As I mentioned on my Facebook Live video Tuesday, we received a notice from Blue Cross Blue Shield of Tennessee letting us know about the changes that they will be required to make due to the Affordable Care Act and its rulings.
With the final regulations coming on May 18, 2016 carriers are now stating the things they must do to comply with the law. The changes to their specific policies must be in place by January 1, 2017 when all the individual policies in Tennessee (and the whole US) renew. Blue Cross already did this for large groups in 2016. This is one of the many things that Blue Cross Blue Shield of Tennessee will have to do...
- Specific Requirements for Health-Related Insurance and Coverage
In administering or insuring a plan, a covered entity cannot discriminate on the basis of race, color, national origin, sex, age, or disability. This includes the designing and marketing of benefit plans. In addition, covered entities cannot deny or limit coverage based on the gender identity of an individual, if the service or coverage is appropriate, such as for a transgendered individual. Covered entities cannot have blanket coverage exclusions for all services related to gender transition.
One interesting note on this....one of the things that the Affordable Care Act was supposed to do was to create competition by bringing more carriers to the market thus driving down the price. As it stands right now, Blue Cross will probably be the only market available for individual health insurance in Washington County, Sullivan County, Johnson County, Unicoi County, Greene County, and Hawkins County. The insurance department in Tennessee basically said that they feared that if they did not give Blue Cross their desired increase, the health insurance market may have collapsed. I guess it is not working quite as well as hoped!
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From Blue Cross.....
Health Care Reform Update – Week of September 12, 2016
This week's edition includes information about:
- ACA Section 1557: Nondiscrimination in Health Programs and Activities
ACA Section 1557: Nondiscrimination in Health Programs and Activities
The Affordable Care Act (ACA),[1] specifically section 1557, prohibits a covered entity from discriminating in its health programs or activities on the basis of race, color, national origin, sex, age, and disability. Final regulations were issued on May 18, 2016 implementing this section of the ACA.
Entities that receive federal financial assistance (FFA) are considered covered entities. BlueCross is a covered entity – and subject to the prohibitions contained in 1557 – because we receive FFA through our Marketplace and Medicare Advantage health plans. Entities other than insurance companies may be covered entities subject to this rule, including hospitals, doctor’s offices, skilled nursing facilities, and others. For issuers that are covered entities, this rule applies to all of the entity’s operations, and not only the program or activity that receives the financial assistance.
Highlights of Requirements for Covered Entities
The final rule imposes many requirements on covered entities. Some of these requirements existed for covered entities under other civil rights laws and some are new. Here are some highlights:[2]
- Nondiscrimination Notice and Taglines
A nondiscrimination notice and non-English taglines in at least 15 languages must be included in significant publications and communications, in physical locations, and on the home page of the covered entity’s website.
- Effective Communication for Persons with Limited English Proficiency (LEP) and Disabilities
Covered entities must take reasonable steps to effectively communicate with persons with LEP and disabilities. This includes offering services such as oral translations and aids such as large print documents. A covered entity’s website must also be accessible by persons with disabilities who use assistive technologies.
- Specific Requirements for Health-Related Insurance and Coverage
In administering or insuring a plan, a covered entity cannot discriminate on the basis of race, color, national origin, sex, age, or disability. This includes the designing and marketing of benefit plans. In addition, covered entities cannot deny or limit coverage based on the gender identity of an individual, if the service or coverage is appropriate, such as for a transgendered individual. Covered entities cannot have blanket coverage exclusions for all services related to gender transition.
Effective Dates
Generally, the rule was effective on July 18, 2016. However, the rule allows the notice and tagline requirements to be implemented by Oct. 17, 2016. To the extent that health plans must be changed to conform to the rules, the rule permits benefit changes to be implemented on the first day of the plan or policy year beginning on or after Jan. 1, 2017.
What is BlueCross Doing?
BlueCross is currently implementing this rule and working in good faith to satisfy its requirements. As a covered entity, the requirements apply to our operations, including operations related to the administration of a self-funded plan.
Beginning in October, significant publications and communications will include our nondiscrimination notice and taglines. Because BlueCross has to comply with other regulations that require taglines, we have decided to include 20 non-English language taglines in our significant communications.
In addition, BlueCross is making some changes to our insured medical plans. In 2016, we removed the blanket exclusion of gender reassignment surgery and related services for our large group plans. We’ll be removing the same exclusion for individual policies and small groups for policy and plan years beginning in 2017.
For self-funded plans, BlueCross will be removing the blanket exclusion for plan years beginning Oct. 1, 2016 or later. If a self-funded plan doesn’t want to remove the blanket exclusion, it must contact its BlueCross sales or account executive. Self-funded groups with October, November or December 2016 renewals may contact their BlueCross sales or account executive to direct that the exclusion remain until the first day of their 2017 plan year.
Self-funded plans are ultimately responsible for complying with the ACA and should consult with their legal counsel as to their status as a covered entity and possible risks if they decide to continue excluding gender reassignment surgery and related services. If a self-funded plan determines that any aspect of its benefit design is discriminatory, the plan should contact its BlueCross sales or account executive to initiate changes. BlueCross will administer the plan as the employer and/or plan sponsor directs.
For groups with the exclusion removed, gender reassignment surgery and related services will be a covered benefit subject to BlueCross medical policy.
Please contact your BlueCross field agency support team member, sales executive, or account executive for more information.
BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association.
[1] The Patient Protection and Affordable Care Act, Public Law 111-148, was enacted on March 23, 2010. The Health Care and Education Reconciliation Act, Public Law 111-152, was enacted on March 30, 2010. They are collectively known as the Affordable Care Act.
[2] This is a high-level summary of a portion of the provisions of the final rule and is not a comprehensive list.
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