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///co-adshare/...%20[GREEN]/Ohio-Dept%20of%20Insurance/Ohio%20Annual%20Limit%20Restriction%20Waiver%20Request.htm[11/10/2011 11:01

rom: Katherine Melton [[email protected]]ent: Tuesday, November 23, 2010 2:18 PM

To: OCIIO OversightCc: Mary Jo Hudson

ubject: Ohio Annual Limit Restriction Waiver Request

ollow Up Flag: Follow uplag Status: Red

Attachments: Ohio Annual Limit Waiver Request-112310.pdfursuant to your offices Supplemental Sub-Regulatory Guidance of November 5, 2010 (OCIIO 2010-1A), please find attach

hios request for a waiver of the annual limit restriction for 2010.

atherine J. Melton

taff Counsel

hio Department of Insurance

0 W. Town Street - Third Floor - Suite 300

olumbus, Ohio 43215

14-644-2640 (telephone) 614-644-3742 (fax)

[email protected]

n an effort to provide maximum customer service while remaining cost conscious, the Ohio Department of Insurance will b

tilizing a Cost Savings Day on Friday, November 26 after being closed to celebrate Thanksgiving on Thursday, November 2

The agency will re-open Monday, November 29. Have a safe and happy holiday!

My email address has changed to [email protected]. While my old email address will continue to be

ctive for a few more months, I ask that you please update my contact email address in your contact records to reflect myew email address. Thank you!

MPORTANT DISCLOSURE:

though the Ohio Department of Insurance makes every effort to assist consumers, it does not have the authority to provide legal advice or opini

o the general public. As the Department is prohibited from giving or providing legal advice or opinions to the general public, any information

ontained in this e-mail should not be construed as legal advice to any public person or entity.

OHIO DOI:000001


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Accredited by the National Association of Insurance Commissioners (NAIC)

Consumer Hotline: 1-800-686-1526 Fraud Hotline: 1-800-686-1527 OSHIIP Hotline: 1-800-686-1578TDD Line: (614) 644-3745 (Printed in house)

Ted Strick land, GovernorMary Jo Hudson, Director

50 West Town StreetThird Floor Suite 300

Columbus, OH 43215-4186(614) 644-2658

www.insurance.ohio.gov

November 23, 2010

James Mayhew

Office of Consumer Information and Insurance OversightOffice of OversightRoom 737-F-04200 Independence Avenue SWWashington, D.C. 20101

Re: Waiver of Annual Limits Restriction for 2010

Dear Mr. Mayhew,

The Ohio Department of Insurance (the Department) hereby respectfully requests a waiver of therequirements in Section 2711, of the Patient Protection and Affordable Care Act,(Affordable Care Act)

which restrict annual limits to certain set minimum levels for essential health benefits for the policieswhich form its HIPAA alternative mechanism. The Department is requesting a waiver for the prescribedpolicy forms created under statutory authority in Ohio Revised Code Section (R.C.) 3924.10 et seq. bythe Ohio Reinsurance Board. These policies, known as Ohios Basic and Standard policy forms, arerequired to be offered by all carriers operating in the individual market to insure those who have beendenied coverage elsewhere, including Federally Eligible Individuals (FEIs) and others who do not meetthat definition, pursuant to R.C. 3923.58 and R.C. 3923.581, and also pursuant to R. C. Section 3923.122as conversion policies offered to FEIs. Carriers and related data concerning these policies are attached.

The Department has determined that requesting a waiver on behalf of the many insurers in our individualmarket that issue Basic and Standard policies would result in a more organized HIPAA alternativemechanism market in Ohio and fewer individual requests for waiver that must be reviewed by HHS. We

are applying for this waiver because we are concerned that Ohioans not be denied access to coverage dueto the impact on premium that an increase in benefits may bring. At the same time, we support theAffordable Care Act goal of requiring policies to include certain minimum benefits to better protectconsumers, therefore, if granted this waiver for our Basic and Standard plan design, we intend to requireall of our carriers to offer both the current coverage which does not meet the minimum annual limitdesign as well as coverage that does meet the Affordable Care Act. In this way, Ohio consumers will havea choice of a lower cost policy with a $ annual maximum or a policy with a higher premium and a$750,000 annual maximum from each company that offers Basic and Standard policies, whether tocomply with open enrollment or conversion statutes.

1. The terms of the Basic and Standard policies for which we seek a waiver are attached.

2. The number of individuals covered by the policies: a canvass of Ohio insurers as of June 2010reported that there were lives covered by Basic or Standard policies for open enrollment.For calendar year 2009, Ohio insurers reported lives covered by the Basic or Standardpolicy forms or an equivalent coverage for conversion. We estimate % of conversion policiesare statutorily mandated offerings to FEIs.

