project approach & 2012 release plan - serff · 5/3/2012 · © 2012 national association of...
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![Page 1: Project Approach & 2012 Release Plan - SERFF · 5/3/2012 · © 2012 National Association of Insurance Commissioners Project Approach & 2012 Release Plan Bridget Kieras, Manager](https://reader033.vdocuments.net/reader033/viewer/2022052021/603650a094b94c371463d3d8/html5/thumbnails/1.jpg)
© 2012 National Association of Insurance Commissioners
Project Approach & 2012 Release Plan
Bridget Kieras, Manager III, SERFF/OPTins
Jon Sink, Business Analyst II, SERFF/OPTins
May 3, 2012
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© 2012 National Association of Insurance Commissioners
Release Timeline - 2012
• Summer – Release for EHBs and State Generated Messages
• 3rd Quarter – Potential Release for Configuration Features
• December – Major Release for QHP Submission and Review
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© 2012 National Association of Insurance Commissioners
Release Timeline - 2013
• 1st Quarter – Potential Release(s) for Additional QHP Certification Features
• 2nd & 3rd Quarter – Release(s) for QHP Renewal and Decertification
• 4th Quarter – Potential Release(s) for Additional Features for all KBRs
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© 2012 National Association of Insurance Commissioners
Other Activities
• Training for states and insurers
• Implementation activities
• Support for integration points
• Continued development of business requirements
• Outreach and education for stakeholders
• Regression testing for existing functions
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© 2012 National Association of Insurance Commissioners
Integrating with SERFF
• Separating processes to minimize risk to either SERFF or the Plan Management module
• Integration should be virtually seamless, although plans and filings will be segregated
• Reusing concepts to minimize analysis and development efforts and decrease training needs
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© 2012 National Association of Insurance Commissioners
What It Means
• Single login for SERFF users, but similar functions for plans and filings may be separate
• Filing concepts can be reused for plans, but this is not required
• SERFF and the Plan Management module can be released independently
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© 2012 National Association of Insurance Commissioners
Prioritizing Features
• Project team works with various stakeholders to identify, define, and prioritize features
• Prioritization is an ongoing process
• Tackle the critical and high priority features first
• Always keep Exchange milestones in sight
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© 2012 National Association of Insurance Commissioners
Defining Priorities
• Critical – Feature or activity is crucial for Plan Management and there is no viable alternative
• High – Feature or activity is crucial for Plan Management but has viable (if not ideal) alternative
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© 2012 National Association of Insurance Commissioners
Defining Priorities
• Medium– Feature or activity is important for Plan Management but has acceptable alternative
• Low– Feature or activity is beneficial but not necessary to Plan Management
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© 2012 National Association of Insurance Commissioners
Organizing Features
• Features are organized by Key Business Requirements (KBRs)
• Fifteen KBRs outlined in project scope
• Features for a given KBR may span releases
• Features may be referred to as activities, use cases, or user stories
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© 2012 National Association of Insurance Commissioners
Delivering Functionality
• Define requirements through collaboration with stakeholders
• Use mock-ups, prototypes, and other tools to illustrate functionality
• Work iteratively, revisiting and refining as requirements and guidance evolve
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© 2012 National Association of Insurance Commissioners
Testing Opportunities
• Most testing will be done by the SERFF Project Team
• Web services or other integration services will be tested in a Beta environment
• User acceptance testing will be constrained by time and resources
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© 2012 National Association of Insurance Commissioners
Critical Features
• Included in releases between now and December 2012
• Focus on KBRs 1, 2, 3, 4, 5, 6, 12, 13, 14, and 15
• Based on what we know today and may change
• Many of these in development, even though requirements and guidance still evolving
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© 2012 National Association of Insurance Commissioners
KBRs with 2012 Deliverables
• KBR 01 – Standards (Filing Rules)
• KBR 02 – State Configuration & Settings
• KBR 03 – QHP Submission
• KBR 04 – QHP Data
• KBR 05 – Industry Reusability
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© 2012 National Association of Insurance Commissioners
KBRs with 2012 Deliverables
• KBR 06 – QHP Review & Certification
• KBR 12 – Security
• KBR 13 – Web Services & Integration
• KBR 14 – Ancillary Features
• KBR 15 – SHOP
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© 2012 National Association of Insurance Commissioners
Remaining KBRs
• KBR 07 – Plan Renewal
• KBR 08 – Plan Changes
• KBR 09 – Decertification
• KBR 10 – Compliance
• KBR 11 – Operational
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© 2012 National Association of Insurance Commissioners
KBR 01 – STANDARDS
The system shall provide functionality to publish and view state and federal standards related to QHPs and other Exchange business functions.
