Life & Health

Health Care Reform

SOURCE: National Association of Insurance Commissioners

There are still a lot of unknowns when it comes to the health care reform bill and its requirements of insurance companies. For many of the new coverage mandates and transparency-related requirements, NCDOI will look to the federal government to provide guidelines and clarification, as well as any uniform templates for companies to use when reporting their data.

Several of these new requirements will cause some adjustments to your reporting and filings to the NCDOI, and we are working to identify how your company should amend its filings to address these changes. Of course as soon as we have finalized this, we will notify insurers.

On this Web site you'll find updates about the Patient Protection and Affordable Care Act of 2009 and what it means for the insurance industry. Please check back often for ongoing updates. If you have any questions in the meantime, please contact the Life and Health Division directly at L&Hinbox@ncdoi.gov or at 919-733-5060 ext. 0, and ask to speak to someone regarding Federal health care reform.

Documents

North Carolina Essential Health Benefits Benchmark Information

Analysis of Benchmark Plan Options Study Report - May 14, 2012

Below are the benchmark plan options referenced in the report above:

2011 Small Group Plan 1
2011 Small Group Plan 2
2011 Small Group Plan 3
2011 Commercial HMO Plan
State Employees Health Benefits Plan - Plan Year 2011/2012
Federal Employees Health Benefits Plans (FEHBP):
- BCBS FEHBP Basic and Standard Options
- Government Employees Health Association Benefit Plan Standard Option

North Carolina MLR Adjustment Determination Letter
Medical Loss Ratio Adjustment Report
Medical Loss Ratio Adjustment Request Exhibits
US DHHS Medical Loss Ratio Regulations
Immediate Implementation
Key Deadlines
Market Reforms
NAIC Health Reform Responsibilities (April 2010)
Readable Senate Bill with Reconciliation Changes
Health Insurance Exchanges
Health Care Reform Glossary

Grandfathered Health Plans Under The Affordable Care Act:

The Department of Labor's Employee Benefits Security Administration has posted the following related to grandfathered health plans under the Affordable Care Act:

Interim Final Rule on Internal Claims and Appeals and External Review Processes

The Department of Labor's Employee Benefits Security Administration has updated its web site with the following: Interim Final Rule on Internal Claims and Appeals and External Review Processes.

Small Employer Group Statutory Plan Designs

Grants

The N.C. Department of Insurance has submitted the following grant applications for federal assistance implementing the federal healthcare reform legislation.