Date:March 20, 2014
To:All Insurers Authorized to Write Health Insurance in Wisconsin
From:Theodore K. Nickel, Commissioner of Insurance
Subject:Guidance Regarding the U.S. Department of Health and Human Services Extended Transitional Policy

On March 5, 2014, the Centers for Medicare and Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) issued an Insurance Standards Bulletin extending the transitional policy outlined in a letter to state insurance commissioners on November 13, 2013 (http://oci.wi.gov/bulletin/1113healthplans.htm).

Consistent with state requirements and the Office of the Commissioner of Insurance's (OCI) enforcement authority, OCI will allow carriers to renew, at their option, non-ACA compliant individual and small group coverage and coverage to large employers1 if coverage was in effect on October 1, 2013. Policies may be renewed on or before October 1, 2016. Carriers electing to extend non-ACA compliant plans have the following options for individual and employer-sponsored group outreach and enrollment:

  1. A carrier may permit individuals and employer-sponsored groups currently enrolled in the carrier's non-ACA compliant plan to continue to renew their coverage.
  2. A carrier may provide an additional opportunity to renew coverage in its non-ACA compliant plan to an individual or employer-sponsored group who is currently enrolled in the carrier's non-ACA compliant plan but who has indicated their intent to nonrenew at the end of the plan year.
  3. A carrier may issue a notice providing an opportunity to reinstate coverage to an individual or an employer-sponsored group who, at the last renewal date, chose not to renew their coverage under the carrier's non-ACA compliant plan that was in effect on October 1, 2013. The notice must also state that the carrier will not provide retroactive coverage and that the coverage is on a going-forward basis only.

Carriers may submit rate revisions for 2014, 2015, and 2016 renewals within 30 days after the rates become effective using one of the following methods:

  • If a complete rate filing was submitted for the affected product(s) in 2013, 2014, or 2015 and the carrier wishes to change rates by an annualized trend amount equal to or less than the amount indicated in the 2013, 2014, or 2015 filing, a simplified filing process may generally be used. Carriers electing this option must submit through a filing in SERFF a letter indicating (1) the affected products, (2) the annualized trend amount filed in the complete rate filing, (3) the trend change requested, and (4) the rate change effective date(s). The letter must reflect any incremental implementation of the annualized trend change.
  • If no rate filing was submitted for the affected product(s) in 2013, 2014, or 2015, or the company wishes to increase rates by an amount greater than the annualized trend amount filed in 2013, 2014, or 2015, a complete filing must be submitted. The filing must fulfill all requirements for transitional rate filings. Detailed filing requirements are available on the OCI Web site at http://oci.wi.gov/ociforms/comphealth-ratefilings-ngf.htm.

It is important to note that coverage must have been in force on October 1, 2013. The guidance contained in this bulletin does not apply to "newly obtained coverage." "Newly obtained coverage" does NOT include normal enrollment changes (i.e., adding dependents or new employees) nor does it include coverage that has merely received a price change or plan changes such as modified copayments, coinsurance, deductibles or provider networks before or after October 1, 2013. Consistent with Wisconsin insurance laws and regulations, the individual, small or large business may change their plan options from one non-ACA compliant plan to another non-ACA compliant plan and renew that coverage provided:

  1. Coverage was in force for the individual, small employer or large employer before October 1, 2013; and
  2. The new plan was available for purchase prior to October 1, 2013.

Carriers opting to renew non-ACA compliant plans must provide disclosure to their enrollees including notice that an enrollee's premium may be affected either on the date of renewal or in advance of the date on which the premium change will be affected.

For carriers that are transitioning individuals from an existing plan to a new plan, it is the position of OCI that nothing in the Wisconsin Statutes or regulations prohibits carriers from offering their enrollees auto-enrollment into a similar new plan. Auto-enrollment allows for minimal disruption to consumers as a result of changes required by the ACA. Carriers choosing to offer individual and group insureds the option for auto-enrollment must provide the insured a notice at least 30 days in advance of the renewal date that the insured will be automatically renewed in the existing plan unless the insured exercises his or her right to choose any plan from any carrier and will receive coverage that is guaranteed. While consumers have the right to choose any plan from any carrier, the auto-enrollment option effectuates the right to guaranteed renewable coverage.

This bulletin applies to all insurers offering comprehensive individual and small and large group health insurance plans beginning November 21, 2013. Any questions concerning this bulletin should be directed to J. P. Wieske at jp.wieske@wisconsin.gov or (608) 266-2493.

1 As defined in the March 5, 2014, guidance from CCIIO as "large businesses that currently purchase insurance in the large group market but that, as of January 1, 2016, will be redefined by section 1304(b) of the Affordable Care Act as small businesses purchasing insurance in the small group market."