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© 2012 National Association of Insurance Commissioners
KBR 01 Critical Elements
• Ability for states to configure or describe their requirements for QHPs, including Essential Health Benefits and submission instructions
• Ability for insurers to review state QHP requirements prior to and during plan submission
• Adherence to federal regulations
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© 2012 National Association of Insurance Commissioners
QHP General Instructions
• Highly flexible tool for states to provide information and instructions to insurers
• Will act as a container for other components, like the Essential Health Benefits
• Likely to start simple and enhance through successive releases
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© 2012 National Association of Insurance Commissioners
KBR 02 – STATE SETTINGS
The system shall provide the states with the ability to configure the features offered as part of SERFF Plan Management.
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© 2012 National Association of Insurance Commissioners
KBR 02 Critical Elements
• Ability for states to enable Plan Management
• Tracking of Exchange model used by participating states
• Configuration for payment of QHPs via Electronic Funds Transfer (EFT)
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© 2012 National Association of Insurance Commissioners
Enabling Plan Management
• SERFF support team will work with states on enabling Plan Management
• Exchange Model setting may impact some functions, including integration points
• State instances not using Plan Management will not see Plan Management features
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© 2012 National Association of Insurance Commissioners
Collecting QHP Fees
• States will have a setting to indicate whether they charge fees for QHPs
• States can provide textual instructions related to fee submissions
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© 2012 National Association of Insurance Commissioners
KBR 03 – QHP SUBMISSION
The system shall allow insurers to construct a QHP submission based on
SERFF filings.
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© 2012 National Association of Insurance Commissioners
KBR 03 Critical Elements
• Ability for insurers to build QHP filings, including holding in draft and submitting
• Validations on required data and attachments
• Support for state specific requirements
• Cross reference to approved forms
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© 2012 National Association of Insurance Commissioners
Creating a QHP
• ‘Plans’ will be a new type of submission, distinct from ‘filings’
• Insurers will use a wizard to create a plan
• Data and attachments will be different, but workflow will be like filings
• Insurers can hold plans as draft until they are ready to submit
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© 2012 National Association of Insurance Commissioners
Referencing Forms
• Insurers will have the ability to list one to many forms to be used with the plan being filed
• The plan submission will have links to these forms if filed in SERFF
• This may be extended to Rate Schedule Items and Supporting Documentation
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© 2012 National Association of Insurance Commissioners
State Specific Requirements
• At a minimum, insurers will have the ability to create new ‘Supporting Documentation’ for a filing
• States can provide guidance on format and content of these attachments as needed
• Intent is to offer flexibility to meet a wide variety of needs
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© 2012 National Association of Insurance Commissioners
QHP Validations
• Fielded data must be of proper type and length
• Required fields must be populated
• Rate and Benefit files must be included and must meet format and validation rules
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© 2012 National Association of Insurance Commissioners
KBR 04 – DATA
The system shall allow insurers to supply the full range of QHP data needed for certification and eventual inclusion on an Exchange.
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© 2012 National Association of Insurance Commissioners
KBR 04 Critical Elements
• Collecting benefit and rate data necessary to certify QHPs and populate the Exchange portal
• Standardizing data definitions and file layouts
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© 2012 National Association of Insurance Commissioners
Data Collection
• Exploring both XML and Excel options
• Insurers will upload files to specified locations on a plan, via the SERFF web interface
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© 2012 National Association of Insurance Commissioners
Standardization
• Working with states, insurers, and CCIIO to define the data elements necessary for a QHP
• Data may be collected in uploaded files or via fields in SERFF
• Data must be standardized if it is to be shared and understood across systems
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© 2012 National Association of Insurance Commissioners
KBR 05 – INDUSTRY REUSABILITY
The system shall allow insurers to configure reusable company and plan
information.