3. The annual limit(s):

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James MayhewNovember 23, 2010Page 2

The calendar year maximum for a Basic plan per insured is $ . There are other internal, perservice maximums for both plans listed on page 2 and 3 of the attachment, including:

a) Mental, nervous ($ inpatient and $ outpatient);b) Organ transplant ($ );c) Nursing or convalescent home ($ );d) Outpatient prescription drugs ($ ).

Not allowing a blanket waiver for all companies for Basic and Standard Open Enrollment andGroup Conversion options would lead to an unlevel playing field. Some companies will seekwaivers while others wont. Ultimately, adverse selection for some plans will result andpremiums will increase even more for those plans, causing market disruption.

At this point, most carriers have not yet filed for a rate increase. We have approved four filings to

date which have increase amounts attributable to PPACA mandates quantified. The averageamounts of increase solely attributable to PPACA for Basic and Standard Open Enrollment forthe four filings are as follows:

Basic: % Standard: %

Sample monthly premium rates for non-smoker residents in Columbus, OH, for the four carriersby Open Enrollment plan type:

Carrier PlanMale Female

A Basic

B BasicC BasicD BasicA Standard B StandardC Standard D Standard

As stated above, we are requesting a waiver because we are concerned that the increase in the

annual limit will cause a significant increase in premium for those covered by the Basic andStandard plans which tend to have high premiums already because they are sold on a guaranteedissue basis to people with significantly worse than average health status. These policies are alsoused as conversion policies for both FEIs by law and others who are eligible for conversion whenleaving their group health policy. If conversion policy premiums are increased due to PPACArequirements, we have the same concern. We believe granting a waiver for Open Enrollmentwithout also granting it for conversion would shift enrollment from the conversion market and fillOpen Enrollment quotas. This would result in fewer policies of this type being available topersons unable to get basic health insurance coverage by any other means.

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James MayhewNovember 23, 2010

Page 3

4. The below signer certifies and attests that, to their knowledge based on reports by the issuers ofsuch Ohio policies: 1) lives were covered by Basic and Standard Open Enrollment Policies

and lives were covered by Basic and Standard Conversion Policies or an equivalentcoverage prior to September 23, 2010; and 2) the application of restricted annual limits to such

policies would result in a significant increase in premiums. In addition, the absence of a blanket

waiver for both the open enrollment and conversion use of these Basic and Standard forms would

likely result in making this coverage unavailable to a number of applicants that would otherwise

be able to obtain it.

Thank you for your assistance with this matter. Please contact Kathy Melton at 614-644-2548 or

[email protected] if you have any questions.

Best regards,

Mary Jo Hudson

Director

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OHIOOPENENROLLMENTENROLLEEDATA

(PERJUNE2010CANVASOFCARRIERSREQUIREDTOOFFEROPENENROLLMENTCOVERAGE)

60054 AetnaLifeInsCo 97179 AmericanMedicalSecurityLifeInsC 71773 AmericanNatlLifeInsCoOfTX 60836 AmericanRepublicInsCo 80799 CelticInsCo 10345 CommunityInsCo 77828 CompanionLifeInsCo 81973 CoventryHlth&LifeInsCo* 62324 FreedomLifeInsCoOfAmer 62286 GoldenRuleInsCo 95677 HealthPlantheUpperOHValleyIn 73288 HumanaInsCo 26581 IndependenceAmericanInsCo 65080 John

Alden

Life

Ins

Co

95204 KaiserFoundationHealthPlanofOhio 65781 MadisonNationalLifeInsCo 77216 MckinleyLifeInsCo 29076 MedicalMutOfOH 57991 MennoniteMutAidAssn 66087 MidWestNatlLifeInsCoOfTN 98205 NationalFoundLifeInsCo 67628 PekinLifeInsCo 68462 ReserveNatlInsCo

TOTALSNAIC COMPANYNAMENUMBEROFCOVEREDLIVES

06/18/2010

CDWrigh

an ar e cc en ns o 69078 StandardSecurityLifeInsCoOfNY 10649 SummaInsCoInc 69477 TimeInsCo 70629 WorldInsCo

TOTALS:

06/18/2010

CDWrighOHIO DOI:000005


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2009OHIOCONVERSIONHEALTHPLANDATA

ASREPORTEDBYCARRIERSINTHEOHIOANNUALREPORTOFHEALTHINSURANCEBUSIN

(NOTINDEPENDENTLYVERIFIED)

