A To-Do List for Insurance Regulators

Sometimes there’s so much to do that it’s helpful to have someone help you get organized, make you a check list, and even make you a check list for the check lists. Given the dizzying array of insurance- and exchange-related tasks to complete before 2014, and the importance of the insurance regulator’s role, we worked with the Georgetown University Health Policy Institute to develop a toolkit for state insurance regulators.
The toolkit is designed to help state insurance regulators plan and allocate resources to conduct many of the plan management functions associated with implementing health insurance exchanges, some of which apply whether your state plans to run its own exchange or not. The toolkit includes several self-audits, templates, and checklists to help departments of insurance work in concert with other state agencies in determining which agency will take on specific exchange-related functions. The toolkit can also help state agencies organize and delegate those responsibilities. The specific resources in the toolkit include:

• Form Review Checklist, Model Notices and Examples: The form review checklist is a document for insurance regulators to use in reviewing forms associated with products (insurance contracts, policies, certificates of coverage, etc.) filed by issuers. These forms must be approved prior to offering the products to consumers. To fill out the form, download the editable file here.

• ACA Insurance Self-Audit​: The self-audit is a chronological, step-by-step checklist that gives states a guide as they analyze their insurance laws, rules, and regulations, etc. for compliance with the ACA.

• Exchange Functions Checklist: The exchange functions checklist is a tool to help departments of insurance work with their health insurance exchanges to identify and document functions they may currently perform and to determine which entities should perform these functions going forward.

• Work Plan Template: The work plan template is a matrix designed to allow state officials to identify completed, on-going, and future tasks related to plan management functions.

• Qualified Health Plan (QHP) Certification ‘Cheat Sheet’: This summary of QHP provisions from federal guidance is designed as a quick reference for states and provides a high-level outline of requirements including certification of and minimum standards for QHPs.

• Essential Health Benefits (EHB) Planning Template: This template provides the key decisions and considerations states need to address in choosing an EHB benchmark plan and the related work for the state’s EHB benchmark plan decision to take effect.

How much progress has your state made in developing processes for form review? How have you started to implement insurance market reform provisions? Tell us in the commercial insurance discussion or in the blog comments below.
The toolkit featured in this blog post was developed with support from the State Health Reform Assistance Network, a Robert Wood Johnson Foundation-funded program dedicated to providing technical assistance to states in order to maximize coverage expansion under the Affordable Care Act. Heather Howard is the State Network Program Director and previously served as New Jersey’s Commissioner for Health and Senior Services.