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© 2012 National Association of Insurance Commissioners
KBR 05 Critical Elements
• Collect of additional data elements related to the company entity offering the plan
• Minimize duplicate data entry for insurers
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© 2012 National Association of Insurance Commissioners
Company Attributes
• HHS Issuer ID will be moved to company profile
• Discussing validation strategies with CCIIO
• Additional attributes, such as websites and consumer hotlines, being discussed
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© 2012 National Association of Insurance Commissioners
KBR 06 – QHP REVIEW
The system shall provide functionality to allow state regulators to review QHPs and provide a determination on their suitability for the Exchange.
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© 2012 National Association of Insurance Commissioners
KBR 06 Critical Elements
• Navigation between rate/form filings and plans
• Ability for states to track and manage plan submissions
• Functionality to support communication and correction of issues by insurers
• Ability for states to certify plans according to state specific needs
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© 2012 National Association of Insurance Commissioners
Navigation
• Plans will have references to supporting forms, and possibly rate/rule and supporting information
• States will see related form status directly on the plan
• Hyperlinks will support navigation between filings and plans
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© 2012 National Association of Insurance Commissioners
Managing Plans
• State and insurers will have views and search features to find and track plans
• Basic updates and reviewer/author assignment will be available
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© 2012 National Association of Insurance Commissioners
Correspondence
• Ability for states to communicate issues to insurers
• Ability for insurers to make corrections and updates to fielded data and attachments
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© 2012 National Association of Insurance Commissioners
Certification
• Two step process to allow distinction between approval and certification
• Ability for users to perform one or both functions
• Communication of status to insurers and Exchanges
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© 2012 National Association of Insurance Commissioners
KBR 12 – SECURITY
The system shall provide additional security to control access to data and
functions.
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© 2012 National Association of Insurance Commissioners
KBR 12 Critical Elements
• Ability for states and insurers to control which users can submit QHPs, authorize fees, certify plans, or take other actions
• Ability to limit access to data to authorized users
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© 2012 National Association of Insurance Commissioners
QHP Roles
• Create and Submit QHPs
• Review QHPs
• Read-Only
• Certify QHP
• Transmit to Exchange
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© 2012 National Association of Insurance Commissioners
Data Security
• Data in SERFF protected by user authentication
• Users restricted to certain sets of data based on roles and ‘instance’ access
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© 2012 National Association of Insurance Commissioners
KBR 13 – WEB SERVICES
The system shall provide secured web services and/or other mechanisms to allow Exchange applications to retrieve data from SERFF or send data to SERFF.
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© 2012 National Association of Insurance Commissioners
KBR 13 Critical Elements
• Ability for stakeholder systems to share data for Plan Management functions
• SERFF will both send and receive data
• Each state Exchange will have different needs
• CCIIO, as the facilitator of some Exchanges, will have specific requirements
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© 2012 National Association of Insurance Commissioners
Sharing Data
• Passing of data between systems will be facilitated by the established standards
• Web services the anticipated method for state Exchanges to send and receive data
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© 2012 National Association of Insurance Commissioners
Two Way
• SERFF will collect plan data and send it to Exchange systems
• Exchange systems will return data to SERFF, including confirmations and status updates
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© 2012 National Association of Insurance Commissioners
KBR 14 – ANCILLARY FEATURES
The system shall support normal form/rate review functions for plans in a
manner similar to the way filings are supported.
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© 2012 National Association of Insurance Commissioners
KBR 14 Critical Elements
• State fees can be collected electronically
• System logging of all key milestones
• Search and views of plans
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© 2012 National Association of Insurance Commissioners
Collecting Fees
• State fees can be collected electronically
• Will have option to reference a check payment
• Insurers and states will have a report reflecting all money sent and received
• Functionality to support sending additional fees post-submission will be in place
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© 2012 National Association of Insurance Commissioners
Logging
• Logging of…. – Submission of plan
– Correspondence sent
– Certification of plan
• User will have view of all logged events on plan
• Helpful for tracking and reporting
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© 2012 National Association of Insurance Commissioners
Search & Views
• Basic search functionality will be in place to aid in finding plans
• Views in the SERFF workspace will be implemented – Sortable columns
– Open plans for insurers
– Assigned plans for states
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© 2012 National Association of Insurance Commissioners
KBR 15 – SHOP
The system shall provide functionality to support both individual and small group market plans (SHOP).