NAIC COMPANYNAME POLICIES LIVES PREMIUM C

95109 AETNAHEALTHINC(PA) 60054 AETNALIFEINSURANCECOMPANY 90611 ALLIANZLIFEINSURANCECOMPANYOFNORTHAMERICA 60305 AMERICAN

COMMUNITY

MUTUAL

INSURANCE

COMPANY

60836 AMERICANREPUBLICINSURANCECOMPANY 80799 CELTICINSURANCECOMPANY 10345 COMMUNITYINSURANCECOMPANY 62308 CONNECTICUTGENERALLIFEINSURANCECOMPANY 62375 CONSUMERSLIFEINSURANCECOMPANY 62413 CONTINENTALASSURANCECOMPANY 13935 FEDERATEDMUTUALINSURANCECOMPANY 69140 FIRSTALLMERICAFINANCIALLIFEINSURANCECOMPANY 62286 GOLDEN

RULE

INSURANCE

COMPANY

64246 GUARDIANLIFEINSURANCECOMPANYOFAMERICA 95677 HEALTHPLANOFUPPEROHVALLEYINC 95348 HUMANA HEALTH PLAN OF OHIO INC 73288 HUMANAINSURANCECOMPANY 95204 KAISERFOUNDATIONHEALTHPLANOFOHIO 77216 McKINLEYLIFEINSURANCECOMPANY 95828 MEDICALHEALTHINSURINGCORPORATIONOFOHIO 29076 MEDICALMUTUALOFOHIO 97055 MEGALIFEANDHEALTHINSURANCECOMPANY,THE 66168 MINNESOTALIFEINSURANCECOMPANY 95189 PARAMOUNTCAREINC 68241 PRUDENTIALINSURANCECOMPANYOFAMERICA 25178 STATEFARMMUTUALAUTOMOBILEINSURANCECOMPANY 60016 THPINSURANCECOMPANYINC 69744 UNIONLABORLIFEINSURANCECOMPANY,THE 95186 UNITEDHEALTHCAREOFOHIOINC

TOTALS:


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ThefollowingcarriershaveconversionproductsfiledwithODIbutdidnotreportanyconversion

businessinthe2009OhioAnnualReportofHealthInsuranceBusiness:

NAIC COMPANYNAME

19720 AmericanAltInsCorp

71773 AmericanNatlLifeInsCoOfTX

81973 CoventryHlth&LifeInsCo

57991 EverenceAssnInc

74209 EverenceIns

Co

71218 GrangeLifeInsCo

26581 IndependenceAmerInsCo

11518 ParamountInsCo

61271 PrincipalLifeInsCo

69078 StandardSecurityLifeInsCoOfNY

10649 SummaInsCoInc

95202 SummacareInc

79413 UnitedHealthcareInsCo

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///co-adshare/...o-Dept%20of%20Insurance/Ohio%20Waiver%20of%20the%20Annual%20Limits%20Requirements%201-3-2011.htm[11/10/2011 11:01

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Monday, January 03, 2011 11:03 AM

To: '[email protected]'ubject: Ohio Waiver of the Annual Limits Requirements 1-3-2011

mportance: High

Attachments: Ohio Letter .pdf

ood Morning,Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act

ection 2711 for Ohio.HHS has reviewed your application and made its determination. Please see the attachetter.

Please confirm receipt of this letter by replying to this e-mail.

Please let me know if I can be of further assistance.

incerely,

Alexandra Botwinick

ffice of Oversight

HHS/[email protected]

OHIO DOI:000010
mailto:[email protected]:[email protected]


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rom: Kottenmeier, Erika (HHS/OCIIO)ent: Thursday, January 13, 2011 9:57 AM

To: '[email protected]'Cc: Habit, Sandra (HHS/OCIIO); Combs, Darrell (HHS/OCIIO)ubject: Modification of Notice Language for State Waiver Recipientsear Ms. Melton,

ursuant to a question from another State waiver grantee, OCIIO has determined that the model language posted in the Decem

2010 Supplemental Guidance may be modified slightly for carriers who receive waivers of annual limits for State-mandated

olicies. The notice language may be amended in the third paragraph to read The State, on behalf of your health plan, requeswaiver instead of your health plan requested a waiver However, this is the only change HHS will permit. The notice

nguage must be displayed on all materials without any other changes or it will not be in compliance with the Bulletin.

ind Regards,

rika M. Kottenmeier

ivision of Enforcement

ffice of Oversight

HS/OCIIO

301) 492-4170

[email protected]

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:

This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be

disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the

extent of the law.

OHIO DOI:000011
mailto:[email protected]:[email protected]

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Ohio DOI-Redacted HWM