Officials at the federal public exchange oversight agency say private exchange plan issuers should do more to resolve enrollees’ problems.
The Center for Consumer Information & Insurance Oversight says a qualified health plan issuer should resolve any problems it can resolve on its own, without referring the consumer or other stakeholder to HHS or an exchange call center for help, officials say.
Any exchange plan issuer that hasn’t already received an account at the federal exchange Health Insurance Casework System should get a HICS account, quickly, officials say in a new batch of casework guidance.
A plan issuer should monitor the HICS case lists closely and tell its exchange account manager about any activities that could lead to a flurry of new cases, officials say.
Officials note that they told the plan issuers about the HICS system back in September.
CCIIO understands that it needs to work with the plan issuers closely because the exchange program is new, officials say.
HHS will consider issuers to be in compliance with service requirements if they make a good faith effort to comply, by, for example, forwarding issues in need of HHS intervention quickly, officials say.
“However, HHS generally will not consider a [plan] issuer to be making good faith efforts to comply with the requirements where the failure to act within required time frames may jeopardize the health, safety, or life of the consumer,” officials say.