Regulators draft PPACA complaint codes

Excerpt from a draft complaint form (NAIC image) Excerpt from a draft complaint form (NAIC image)

State insurance regulators are working on form changes that could shape how consumers and others complain about the Patient Protection and Affordable Care Act.

The regulators, members of the Market Conduct Examination Standards Working Group at the National Association of Insurance Commissioners, are trying to update the NAIC Standard Complaint Data form.

The NAIC could add codes for new, PPACA-related groups and codes for issues highlighted by PPACA 

In a list of codes for organizations, a recent draft gives one code – 152 – for PPACA “certified application counselor” organizations – and another code – 151 – for PPACA navigator organizations.

A newly proposed code –150 – would identify the nonprofit, member-owned CO-OPs.

A list of codes for individuals now includes identifiers for those who work as PPACA navigators, PPACA certified application counselors and PPACA in-person assisters, along with the traditional codes for adjusters, consultants and managing general agents.

The reason-for-complaint section could expand to include codes for many possible PPACA-related problems, such as violations of the new PPACA waiting period standards, violations of mental health parity rules, conflicts with the PPACA rules on annual out-of-pocket maximums, and problems with the rebates plans send when they fail to meet PPACA minimum medical loss ratio levels.

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