Bulletin, November 21, 2013, Non-ACA Compliant Plans

Last Updated: November 21, 2013

Date: November 21, 2013
To: All Insurers Authorized to Write Health Insurance in Wisconsin
From: Theodore K. Nickel, Commissioner of Insurance
Subject: Non-ACA Compliant Plans

​On Thursday, November 14, 2013, Gary Cohen, Director of the Center for Consumer Information and Insurance Oversight (CCIIO), sent a letter to state insurance commissioners. The letter provided options under which health insurance issuers may choose to renew between January 1, 2014, and October 1, 2014, individual and small group coverage that would otherwise terminate due to federal health insurance market reforms required under the Patient Protection and Affordable Care Act (ACA).

Consistent with state requirements and the Office of the Commissioner of Insurance's (OCI) enforcement power of state and federal law, OCI will allow carriers to renew at their option non-ACA compliant individual and small group coverage that was in effect on October 1, 2013, for a policy year starting between January 1, 2014, and October 1, 2014. Carriers may submit rate revisions for 2014 renewals within 30 days after the rates become effective using one of the following methods:

  • If a rate filing was submitted for the affected product(s) in 2013 and the carrier wishes to change rates by an annualized trend amount equal to or less than the amount indicated in the 2013 filing, a simplified filing process may 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 2013, (3) the trend change requested in 2014, 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 or the company wishes to increase rates by an amount greater than the annual trend amount filed in 2013, a complete filing must be submitted. The filing must fulfill all requirements for 2013 Non-Grandfathered 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, and that this OCI guidance 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 before OR after October 1, 2013. Consistent with Wisconsin Statutes related to plan changes, the small business or individual may change their plan options from one non-ACA compliant plan to another and renew that coverage in 2014 provided:

  1. Coverage was in force for the individual or small 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 the date on which the premium will be affected. Since the letter was sent too late for some carriers to comply with notice provisions under Wisconsin law, the 60-day notice provision under s. 631.36 (5), Wis. Stat., will not be enforced for affected products from the date of this bulletin until March 1, 2014.

Many Wisconsin carriers have already offered their enrollees an early renewal option. OCI will continue to allow carriers to offer an early renewal for non-ACA compliant individual and small group coverage in 2014. As required under state law, renewals must be treated uniformly and without regard to health status.

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. In communicating with enrollees regarding plan change options and auto-enrollment, insurers must inform them of their guaranteed issue right to choose any plan. While consumers have the right to choose any plan, the auto-enrollment feature helps ensure they are provided with the right to guaranteed renewable coverage afforded under Wisconsin law.

This bulletin applies to all insurers offering comprehensive individual and small 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.