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© 2012 National Association of Insurance Commissioners
Individual vs. SHOP
• No significant difference in the submission or review process
• Expected differences in mid-year plan changes
• Analysis will continue to be done, and development will be specific when warranted
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© 2012 National Association of Insurance Commissioners
Keep up to date on SERFF’s Plan Management project at
http://www.serff.com/hix.htm
![Page 59: Project Approach & 2012 Release Plan - SERFF · 5/3/2012 · © 2012 National Association of Insurance Commissioners Project Approach & 2012 Release Plan Bridget Kieras, Manager](https://reader033.vdocuments.net/reader033/viewer/2022052021/603650a094b94c371463d3d8/html5/thumbnails/59.jpg)
Preparing for 2013: Issues and Planning
Bridget Kieras, Manager III, SERFF/OPTins
May 3, 2012
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Release Timeline - 2013
• 1st Quarter – Potential Release(s) for Additional QHP Certification Features
• 2nd & 3rd Quarter – Release(s) for QHP Renewal and Decertification
• 4th Quarter – Potential Release(s) for Additional Features for all KBRs
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2013 Critical Path
• Complete any high priority features for QHP Certification not released in 2012
• Complete critical and high priority features for QHP Renewal and Decertification
• Complete critical and high priority features for other Exchanges operations, as needed
• Introduce additional features by priority
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KBR 01 - STANDARDS
The system shall provide functionality to publish and view state and federal standards related to QHPs and other Exchange business functions.
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KBR 01 Decisions & Issues
• Critical and high priority needs met in 2012
• At this time, TOIs and Sub-TOIs are believed unnecessary for plan submission
• The need for Submission Requirements is expected, but may not be delivered by December
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KBR 01 Enhancements
• Expanded support for configuring EHBs and state mandated benefits
• More searching and sorting features
• Refinement of QHP General Instructions
• Closer integration with Filing Rules for standard filing submissions
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KBR 02 – STATE SETTINGS
The system shall provide the states with the ability to configure the features offered as part of SERFF Plan Management.
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KBR 02 Decisions & Issues
• Fee amounts will not be automatically calculated
• Undetermined whether ability to direct QHP fees to a separate account than filing fees will be delivered by December
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KBR 02 Enhancements
• Additional settings to control and streamline workflow
• More configuration options for accepting additional data sets
• Increased visibility of state differences to insurers
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KBR 03 - QHP SUBMISSION
The system shall allow insurers to construct a QHP submission based on
SERFF filings.
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KBR 03 Decisions & Issues
• Multi-state plan creation may not be available by December
• Considering options for dealing with forms filed on another industry instance
• Uncertain if Submission Requirements will be delivered by December
• Considering options for transaction fees
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QHP Transaction Fees
• Hoping to implement a less complex transaction model for QHPs
• Considering a flat transaction fee per submission
• Discussing ability to collect transaction fees via EFT (ACH Debit) at submission vs billing monthly
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KBR 03 Enhancements
• Increased validation of uploaded data sets
• Enhanced support for Exchange contacts
• QHP State Specific Fields
• Ability to clone a QHP for resubmission
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KBR 04 - DATA
The system shall allow insurers to supply the full range of QHP data needed for certification and eventual inclusion on an Exchange.
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KBR 04 Decisions & Issues
• Detailing data elements of benefits and rates is ongoing
• Unsure what additional data sets may need to be collected in SERFF
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KBR 04 Enhancements
• Enhanced validation for uniform data sets, including rates and cost sharing
• Collection of additional data or data sets, as needed
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KBR 05 - INDUSTRY REUSABILITY
The system shall allow insurers to configure reusable company and plan
information.
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KBR 05 Decisions & Issues
• The role of ‘Product’ as a way to organize data has not been determined
• Some reusability features may need to be postponed until after the December release
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KBR 05 Enhancements
• Additional attributes for companies and contacts
• More reusability features for data sets and other common elements of a QHP filing
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KBR 06 - QHP REVIEW
The system shall provide functionality to allow state regulators to review QHPs and provide a determination on their suitability for the Exchange.
