Bulletin, December 7, 2016, Guidance Regarding Guaranteed Renewability of Individual Policies

Last Updated: December 8, 2016

Date: December 7, 2016
To: All Insurers Authorized to Write Health Insurance in Wisconsin and Sell on the 2017 Federal Health Insurance Exchange
From: Theodore K. Nickel, Commissioner of Insurance
Subject: Guidance Regarding Guaranteed Renewability of Individual Policies

​The Office of the Commissioner of Insurance (OCI) is issuing this bulletin to ensure all insurers participating on the federal healthcare exchange comply with state insurance laws and regulations regarding guaranteed renewability of individual health insurance policies.

It has come to OCI's attention the Centers for Medicare and Medicaid Services (CMS) recently issued informal, sub-regulatory guidance directing insurers to nonrenew exchange members for whom CMS has not sent a renewal transaction to the insurer. Additionally, OCI understands CMS directed insurers not to roll these members into off-exchange plans at the end of the current benefit year unless specially requested to do so by the member or by the insurer's state regulator. CMS' directives violate s. 632.7495, Wis. Stat., which requires individual health insurance policies be guaranteed renewable. OCI expects insurers to comply with state guaranteed renewability requirements.

Insurers with 2016 exchange enrollees who would be impacted by the CMS guidance referenced above should contact OCI. OCI will then take affirmative steps with each insurer to ensure compliance with state law without penalty. Note that current law does not require consumers with a guaranteed renewability right to accept coverage for the following year. However, for those consumers who wish to continue coverage, insurer compliance with state law will ensure the consumer's right to a guaranteed renewable policy is honored. 

Insurers should contact Diane Dambach at diane.dambach@wisconsin.gov and provide OCI with the approximate number of affected consumers. Any questions concerning this bulletin should be directed to Elizabeth Hizmi at elizabeth.hizmi@wisconsin.gov.