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COHBE Qualified Plan Certification

COHBE Qualified Plan Certification. SB-200 Requirements.

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COHBE Qualified Plan Certification

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  1. COHBE Qualified Plan Certification

  2. SB-200 Requirements • CRS 10-22-104The exchange shall not duplicate or replace the duties of the commissioner established in section 10-1-108, including rate approval, except as directed by the federal act. The exchange shall foster a competitive marketplace for insurance and shall not solicit bids or engage in the active purchasing of insurance. • CRS 10-22-106(1) • (i) Consider the unique needs of rural Coloradans as they pertain to access, affordability, and choice in purchasing health insurance; • (j) Consider the affordability and cost in the context of quality care and increased access to purchasing health insurance; and • (k) Investigate requirements, develop options, and determine waivers, if appropriate, to ensure that the best interests of Coloradans are protected.

  3. Marketplace Rules

  4. Plan Management • Certification, recertification, decertification • Regulatory requirements • Accreditation standards • Business Relationship • Data exchange standards • Customer service standards • Exchange will develop objectiveplan management standards and communicate those standards to carriers before certification.

  5. Exchange Partners • Exchange will work with Division of Insurance, Department of Public Health and Environment, and Department of Health Care Policy and Financing to minimize QHP burdens

  6. Certification Requirement Activities

  7. State, Federal, or UX Guidance

  8. New Processes

  9. Decertification • The Exchange will only decertify an issuer during the year if the issuer is not able to meet responsibilities (loses licensure, insolvency, or inadequate network, etc.) • The Exchange will work to move members to a new QHP in an efficient manner • An issuer who fails to meet necessary business partnership levels will not be recertified but members will continue to be enrolled in the QHP

  10. Recertification • The Exchange will develop an annual recertification process • The recertification will allow the Exchange board to change the baseline certification processes in future years

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