The National Association of Insurance Commissioners (NAIC) has posted draft model language for health coverage provisions concerning preventive services, rescissions and lifetime and annual benefits limits.
The task force also has posted utilization review and grievance procedure model draft provisions.
The exposure drafts are on the website section of the Regulatory Framework Task Force, an arm of the Health Insurance and Managed Care Committee at the NAIC, Kansas City, Mo..
The task force is helping the NAIC and state insurance regulators implement provisions of the new Affordable Care Act, the federal legislative package that includes the Patient Protection and Affordable Care Act.
The NAIC’s rescission model draft, for example, is less than 3 pages long. It states that “a health carrier shall not rescind coverage under a health benefit plan with respect to an individual, including a group to which the individual belongs or family coverage in which the individual is included, after the individual is covered under the plan,” unless the “individual or a person seeking coverage on behalf of the individual…performs an act, practice or omission that constitutes fraud,” or “the individual makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan.”
The proposal would require a health carrier to give individuals affected by proposed rescissions at least 30 days advance written notice.