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KBR 06 Decisions & Issues
• Correspondence will be similar to filings, but may not be as robust in early releases
• Some correspondence may still happen outside of SERFF
• Different workflows by state or Exchange model will need to be supported
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KBR 06 Enhancements
• Additional correspondence options or controls for QHPs
• Tighter integration between filings and QHPs
• More tools support for state specific workflows
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KBR 07 – QHP RENEWAL
The system shall support the processes of QHP renewal/recertification and
voluntary withdrawal of a plan from the Exchange.
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KBR 07 Critical Elements
• The ability for an insurer to request and a state to process QHP renewals
• Support for voluntary withdrawal of a QHP from an Exchange after certification
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QHP Renewal
• Process anticipated to be similar to QHP Initial Certification
• Functionality to support reuse of existing QHP components will ease the process
• Federal and state timelines may vary
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Voluntary Withdrawal
• Support allowable voluntary withdrawals
• Anticipate insurer initiates and state or Exchange (or both) must acknowledge or approve
• Potentially needed during first plan year
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KBR 08 – PLAN CHANGES
The system shall support the process of filing plan changes outside of the annual renewal/recertification window.
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KBR 08 Critical Elements
• Recognition of allowed plan changes
• Support for differences in allowed plan changes by market type (individual or SHOP)
• Controls on submission and approval of plan changes within these constraints
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Plan Changes • Allowed changes will be different for
individual vs small group plans
• Will need to assess impact of changes related to Rate/Form filings
• Multiple avenues may be available depending on the type of change
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KBR 09 - DECERTIFICATION
The system shall support the process of decertification of an insurer and/or one or more of an insurer’s plans.
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KBR 09 Critical Elements
• Decertification is a regulatory action
• Decertification can happen at the insurer or the plan level
• Decertification may not be an activity that happens in SERFF, but SERFF will need to know and respond to decertification actions
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Decertification
• Implementation of a user interface control to indicate decertification, with supporting date and comments fields
• Web services to allow authorized applications to advise SERFF of a decertification
• Updates to QHPs when the insurer is decertified
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KBR 10 – COMPLIANCE MONITORING
The system shall support the necessary functions or information needs related to monitoring compliance and enforcement agencies.
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Compliance Monitoring
• Scope of compliance monitoring has not been fully defined
• Anticipate SERFF would support compliance monitoring with existing or additional data collection and/or processes
• Supporting data provided via web services and/or reporting functions
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KBR 11 – OPERATIONAL DATA
The system shall support necessary functions or information related to collecting operational data.
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Collecting Operational Data
• Scope of operational data has not been fully defined
• Anticipate SERFF would support this function with existing or additional data collection and/or processes
• Supporting data provided via web services and/or reporting functions
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KBR 12 - SECURITY
The system shall provide additional security to control access to data and
functions.
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KBR 12 Decisions & Issues
• Existing granularity of SERFF roles and permissions will be extended to QHPs processes
• Existing controls over access to data are sufficient for QHP processes
• All core security measures will be implemented by December 2012
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KBR 13 - WEB SERVICES
The system shall provide secured web services and/or other mechanisms to allow Exchange applications to retrieve data from SERFF or send data to SERFF.
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KBR 13 Decisions & Issues
• Web services are preferred data exchange mechanism for NAIC applications
• Differing Exchange data needs will be a challenge
• Uniform data package and push model API being proposed for state Exchanges
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Uniform Data Package
• Define a consistent set of data to be transmitted for all state Exchanges
• Recipient systems will process and persist only the data they need
• State DOIs may act as an intermediary to adapt data for a state Exchange
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Push Model API
• Avoids resource intensive and inefficient ‘polling’ mechanisms
• SERFF user role has control over timing of the transmission
• Supports multiple transmissions if needed
• Entire plan sent with each transmission
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Partnership & FFE Exchanges
• Working closely with CCIIO to define special needs and requirements for FFE and Partnership Exchanges using SERFF for QHP Certification
• Integration points and business processes may be different from state Exchanges
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KBR 14 - ANCILLARY FEATURES
The system shall support normal form/rate review functions for plans in a
manner similar to the way filings are supported.
