Access Health to tighten midyear sign-up rules, restore broker fees

This is a photo of Pedro Lopez asking how long it will take to sign up for insurance at the Access Health CT store in New Britain.

Arielle Levin Becker / The CT Mirror

Pedro Lopez, 43, inquires about the wait time at the Access Health CT store in New Britain. (File photo)

The board overseeing Connecticut’s health insurance exchange voted Thursday to tighten the process for people to get coverage after the annual open-enrollment period, a response to concerns among insurers that people have been waiting until they get sick to sign up.

The Access Health CT board also voted to require insurance companies to pay commissions to brokers who help customers sign up for 2018 coverage. This year, the two insurers selling health plans through the exchange stopped paying commissions, and the percentage of customers who got help from brokers fell from 50 percent to 25 percent, according to data presented at the meeting Thursday.

As of Wednesday, 107,736 people had signed up for private insurance through Access Health. That includes more than 12,000 who had not purchased private insurance plans through the exchange before, according to the exchange.

Sixty-eight percent of customers picked plans sold by ConnectiCare Benefits, while 32 percent chose plans from Anthem Blue Cross and Blue Shield. Just over three-quarters of the customers qualify for federal tax credits to discount their premiums.

The open enrollment period for private insurance runs through Jan. 31.

Tightening midyear enrollment process

Once the annual open-enrollment period ends, people are only allowed to sign up for private insurance if they experience a change that affects their coverage, such as losing a job or getting divorced. But exchange officials and insurance companies have expressed concerns that some people are signing up without a valid reason and getting covered, allowing them to avoid paying premiums until they need care.

On average, more than 500 people per month sign up outside the open-enrollment period, said Susan Rich-Bye, Access Health’s director of legal affairs and policy. Nearly 80 percent of them cite a loss of other coverage as their reason for qualifying for the midyear sign-up.

Feedback from insurance companies indicates that people who sign up outside the open-enrollment period are significantly costlier to cover and more likely to drop coverage before the end of the year. Insurance companies indicated that the adverse selection of mid-year enrollees accounts for 6 to 10 percent of rate increases, Rich-Bye said.

The exchange currently lets people who request a “special enrollment period” get coverage before verifying that they qualify for the sign-up period exception. The board voted Thursday to change the procedure so people must provide documentation to show they qualify for the special sign-up period before their coverage can begin.

Broker commissions

The requirement to pay broker commissions will apply to plans sold for 2018 coverage. It does not specify how much insurance companies must pay, but requires that companies pay the same commissions for individual-market plans sold through the exchange as those sold outside the exchange.

In an attempt to get advice to potential customers this year, the exchange made 21 brokers available through its call center. But Deb Polun, director of government affairs and media relations at the Community Health Center Association of Connecticut, told the board Thursday that wasn’t an adequate substitute for having brokers available in the community.

Community health centers have staff who can help people with the sign-up process, but they are not allowed to advise people on what plans to pick.

“There have been a lot of struggles,” Polun said.

Some clients have taken time off work or gotten child care so they could spend time signing up at a health center. But when they get to the point of picking a plan, Polun said, they have to call the exchange’s call center to reach a broker, and if a broker isn’t available, have to leave a message and get a call back at another time.

Polun added that it’s been particularly problematic for clients who speak foreign languages. Some clients who speak Spanish have not received calls back from brokers in the call center, she said.

She urged the board to do whatever it could to ensure brokers would be available in the community next year. (“Assuming there’s a next year,” she said, alluding to the uncertainty about Obamacare. “There will be a next year. I don’t know what we’ll be doing in it,” Lt. Gov. Nancy Wyman, the exchange’s board chair, said to laughter.)

Demian Fontanella, general counsel for the state Office of the Healthcare Advocate, said there’s a significant need for health literacy among people who are newly insured, and said brokers can help people get into the right plan for them and understand how to use it. “While there may be increased costs from boosting this stream, there’s probably going to be some downstream savings through better utilization of the system,” he said.

Brokers provide a valuable service, Access Health CEO Jim Wadleigh said. But he added that insurance companies would probably say their decisions to remove broker commissions reflected efforts to keep premiums down.

That was one factor Anthem cited last year. The company also said a small percentage of individual-market business came from brokers and that customers could use the exchange’s tools to shop on their own.

When asked about the possibility of requiring broker commissions, Anthem spokeswoman Sarah Yeager said last week that the company will follow the guidelines the exchange determines.

ConnectiCare said in a statement Thursday that the decision “will have a rate impact for 2018 as broker commission will need to be included in the rates for both on and off-exchange individual policies.”

“While we cannot speculate on the future of the [Affordable Care Act], we are committed to our broker partners and to offering our customers affordable health plans,” the company said. “We remain focused on our mission to make it easy for our members to get the care they need.”

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