Student Health Plans, March 28, 2016

MIKE KREIDLER

STATE INSURANCE COMMISSIONER

STATE OF WASHINGTON

OFFICE OF

INSURANCE COMMISSIONER

OLYMPIA OFFICE:

INSURANCE BUILDING

P.O. BOX 40258

OLYMPIA, WA 98504-0258

Phone: (360) 725-7000

Technical Assistance Advisory 2016-01•

TO:

All Student Health Pla.n Issuers

FROM:

Insurance Commissioner Mike Kreidler

DATE:

March 28, 2016

SUBJECT:

Submission of Higher Education Student Health Insurance Plans

The pwpose of this advisory is to summarize current law and to provide guidance to student health

plan issuers related to the submission of higher education student health plan rate, form and network

filings for 2016/17 and beyond.

Higher Education Student Plans are Individual Health Plans

Student health insurance coverage is a type of individual health insurance coverage that is provided

pursuant to a written agreement between an institution of higher education and a health insurance

issuer, and provided to students enrolled in that institution of higher education and their dependents.

Id.; 45 CPR § 144.103. The Affordable Care Act defines higher education student health plans as

individual health plans. 45 CPR § 14 7.145.

This federal definition has pre-empted Washington State's exemption of"student-only plans" from

the definition of"health plan or health benefit plan". See RCW 48.21.040(1)(e), and RCW 48.43.005

(26)(1). Under federal law, higher education student health plans are now considered "individual

coverage" that must comply with the individual health plan requirements including essential health

benefit (EHB) requirements, and actuarial value or "metal level" requirements. 45 CPR§§

147.145(a), 147.150(a), and 156.140; 42 U.S.C. § 18022(a) and (d)

n". See RCW 48.21.040(1)(e), and RCW 48.43.005

(26)(1). Under federal law, higher education student health plans are now considered "individual

coverage" that must comply with the individual health plan requirements including essential health

benefit (EHB) requirements, and actuarial value or "metal level" requirements. 45 CPR§§

147.145(a), 147.150(a), and 156.140; 42 U.S.C. § 18022(a) and (d).

Filing Timeline:

Following Center for Consumer Information and Insurance Oversight (CCIIO) guidance, the

deadline for filing individual health plans, small group health plans, and stand-alone dental plans that

provide pediatric dental benefits as one of the essential health benefits, is set each year by the

1 This advisory is an interpretive policy statement released to advise the public of the OIC's current opinions,

approaches, and likely courses of action. It is advisory only. RCW 34.05.230(1).

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Commissioner. WAC 284-43-0200. Because they are individual health plans, this deadline also

applies to higher education student health plans. See 45 CFR §§ 144.103, 147.145. The deadline for

the 2017 plan year (2016-17 policy year) is May 6, 2016.

Form Filing:

No higher education student health plans may be issued, delivered, or used unless the forms have

been filed with and approved by the commissioner. RCW 48.18.100.

Issuers filing higher education student health plan forms must comply with the form filing

instructions applicable to the individual health plan as required in Washington State SERFF Health

and Disability Form Filing General Instructions. WAC 284.58.025. Student health plans must be

filed using the Type oflnsurance (TOI) ofH22 in SERFF filings. See Washington State SERFF

Health and Disability Form Filing General Instructions (2016), p. 3; NAIC Uniform Life, Accident &

Health, Annuity and Credit Product Coding Matrix (2015), p. 23

plan as required in Washington State SERFF Health

and Disability Form Filing General Instructions. WAC 284.58.025. Student health plans must be

filed using the Type oflnsurance (TOI) ofH22 in SERFF filings. See Washington State SERFF

Health and Disability Form Filing General Instructions (2016), p. 3; NAIC Uniform Life, Accident &

Health, Annuity and Credit Product Coding Matrix (2015), p. 23. As part of the Form Filing General

Instructions, issuers are also required to properly complete the current analyst checklist "2017

Disability Individual Analyst Checklist" and include the checklist in the initial form filing.

Washington State SERFF Health and Disability Form Filing General Instructions (2016), p. 19. For a

copy of the current Filing Instructions, coding matrix and checklist, see

http://www.insurance.wa.gov/for-insurers/filing-instructions/file-health-care-disability/.

Rate Filing:

Issuers must submit the student health plan rate filing concurrently with the corresponding form

filing. WAC 284-58-033.

Higher education student health plans are individual plans subject to the essential health benefit and

actuarial value requirements. 42 U.S.C. § 18022 (a) and (d); 45 CFR §147.145(b)(2). As a result,

the plan must provide at least 60 percent actuarial value. 45 CFR § l 47. l 45(b )(2).

