Question: Do you think that offering nationwide health plans is a good idea for Covered California?
Answer: First a little background for our users: at least two multi-state health plans chosen by the federal government will compete with private health plans in state Exchanges. These health plans are similar to those available to members of Congress and other federal employees and will be offered by private insurance companies under contract with the United States Office of Personnel Management (OPM).
The Covered California board has expressed concerns because these federal plans do not appear to be under the same requirements and restrictions as California health plan issuers participating in the Covered California health insurance marketplace. Some of the reservations expressed by the board are:
- Participation Fees: If the participation fee imposed by OPM is lower than the Covered California health insurance marketplace, California’s QHPs will be at a competitive disadvantage.
- Essential Health Benefits: Will the multi-state plans be allowed substitutions to essential health benefits. California law prohibits this, but the rules for multi-state plans are unclear.
- Cost-Sharing and Standardization: The federal proposal does not require the multi-state plans to adopt the same cost-sharing and standardized plan designs that other health plans must meet by state law.
- Recertification and Decertification of QHP: The proposed rules exempt the multi-state plans from decertification and decertification by Covered California.
- Regulatory Oversight: California’s role in ongoing oversight of the multi-state plans is unclear.