CMS publishes limited relief for health insurance issuers having problems posting policies

For issuers encountering difficulties posting individual coverage policies and group certificates of coverage to websites, as is generally required for this fall, the Centers for Medicare & Medicaid Services (CMS) has stated that it will not take enforcement action as long as the necessary documents are posted by November 1, 2015. The CMS cautions, however, that the relief is only for the requirement to post the individual coverage policy or group certificate of coverage, so a summary of benefits and coverage (SBC) must still be provided in accordance with the timeframes set forth in final rules published on June 16, 2015 (see 80 FR 34292).

Also, by November 1, 2015 issuers must provide on the SBC the web address where the documents will be available, and they must include language on the web page indicating the documents will be accessible on November 1, 2015.

Under Patient Protection and Affordable Care Act (ACA) ((P.L. 111-148) Sec. 1001(5) and PHS Act section 2715(b)(3)(i), health insurance issuers must include an Internet web address where an actual individual coverage policy or group certificate of coverage can be reviewed and obtained on the SBC.

In accordance with the newly-issued relief, if a group health insurance issuer is required, in accordance with June 12, 2015 SBC final rules (see 80 FR 34298), to provide an internet web address on the SBC before October 31, 2015, HHS will not take enforcement action against that issuer if it provides an internet web address for group certificate of coverage documents no later than November 1, 2015.

Some issuers are overwhelmed by posting requirements. The HHS realizes that, since this is the first year this process has been necessary, some issuers have had trouble making the necessary documents accessible online by the due dates, especially since some issuers have several hundred documents that must be posted in compliance with this requirement for both individual coverage and group coverage.

The original due dates are as follows:

• For disclosures with respect to participants and beneficiaries who enroll or re-enroll in a group health plan through an open enrollment period (including reenrollees and late enrollees), beginning on the first day of the first open enrollment period that begins on or after September 1, 2015;

• For disclosures with respect to participants and beneficiaries who enroll in group health plan coverage other than through an open enrollment period (including individuals who are newly eligible for coverage and special enrollees), beginning on the first day of the first plan year that begins on or after September 1, 2015;

• For disclosures with respect to plans, beginning September 1, 2015; and

• For disclosures with respect individuals and covered dependents in the individual market, beginning with respect to SBCs issued for coverage that begins on or after January 1, 2016.

The CMS adds that the newly-published relief is only applicable with respect to the requirement to make individual coverage policy and group certificate of coverage documents accessible online, and does not apply to any other requirements of the June 16, 2015 final rules.
The CMS also states that, for coverage that is no longer being offered for purchase (closed blocks of business), it will not take enforcement action against an issuer of a closed block of business that does not satisfy the safe harbor criteria that limits access to the individual coverage policy or group certificate of coverage documents to plan sponsors that have already purchased and individuals who are currently enrolled in the coverage. This is based on its recognition of concerns that consumers shopping for coverage might access the individual coverage policy or group certificate of coverage documents for a closed block of business in which they are not eligible to enroll, leading to confusion and delay.

SOURCE: CMS Q&A on SBC Online Posting of Policy and Certificate of Coverage Documents, September 8, 2015

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