “essential hospital services,”
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