Higher education student health insurance is subject to the Faif Health Insurance Premium rating

requirements. See 42 U.S.C. § 300gg; and see 45 CFR §147.102. Issuers are required to submit an

explanation and justification to demonstrate how they comply with the provisions relating to the

rating of higher education student health insurance coverage. WAC 284-58-033; see RCW

48.18.100, RCW 48.18.110(2). Specifically, rates for each student health plan must be based on per-

member-rating, and structured to comply with "school-specific group community rating" as outlined

in the comments to 45 CFR §147.145

stification to demonstrate how they comply with the provisions relating to the

rating of higher education student health insurance coverage. WAC 284-58-033; see RCW

48.18.100, RCW 48.18.110(2). Specifically, rates for each student health plan must be based on per-

member-rating, and structured to comply with "school-specific group community rating" as outlined

in the comments to 45 CFR §147.145. 78 FR 13406-01, 13424 (February 27, 2013).2

2 Although HHS Notice of Benefit and Payment Parameters for 2017 states that a health insurance issuer that offers

student health insurance coverage may establish one or more separate risk pools for an institution of higher

education, if the distinction between or among groups of students (or dependents of students) who form the risk pool

is based on a bona fide school-related classification and not based on a health factor (as described in 45 CFR

§ 146.121) , it does not change the 2013 final market rule. Furthermore, comments to the HHS Notice of Benefit and

Payment Parameters for 2017 final rule state; "We note that nothing prevents a State from requiring broader risk

pooling with respect to student health insurance coverage than provided for in this final rule (for example, requiring

each student health insurance issuer to establish one risk pool comprised of its entire student health insurance book

of business)." Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for

2017, 81FR12204-01, 12215 (March 8, 2016).

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ooling with respect to student health insurance coverage than provided for in this final rule (for example, requiring

each student health insurance issuer to establish one risk pool comprised of its entire student health insurance book

of business)." Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for

2017, 81FR12204-01, 12215 (March 8, 2016).

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Health Insurance Oversight System (BIOS) Filing:

Issuers should review the "Rate Review Justification Instructions for Transitional and Student Health

Plans" guidance issued by CMS/CCIIO on April 1, 2015. The guidance may be accessed at the

following link: http://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-

Resources/Downloads/RRJ-Instructions-Manual-20150401-Final.pdf. This federal guidance provides

the technical instructions for issuers to submit the Preliminary Justification in the federal Rate

Review Justification (RRJ) module of RIOS for student health plans.

For all proposed rate increases that are 10% or greater, issuers must submit the Preliminary

Justification to CMS on the same day that the issuer submits the rate filing to the state. Rate Review

Justification Instructions for Transitional Policies and Student Health Plans, pp. 7-9 (April 1, 2015).

Issuers that submit proposed rate increases that are less than 10% are not required to submit the

Preliminary Justification in the federal Rate Review Justification module of HI OS. Id.

Network Filing:

Issuers must file all provider contracts and provider compensation agreements with the commissioner

thirty calendar days before use. RCW 48.43.730. This requirement applies to all lines of business.

Issuers participating in the individual market, including higher education student plans, must submit

their network access reports demonstrating compliance with 284-43 WAC Subchapter B when they

submit rate and form filings. WAC 284-43-9976

d provider compensation agreements with the commissioner

thirty calendar days before use. RCW 48.43.730. This requirement applies to all lines of business.

Issuers participating in the individual market, including higher education student plans, must submit

their network access reports demonstrating compliance with 284-43 WAC Subchapter B when they

submit rate and form filings. WAC 284-43-9976.

No SERFF Plan Binder Filing:

Higher education student health insurance coverage is exempted from the single risk pool

requirements of 42 U.S.C. § 18032; 45 CFR § 147.145(3). As a result, student health plans are not

required to be pooled with the other ACA individual market plans or included in the individual plan

binder filing. Therefore, higher education student health plans are not subject to HHS Parts I

(URRT), II, and III requirements.

Transparency Tool

Washington law requires each carrier offering or renewing a health benefit plan on or after January 1,

2016 to offer member transparency tools with certain price and quality information to enable the

member to make treatment decisions based on cost, quality, and patient experience. RCW 48.43.007.

Prior to the Affordable Care Act, student blanket plans could be exempted from this requirement

under the exception to the definition of "health plan" or "health benefit plm". As noted above, this

exception has been pre-empted by the federal definition of higher education student health plans as

individual plans.

Higher education student health plans are subject to the state requirements related to Transparency

tools. RCW 48.43.007.

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