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KBR 14 Decisions & Issues
• SERFF has a number of tools and features that support filing activity
• These can be expanded to QHPs where it makes sense
• Timing will be according to effort and priority
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KBR 14 Enhancements
• Expanded Search and Views for QHPs
• Messaging for QHP actions and updates
• PDF Pipeline for QHPs
• Support for Public Access on QHPs
• Export Tool and Reporting Options
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KBR 15 - SHOP
The system shall provide functionality to support both individual and small group market plans (SHOP).
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SHOP Requirements
• No significant differences in the submission or review process have been identified
• Analysis will continue and development will be specific when warranted
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Questions?
Keep up to date on SERFF’s Plan Management project at
http://www.serff.com/hix.htm
![Page 108: Project Approach & 2012 Release Plan - SERFF · 5/3/2012 · © 2012 National Association of Insurance Commissioners Project Approach & 2012 Release Plan Bridget Kieras, Manager](https://reader033.vdocuments.net/reader033/viewer/2022052021/603650a094b94c371463d3d8/html5/thumbnails/108.jpg)
SERFF Project Q&A
![Page 109: Project Approach & 2012 Release Plan - SERFF · 5/3/2012 · © 2012 National Association of Insurance Commissioners Project Approach & 2012 Release Plan Bridget Kieras, Manager](https://reader033.vdocuments.net/reader033/viewer/2022052021/603650a094b94c371463d3d8/html5/thumbnails/109.jpg)
© 2012 National Association of Insurance Commissioners
Plan Management Data in SERFF
Bridget Kieras, SERFF Manager III
May 3, 2012
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© 2012 National Association of Insurance Commissioners
Importance of Data
• QHP review process will be more data intensive
• The data collected will help populate the consumer shopping portal
• Reports will be needed to monitor QHP and Exchange operations
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© 2012 National Association of Insurance Commissioners
Data Challenges
• Data will be coming from a number of different sources
• Data collected for QHP will need to be shared across applications
• Insurers and states have a variety of processes and business needs
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© 2012 National Association of Insurance Commissioners
Standardizing Data
• Technology Study Group (TSG) discussions around data definitions and issues
• Consultation with states working on Exchanges
• Guidance from CCIIO
• Input from consumer advocacy groups, vendors, and other interested parties
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© 2012 National Association of Insurance Commissioners
Uniform Data Sets
• Insurer
• Plan/Product
• Benefits and cost sharing
• Rates
• Formulary
• Quality Data
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© 2012 National Association of Insurance Commissioners
Supporting State Specific Needs
• Allow states or state Exchanges to individualize data collection and processes
• Support needs of Exchange operations handled by CCIIO
• Minimize burden to insurers
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© 2012 National Association of Insurance Commissioners
Potential State Differences • Requirements to facilitate review of
rates and forms and certification of QHPs
• Data collection outside of SERFF supported file uploads
• Review and certification workflows and division of responsibilities
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© 2012 National Association of Insurance Commissioners
Data Collection Methods
• SERFF Application Fields – User entered – System generated
• XML – Validation of the format – Display to user
• Excel – Standard templates
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© 2012 National Association of Insurance Commissioners
Processing the Data
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© 2012 National Association of Insurance Commissioners
Questions?
