Hurricanes Katrina and Rita Health Insurance Protections

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Hurricanes Katrina and RitaHealth Insurance
Protections
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Alan M. Miller Moderator

• Ph.D., M.D.
• Associate Senior Vice President
• for Health Sciences
• Tulane University HSC

Scott Kipper Panelist

• Deputy Commissioner
• Office of Health Insurance
• Louisiana DOI

Deborah Perry Panelist

• Supervisory Benefits Advisor
• U.S. Department of Labor
• Employee Benefit Security Administration

Hurricanes Katrina and Rita - Health Insurance
Protections
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Emergency Rules for Health Insurance

• 15 17 19 20

• Interest of All
• Consumers
• Providers
• Insurers

Consumer Protection

• Rules apply only to affected parishes, not
  entire state
• Includes primary parishes
• Limited application to
  secondary parishes

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Emergency Rules for Health Insurance

• Rules 17 and 20 apply only to products regulated
  by LDOI
• Does not apply to ERISA self-funded plans,
  Medicare, Medicaid or State OGB

• NO cancellations or terminations of group or
  individual policies allowed during State of
  Emergencyeven if premium not received

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Emergency Rules for Health Insurance

• Requirements suspended

• Medical certifications
• Referrals
• Medical necessity reviews
• Notification of
  hospital admissions
• Right to conduct medical
  necessity reviews
  (for non-elective
  services)

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Emergency Rules for Health Insurance

• NO non-renewals allowed until January 1, 2006

• NO rate increases allowed until January 1, 2006
• ALL restrictions relative to out-of-network
  access to health care are waived
• Laws relative to Timely Payment of Claims
  are suspended

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Emergency Rules for Health Insurance

• When a claim is submitted but the premium has not
  been received

• Insured is responsible for copayments,
  deductibles and coinsurance
• Insurer pays 50 of either contracted rate
  or the non-participating rate
• Provider accepts said 50 as payment
  in full and cannot balance bill the patient
• If premium subsequently received, claim
  is readjudicated based on receipt of
  entire premium and paid according to
  contract

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Emergency Rules for Health Insurance

• Cannot reject or pend claim for an initial 30 day
  supply of Rx meds, regardless of date of last
  refill

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Emergency Rules for Health Insurance

• Cannot reject or pend claim for an initial 30 day
  supply of Rx meds, regardless of date of last
  refill

• When premiums are paidBusiness As Usual

• Credentialing requirements for
  providers is suspended
• If employer lays off an employee, he must be
  continued under the previous provision by the
  insurer until State of Emergency is lifted
• Enrollment timeframes extended for
• COBRA
• State-Continuation (mini-COBRA)

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Directive 187 and 189 promulgated to provide
interpretive guidelines for Emergency Rules
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Alan M. Miller Moderator

• Ph.D., M.D.
• Associate Senior Vice President
• for Health Sciences
• Tulane University HSC

Scott Kipper Panelist

• Deputy Commissioner
• Office of Health Insurance
• Louisiana DOI

Deborah Perry Panelist

• Supervisory Benefits Advisor
• U.S. Department of Labor
• Employee Benefit Security Administration

Hurricanes Katrina and Rita - Health Insurance
Protections
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Response to Hurricane Katrina

• Department of Labor toll certain time periods

HIPAA
COBRA
Group Health Plan Claims Procedures
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Regulations
EBSA 29 CFR Parts 2560 and 2590
IRS 26 CFR Part 54
Fed. Register (70 FR 55500) dated 9/21/05 listed
tolling period as 8/29/05 to 1/3/06
Fed. Register (70 FR 59620) dated 10/12/05
extended timeframes to 8/29/05 to 2/28/06
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Disclaimer

• Information provided in these slides was prepared
  in order to present a brief summary of the
  changes made to the regs affecting Group Health
  Plans in response to Hurricane Katrina

• It does not constitute legal advice
• For complete and accurate information, please
  refer to the Federal Register documents

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Affected Parties(see definition section)

• Participants
• Beneficiaries
• Qualified Beneficiaries
• Claimants

who resided, lived, or worked in one of the
disaster areas

• Affected Plans

• Single Employer PlanPrinciple place of business
  was in the affected area

• Multi-Employer PlanPrinciple place of business
  that employs more than 50 of active participants
  
• Office of Plan, Plan Administrator or Primary
  Record keeper was in the disaster areas

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Disaster Area for Affected Parties

• Counties and parishes in Louisiana, Mississippi
  or Alabama that have been or are later designated
  as disaster areas eligible for Individual
  Assistance by FEMA because of the devastation
  caused by Hurricane Katrina

Tolled timeframes have only been applied to
Katrina
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Relief Affected Plan Participants,
Beneficiaries, Qualified
Beneficiaries and Claimants

• Plans must disregard the period

8/29/05
2/28/06
when determining

• 63 day break in coverage
• 30 day period to secure creditable coverage for
  certain children (i.e. special enrollment for
  children, born or adopted)
• 30 day period to request special enrollment
• 60 day period to elect COBRA coverage

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Relief Affected Plan Participants,
Beneficiaries, Qualified
Beneficiaries and Claimants

• Plans must disregard the period

8/29/05
2/28/06
when determining

• Date for making COBRA premiums

• Date for individuals to notify the plan of a
  qualifying event or determination of disability
• Date within which individuals may file benefit
  claims or appeals under the plans claims
  procedures

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Relief Group Health Plans

• Period must be disregarded

8/29/05
2/28/06
when determining the following dates

• Date for providing automatic certificates of
  creditable coverage
• Date for providing a COBRA election notice
• Notices should be sent out as soon as feasible

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Questions Answers
Hurricanes Katrina and Rita - Health Insurance
Protections