Changes and Developments in Insurance: What Employers Should Know

What is Department of Insurance’s Mission and Role? The mission of the DOI is to: Enforce the insurance laws and regulations of the State impartially, honestly, and expeditiously; to serve the consumer of insurance; Encourage a healthy insurance marketplace; and Promote change to better serve the public interest. To this end, the highest ethical, professional, and work quality standards will be exercised in all formal and informal relationships with individuals, agencies, and companies affected by the policies and actions of the department. The role of the DOI, through the Insurance Commissioner: To enforce the WY Insurance Code, (W.S. Title 26) including the licensing of companies, producers, agents & brokers; oversight of the WY insurance market, financial examination & monitoring, outreach, and consumer protection.”

Small Group Employers Wyo. Stat. §26-29-306(c)(iv): If a small employer carrier offers coverage to a small employer, it shall offer coverage to all of the small employer’s eligible employees and may offer coverage to their dependents. Can not offer coverage to only certain persons in a group or to only part of a group, except in the case of late enrollees Plans must be Qualified Health Plans and contain the 10 essential health benefits. For tax considerations go to: https://www.irs.gov/affordable-care- act/employers/affordable-care-act-tax-provisions-for-small-employers

Ten Essential Health Benefits (EHB) in ACA Ambulatory/outpatient care Emergency Room Hospitalization Maternity & newborn Mental health and substance abuse 6. Prescriptions 7. Rehabilitative services 8. Laboratory 9. Preventive, wellness and chronic disease 10. Pediatric If states are given responsibility to redefine the EHB under a “Repeal and Replace Plan” this list could be much different.

Wyoming Health Insurance Companies Plans On Exchange: Blue Cross Blue Shield: individual and small group Plans Off Exchange: United Healthcare: small group only

Costs in Wyoming Why is health insurance cost high in WY? COST of healthcare Why is healthcare cost high in WY? 1. Low population (less than 600,000); 2. Large geographic area (97,818 sq. miles); 3. Fewer providers than urban areas; 4. Aging population; 5. Smoking (19.6% compared to 16.8% nationally); 6. Population centers near state borders; out-of-state migration for care; 7. Cost shifting.

Multiple Employer Welfare Associations (MEWAs) & Association Health Plans (AHPs) MEWAs –existed since 1980’s under ERISA, & have had limited regulation under WY law; (Remember: MEWAs are associations of employers, not associations of employees.) Association Health Plans (AHPs) were introduced by Administration in Sept. Allowed expanded definition of employer to go beyond employers sharing an economic or common purpose to include connection by geography or business/professional interest, included self-employed. In March, WY Legislature passed SF44 (SEA49) to license MEWAs; DOI rules are being developed. Will require filing of M1, annual audited financial statement, license fee

MEWA/AHP cont. Anticipated would allow small businesses to band together to buy insurance and get benefits that large group employers have. Hoped AHPs could reduce costs. AHPs were being phased-in when Federal Court ruled that AHPs were beyond the scope of authority of Dept. of Labor. Essentially, case hit “pause button” on new Association Health Plans. MEWAs can still exist or be created, but can’t use expanded definition of employer or include self-employed --for now. Senator Enzi introduced bill in U.S. Senate to put AHPs into law (not agency reg.) but uncertain it will pass.

Short Term, Limited Duration or Limited Benefit Plans Consumers should consider: Is it sold by a licensed WY insurer? Check with DOI. What’s extent of coverage? – may not include Essential Health Benefits (EHB)or preventive care even if marketed as “comprehensive” or “complete”. What’s covered? - plans may only cover a short period time (<6 months), specific type of disease (e.g. cancer) or incident (e.g. hospitalization). What’s the network? (e.g. A plan sold in Wyoming but based in Florida may not have providers or network in Wyoming…)

2019/2020 Wyoming Marketplace What is impact of having just one insurer in the Marketplace? Are additional insurance carriers coming into WY? How stable is our market? Are there anticipated rate increases? Other Note: Discuss Delta Dental’s withdrawal from Marketplace stand-alone plans

2019 Legislative Update (selected) HB7 [HEA2] – Wyoming health insurance pool amendments Removes the Wyoming Health Insurance Pool's (WHIP) coverage exclusions regarding organ transplants.  The Pool will now provide coverage for transplants that are a covered benefit of Medicare.  HB194 – [HEA112] Air ambulance coverage-Medicaid Creates a new approach for coverage of air ambulance transport by creating an air ambulance coverage account and expanding Medicaid for air ambulance transport coverage only to all Wyoming residents. Requires federal approval. HB211 – [HEA89] Mental health and substance use coverage parity Authorizes the Insurance Commissioner to enforce the provisions of the federal Mental Health Parity and Addiction Equity Act of 2008 and related rules. SF44 – [SEA49] Multiple employer welfare arrangements Establishes a licensure requirement for multiple employer welfare arrangements (MEWAs) including Association Health Plans (AHPs) subject to Wyoming jurisdiction.

Other Insurance Topics Outcome of litigation re health insurance – Texas v. Azar Flood Insurance – NFIP & private plans; 30 day requirement – (note April PSA) Long Term Care Insurance – top priority for NAIC Cybersecurity – Data Security Model DOI news, information, and updates: DOI website - doi.wyo.gov Monthly PSAs on a variety of insurance topics Commissioner’s Corner

Wyoming Department of Insurance Website: DOI.wyo.gov Address: 106 E. 6th Avenue Cheyenne, WY  82002 Phone: Main (307) 777-7401 Licensing (307) 777-7319 Toll Free in Wyoming - (800) 438-5768