Keep up to date on SERFF’s Plan
Management project at
http://www.serff.com/hix.htm
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© 2012 National Association of Insurance Commissioners
Updated Project Scope and Timeline
Joy Morrison, Asst Dir., SERFF/OPTins
May 3, 2012
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© 2012 National Association of Insurance Commissioners
Exchange Components
• Exchanges have five components: • Eligibility
• Enrollment
• Plan Management
• Consumer Assistance
• Financial Management
• Our focus is on Plan Management
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© 2012 National Association of Insurance Commissioners
Key Assumptions
• States will continue to regulate health insurance or play a key role in product review/approval
• Exchange solutions should minimize the regulatory burden
• State insurance regulators wish to use existing information technology investments vs. building new ones
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© 2012 National Association of Insurance Commissioners
Project Objectives
• G01 Enhance SERFF so that states can use it to meet their plan management functions and retain sole authority over regulating health plans in the individual and small group markets
• GO2 Streamline the process for insurers submitting plans for inclusion on an Exchange
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© 2012 National Association of Insurance Commissioners
Project Objectives
• GO3 Support integration between applications involved in Exchange operations
• GO4 Provide flexibility to the states in how SERFF is used for Plan Management
• GO5 Minimize duplicative data entry
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© 2012 National Association of Insurance Commissioners
SERFF Role and Approach
• Leverage existing system
• Assist states in certifying QHPs
• Facilitate integration
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Industry SERFF Plan
Management
Other Data Sources State DOIs, State Agencies,
Exchanges
CCIIO
Consumer
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© 2012 National Association of Insurance Commissioners
CCIIO Collaboration
• Meet the deadline
• Share the information
• Reduce the regulatory burden
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© 2012 National Association of Insurance Commissioners
Using SERFF with Exchange Models
• Fully Facilitated Exchange Model
• Partnership Model
– State handles QHP Certification
– State handles all of Plan Management
• State Exchange
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© 2012 National Association of Insurance Commissioners
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© 2012 National Association of Insurance Commissioners
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© 2012 National Association of Insurance Commissioners
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© 2012 National Association of Insurance Commissioners
Risk Management
• Risk Assessment
– Aggressive Timeline
– Evolving Business Requirements
– Many Stakeholders
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© 2012 National Association of Insurance Commissioners
Risk Management
• Enhancement Prioritization
• Iterative Development
• Code Separation
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© 2012 National Association of Insurance Commissioners
Scope Decisions
• Notice of Intent/Insurer Cert-Out of Scope
• QHP submissions include
– benefits and rates data-In Scope
– formulary data-In Scope
• Network Adequacy-Out of Scope
• Compliance Data-Out of Scope
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© 2012 National Association of Insurance Commissioners
Questions?
Keep up to date on SERFF’s Plan Management project at
http://www.serff.com/hix.htm
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© 2012 National Association of Insurance Commissioners
SERFF Release Summer 2012
Thea Cook, Implementation Manager SERFF/OPTins
May 3, 2012
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© 2012 National Association of Insurance Commissioners
Overview
• First of several releases for SERFF Plan Management
• Two major enhancements
– State Generated Messages
– EHB Configuration-Part 1
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© 2012 National Association of Insurance Commissioners
State Generated Messages
• Introduced in 2011
• 17 State instances currently set up to use
• State specific messages sent to industry
• Similar to a subscription process
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© 2012 National Association of Insurance Commissioners
State Generated Messages
• Currently limited to two business types – LAH, PC
• Business type expansion for ACA – Life, Annuities, Health separated
– Three options for Health • All Health, ACA related, Exchange related
• Functionality guided by a role
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© 2012 National Association of Insurance Commissioners
State Generated Messages
• Importance of the feature
– Timely
– State controls the message
• How it works
– Link on the Message Center to generate
– Messages sent to industry user’s SERFF Message Center
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© 2012 National Association of Insurance Commissioners
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© 2012 National Association of Insurance Commissioners
State Generated Messages
• Migrating subscription options after the split
• Insurers need to subscribe
• Implementation team efforts toward adoption
– Who uses it now?
– Newsletter
– Education for states
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© 2012 National Association of Insurance Commissioners
Essential Health Benefits
• Configuration of EHBs
• The basics
– Guidance from CCIIO allows state flexibility
– Each state to select a benchmark plan
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© 2012 National Association of Insurance Commissioners
Essential Health Benefits
• How it works in SERFF
– Target-Source for 10 benefit categories
– List of services
– Notes fields for additional state information
• First step towards QHP Filing Rules
• Will be on a new QHP tab
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© 2012 National Association of Insurance Commissioners
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© 2012 National Association of Insurance Commissioners
Essential Health Benefits
• Summer release – Informational only
• Subsequent releases – Integration with CCIIO
– Validation of benefit file upload
– Refine service attributes
– Enhanced validation
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© 2012 National Association of Insurance Commissioners
Questions?
Keep up to date on SERFF’s Plan Management project at
http://www.serff.com/hix.htm